The Contemporary – Jessica Saxe, MD, FAAFP

[0:00] Have a vision of what you think medicine should be and what your place is in.

[0:06] Music.

[0:12] Paging dr. cook paging dr. cook dr. cook you’re wanted in the o.r. dr.

[0:18] Music.

[0:41] Hello everyone and welcome to the prescription for Success podcast I’m dr. Randy cook and I’ll be your host.
Our podcast is a production of MD coaches providing leadership and Executive coaching for Physicians by physicians.
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Develop as a leader or whatever your goal might be visit MD coaches on the web at my MD coaches.com.
Because you’re not in this alone
my guest today is a board certified family physician who was a strong advocate for the underserved during her 34 years of.
Practice now that she’s retired doctor Jessica Sachs continues to use her voice to speak up for the less fortunate I’m pleased that she found the time to sit down with me
and talk about how she does that.

[1:36] Music.

[1:41] I am so happy today to be.
Speaking with Doctor Jessica szohr sacks up in Charlotte North Carolina it’s up in Charlotte from where I sit,
Jessica it’s just a great honor to be able to talk to you today and I’m looking forward to the conversation great to be with you Randy I’m also looking forward to it well as we always do let’s see if we can get some of your origin story to begin with
I have a feeling that you didn’t grow up in the Charlotte area where did you grow up no I grew up in Northern Virginia near d.c. I see,
was was your family involved in government or did you just happen to Landing oh yeah my father would say he was in a he did a number of different things but he was in and out of the government where then did the influence
come from that interested you and going to medical school,
well the first time I was interested in being a doctor I was about 6 and when.
It was an early start well we’re we all precocious has it well I it was early start and I was very committed to it and for several years from like about 6 to 10 I read.
Every children’s doctor book in the library and we had some kind of,
Red Cross book and I practice bandaging and I told everybody I was going to be a doctor and that was in the 1950s and to my parents great credit.

[3:10] They encourage me,
nobody ever said to me you know girls can’t be doctors so that although that would have been the conventional wisdom at the time that is precisely what I was going to ask next did you ever feel any of that kind of pressure from anybody.
But sounds like the answer was no not you know not from my family at the time,
but I did kind of drop the idea when I was about 10 or so and then I became more kind of a.

[3:40] I don’t know Humanities social science kind of person and and middle school and high school and wasn’t really interested in science and I think that probably some of that had to do with.
Socialization you know the feeling that that wasn’t really what what girls did
and really I thought I had left that far behind me then when I went to college I went to Oberlin College and the first year what I was there was the first year that over one had
winter term in January where you could pick something else to do you know there wasn’t necessarily academic and
I had done all kinds of volunteer work which mainly Social Work kinds of things but I had a friend there
who had been a nurse’s aide and that sounded like kind of a cool thing to do
so I got trained to be a nurse’s aide I’m it just makes me laugh when I think about it because now everything you know everybody.

[4:40] They had training instructor and nursing assistants are licensed and nobody would let them do anything unless I were but I
went to the hospital little tiny little Hospital in Oberlin and asking if they trained me and they did and then I went and worked at Grady Memorial Hospital
for a mile and,
you know with that little that little tiny bit of training and I was just doing it as something different to do a different kind of volunteer work but I found that I got just really interested in it I I like,
being with patients and I was intrigued by the medical aspects of it and so I went back to Oberlin and said what do I have to do to be a pre-med that’s a great story and,
one thing that I would like to ask you for purely personal reasons,
digital learn anything during those Nurses Aide.

[5:42] Years that you found to be valuable once you became a physician that’s a that is a great question,
yeah because I did it and then I then I actually worked as a nurse’s again in a hospital and
Paris near Paris the I think the following summer so I had some different experiences you know I think I learned some things about
taking care of patients you know you’re really close to them as an egg
you spend more time with them the summer that I did it in France I had kind of rudimentary French and again they just
let me do it without you know people didn’t ask a lot of questions then it wouldn’t need a lot of credential it was a different time it was a it was a it was a whole different time and.
I had lots of years of having learn French but never having spoken of but one of the things that I remember remember from them is that my friends got much better because I had like a captive audience.

[6:46] You know I’d be with people and they were sick and they wanted company and they would talk to me and they would tolerate my you know they would tolerate my French for them
for the company I think it was a good experience and actually I think it’s really great now that nurse as far as I can tell most nursing programs have
nurses start out and get their CNAs and work directly with patients.
Yeah because I think it’s a very good experience in that way and yeah I had an experience as an orderly prior to getting into medical school and I think it’s the most valuable educational experience of the entire.

[7:21] In the end the entirety of my medical education but that’s another story we’re here to talk about you so what happened then when you got back to Oberlin and
and asked what you should do to prepare for medical school what did they say
so I remember going to the pre-med advisor to kind of said I couldn’t do anything right away I already had my second semester courses and what I needed to do was take science courses they were year-long courses so I couldn’t do anything until my sophomore year so My
sophomore year I jumped right in and I took I remember I took calculus and chem 101
maybe something else I had not had any math or science since my junior year in high school since I wasn’t a science person well yes wow wow would be exactly the right,
reaction because it just about killed me,
did you did you at some point thing maybe you made a mistake once you got into that.
Well yes very shortly I mean calculus actually was okay chem 101 was I think the hardest course I ever took in my life but I didn’t know that at the time I just knew it was the hardest course I’d taken that far and
it had our chemistry course had physics in it and I hadn’t taken any physics and as far as I could tell I was in a classroom and which
everyone else was a pre-med freshman pre-med who had gone to Bronx High School of science that would be about right.

[8:50] Right and I just felt so far behind and then so then in the middle of the year I kind of said to myself
well I am I going to stick with this or am I going to take my junior year abroad which I know will be fine or am I going to do this which I don’t know
I didn’t know whether it would just really going to go anywhere and so that was not a very hard decision and I decided to spend my junior year abroad which you know now I see the medical students do it all.
You know they’re you know they’re pre-meds they go abroad they had these experiences they do all kinds of things but back then you know if you were pre-med you kind of
yeah I guess you can probably identify with this absolutely you tread the path that said yeah.

[9:38] And you you weren’t supposed to do anything off the Beaten Track what I did interesting decision I did make was,
to finish those courses though and so I finished my year-long horses and I went away for a year,
and then I came back and I wasn’t sure what I was going to do and kind of at the end of my senior year that I started thinking about medicine again my father.
Who was very wise,
the try usually tried not to intervene at this very gentle conversation with me and he’s said,
you know I think this is what you really want to do and so then I set out
to pursue medicine for the last and serious time and I took organic chem during the summer and then I took some more pre-med courses and applied to medical school
one year after I had finished college do you think had it not been for that conversation with your dad where he gave you that encouragement do you think that might have changed things.
How important was it.

[10:45] I think it was a very important conversation you know you never really know what might have happened whether I would have come upon it at some other way but
it was a conversation that was clearly critical and memorable to me and and and it was the conversation that sent me on that path with that time,
you have such a broad-based background that I’m really impressed with and I’m wondering if you could talk a little bit about your experience at the,
Jacob Hiatt Institute in Jerusalem,
well that was really great that was my that was the beginning of my year abroad it was a program that was through Brandeis University then that was the Hyatt Institute and we got a really broad education about
the history and culture of Israel
we were not Hebrew speakers we took Hebrew while we were there and the faculty were Brandeis faculty so it really was on par with American universities of the quality was good and and I learned a lot of things there
said I remember to this day and I also learned I was there for six months and then I.
I knew that that wasn’t enough I just felt like I wanted to stay for a longer and I want an experience where I wasn’t just surrounded by other American
University students and so I arranged to do a volunteer job.

[12:14] In in Jerusalem for another basically another semester I work in a,
it was called a social club for chronic mental patients where we taught them behavioral skills wow.
Another captive audience yeah and they make something,
a powerful experience to say the least for someone of such Tender Years.

[12:42] It was very powerful experience it was great I mean it was wonderful of me was another experience where I was a little.
Out of the regular culture I was younger than anybody else who work there but I was treated like staff and it was just a really great experience gave me a whole window into another world
I’m going to have to say I think you had the,
enormous Good Fortune to have done it right you and I actually were training in medicine doing our beginning training in medicine almost simultaneously.
And I can guarantee you I had nothing like the diversity of the experience that you did so.
Congratulations to you it sounds like you sort of stumbled into it a little bit but I bet it made you a much better physician.

[13:33] Let’s move the story along a little bit so you got yourself into medical school at Tufts and and,
one thing I would like to know is where there are multiple applications and you did did you get accepted everywhere or was it hard to get in what’s the story there
no I didn’t get in Everywhere by any means I think I applied to 12 schools
I think I got it I don’t have to three or four but I know my family were New York residents at that time and I got into Buffalo,
I also got into g w which of course was in Washington which is where I lived and I also got into Tufts.
And so how did you pick Tufts
an interesting reason I picked Tufts I was interested in community medicine and I knew something about the community benison that had been there Jack Geiger had been on the faculty there and he had
started Been instrumental in starting I believe the First Neighborhood Health Center in the country Colombia point I think that that’s right in Boston and he had also been involved in
a project in Mississippi and so I felt like that was a good place that had Community medicine.

[14:52] But he lost before I got there.
But surely he left his mark But the thing that impresses me about this the most is how deliberate you are and make in making these choices,
again much of my education was different from yours because of
choices that were available to me but I have to say I didn’t really think it through like you apparently did and I’m very impressed that you were doing that in your early twenties I don’t know many people
who do so congratulations to you for that,
and and the entire medical school experience did you find it when you talked about finding the science intimidating when you were
undergrad but did that change any when you got into medical school.

[15:42] Oh I still found it very intimidating medical school was very hard for me
it was just very it was it was one of the hardest periods of my life hi I’m Rhonda Crowe founder and CEO Forum D coaches
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[16:56] We’ll get back to our interview in just a moment but right now I want to tell you a little bit about physician Outlook.
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And now let’s get back to today’s interview.

[18:02] Music.

[18:07] The nature of the subject matter or was it the volume it was both it was and it was how grueling it was and.
File so that it was you know when you and I where did you go to medical school University of Alabama School of Medicine,
in Birmingham hey well I’m imagine if you want about the same time I would did that it was
basically Monday to Friday all day long we had half the day off for electives actually one reason there were two reasons I didn’t want to go to g.w.
And one was that it was the most expensive medical school in the country possible
possibly still is I don’t know and the other was that they had anatomy lab on Saturday morning oh my goodness it right exactly and I was like you know really I think Monday through Friday is enough I met you know and then you start
you’re in class all day long and then after that you study
and I you know I found that grooming and I had been interested in medicine because I like working with people and you know the first two years of medical school they didn’t let us near.
Any people who were breathing and word our classmates or our professors at a distance.
And where there are there any moment during those first couple of years where you thought.

[19:33] Maybe I made a mistake or did you just feel like it was part of the test.
Um I think I felt like it was part of the team you know I don’t remember moment to moment and their marriage may have been moments that are.
Thankfully erased fight me with time.
I don’t remember seriously thinking of quitting what I remember saying to myself really all through medical school
even even the hospital part which was better in some ways was that I kept saying this is medical school this is not Medical Practice Medical Practice will be different yeah in many ways it sounds like a fairly typical.
Medical School experience amongst the people that I talk to there’s nothing really.

[20:23] It’s not really when you’re having a good time but it’s some point you made the decision that you’re.
Career choice was going to be family medicine and I’m interested to know.
Did you know that going into medical school or did it happen somewhere along the way I knew that going into medical school that was the only way you came out of tough to the family doctor at the time yeah because I had heard about Family Medicine.
And it just made sense to me the idea that you take care of a family unit and the way you knew about one of them would help you with the others.
Maybe the doctor that the whole family and
one of my big disappointments with tuft was that there was absolutely no support for Family Medicine there wasn’t anybody for instance you know when the time came
to help me decide on the Family Medicine Residency I did I really did that I think all of my own whatever word about there was times.
It was a recollection is it was not even board certification available in and the early nineties are mid 90s like that so you’re you are a Trailblazer just like everybody else in Family Medicine.

[21:37] Yeah 70s yeah great I’m so sorry yeah you’re exactly right yeah well,
poured syrup well that’s interesting I mean there was board certification by the time I’ve finished my residency in 1980 I don’t but it was fairly new that was one factor and the other Factor was Boston.

[21:58] You know which was I was in Boston which considered itself.
The in the medical Mecca of the world and this and that if it,
wasn’t in Boston and you know there couldn’t be any value to it so I came across that quite a bit so I think that leads me into the next question and that is.
The decision.
Of where you were going to do your postgraduate training your residency and you picked North Carolina so tell us the story of how that unfolded.

[22:34] Well I had this epiphany
and and my when I was deciding that I’m going to a residency I realize that I didn’t like cold weather although I had lived in cold weather my entire life.
That’s a good.
And so that was one thing and I also didn’t like the chill about family medicine so I wanted to go somewhere that was warmer both in temperature and toward my
chosen path and so again I applied to a number residencies but I really like Duke a lot
largely because their behavioral orientation and their General kind of comprehensive Family Medicine orientation and I and I think I had.

[23:27] Possibly never been to North Carolina before I interviewed,
but I like the program a lot yeah and and when you went for That interview how did how were you struck by what you saw in North Carolina
I like that I like living in Durham another another early member memory just about being in the South not about the residency was.
That I went to the mall
I can’t imagine how I ever had time to go to the mall but I must have had a day off or something it was probably during our orientation and,
somebody I was with a friend and somebody just took all the time in the world answering our questions and waiting on us
and as opposed to it as opposed to you know like shopping in New York or Boston where we’re doing Bam Bam and I was like,
Jesus is a different way of life I think I could get used to this like the southern Vibe that’s good news.
Yeah I did yeah I did I liked it and I liked my residency a lot and and it was the first place that I think that I really felt at home in medicine.

[24:34] Well that’s good to hear and I also think that it’s very interesting I don’t think I have to.
Explain it to you of course but Duke University considers itself to be a significant.
Epicenter of Higher Learning in.
Medicine but it sounds like their attitude toward Family Practice was noticeably different from what you had experienced in Boston is that fair to say.
That’s a very interesting question Randy the attitude of the university and the medical school itself was not that warm,
toward Family Medicine they had a Department of Family Medicine I think because of pressure or money or both from the state legislature yeah as I recall and.

[25:22] The medical school itself was not that warm toast we had.
We practiced it a different hospital and we had a clinic that was separate from duke and we only did a couple of rotations that were actually in Duke Hospital.
That’s interesting and again I think that it’s probably not unlike most major medical universities.
During that time as I mentioned for you I was in school at University of Alabama in Birmingham which was an epicenter of cardiac surgery at the time and,
what they did was to enlarge,
the numbers that they took in their basic science classes and then after the first two years they got farmed out to the Family Medicine residents he’s in Huntsville and Tuscaloosa what you’re describing sort of fits.
My impression of how the huge universities dealt with this thing I just didn’t quite know what to do with it do you think that’s different now do you think the bigger universities are
better equipped at recognizing that there is a big need for Family Medicine in the big cities or not
yeah my impression is that there is a big change I think Family Medicine is more accepted to Duke also Tufts now has a department of family medicine has for several years.

[26:50] You don’t want to
my co residence was the chair of Family Medicine there for several years and when I heard that they were doing that I was like oh this is really a sign that that times have changed
you know I really hope so,
yeah I think so well let’s talk about what happened next did you when you finish your residency did you have any problem deciding where you were going to locate after that,
yeah I had some problems I wanted to go somewhere I thought I wanted to go somewhere that I have lived before but that was conducive to family medicine and you remember I don’t like cold weather so that kind of narrowed it down
and actually I had like you said I strategize and I had a whole strategy to,
go to Washington DC where you know where I’ve grown up and I had some interviewing I wasn’t interested in working on a Health Center and I had some interviews at Washington that
there were just terrible there was a centers that I interviewed with we’re just clearly very disorganized and so that didn’t work so then I went back and I thought
well I’ve spent all this time.

[28:10] You know developing this career out of go someplace that’s a really a good fit and then I just kind of looked again and the way that I ended up here in Charlotte is.
That I have I read the New England Journal of Medicine of course because I’ve gone to Tufts yeah
hi Steve I still read it I can hear I still get it I I can’t give it a good yes I can’t give it up I feel like I’m wedded to it for life,
and one behold there was an ad for a Neighborhood Health Center in Charlotte in the New England Journal of Medicine wow how about that.
Yeah and so I came down here and interviewed eyes and I got the job I think I was the only applicant
there’s a low-budget kind of thing
and the medical Durant know what medical director put it to the in the New England Journal accepted he done his Family Medicine Residency at Worcester Massachusetts so I don’t know maybe that but anyway that was that was where.
I saw it and so I came down here for this job the process of making that connection obviously there was somebody in Charlotte who.

[29:27] I wanted to give you an interview and show you around it can you tell me a little bit about that process I mean this is a.
A little bit of a big deal you kind of been a big city person all your life he began to downsize in Raleigh-Durham I guess but Charlotte is a little bit too well
I don’t know I guess maybe Charlotte might be more urban than the Raleigh-Durham area perhaps but what was the interview process like when you got there did you think oh man this is really it where were you when you were in that phase
well it’s funny because now you’re really asking a historical question about when an interview process was like.
The interview process I mean it’s just when I see how people interview now and how institutions handle interviews and everything and when I think about how it was for me it’s just it makes me.
Laughs really it was very it was very casual
I think I drove down one morning from from Durham and went went to the interview
and spoke to the medical director saw the health center we went out to lunch.

[30:43] But there was nothing there was nothing very formal about the interview at all and they never liked.
I don’t even know if they paid my mileage but there were there were no like a range man’s there were no.

[31:00] They didn’t put me up they didn’t meet a whole lot of people but I like the setting it was it was very small.
Um and it and I wasn’t I wasn’t in any way sophisticated about asking any corn kind of questions about it I don’t think my residency really prepared me very well for that.
And so.
I guess it’s a tie I knew there would be two of us so I knew there would be every other night called that was just what you expect and then and,
I didn’t ask a lot of other questions that mean I never asked questions about what like 401 K’s are retirement until.
Many years later when things became more formal though those kinds of things came up
my mother said when I’m when I accepted it I liked it I liked it and Charlotte seem like a reasonable place to live,
it was not when you say it was more urban than Raleigh probably was were burning Raleigh but it was it Charlotte Charlotte now is urban but it was not in 1980.
And.

[32:22] My mother said when I after I accepted the position I was moving my mother said you should get them to pay your moving expenses and.
And so my mother had said that so I didn’t actually.
Always do things my mother said but it seemed like a good idea and and I asked them and lo and behold they paid my moving expenses that was very nice.

[32:49] Yeah it was nice but I mean now in and I’m sure I didn’t have a lawyer look at the contract I mean you know now everybody is more organized and.

[33:01] As for what they want and so on definitely changed right but tell me a little bit more about the nature of the practice was this.
Fairly standard.
Here’s a family doctor come and see us or was it was it more set up to handle to the underserved population I guess what I’m getting at is when,
when you developed that interest in the needs of the underserved so with that lie then you can take it wherever you like it to go it was a vague question.
What do you think I had always been interested in serving the underserved.
And I knew that that was what I wanted to do I didn’t look only at places that were specifically for the underserved.
I loved it I think I I when I was looking I looked at I think it ate some hmos thinking that they might include them as well but I was very.

[34:04] Interested in a place that was designed for the underserved.
Just being where I felt like I could do the most good and,
this Health Center that I went to work for was it was not a federally funded Health Center ever it had come under,
the hospital the hospital which was not a hospital system yeah they’ve been
by the started privately by some Churches and then the year before I got there it came under the hospital and was a part of the hospital but it was the only Off Campus outpatient setting and in the system and
really they didn’t know what to do with us which was bad in some ways
because there are certain ways in which we didn’t get a lot of help and when they when you say they didn’t know what to do with you who are the they are these just the bureaucrats that were tasked with recruiting Physicians or what,
right well the hospital Administration I see I mean we were just kind of out there true there wasn’t anything else like us.
In the system and and they had other you know they had other priorities yeah so once again you were blazing at Royal.

[35:24] Some ways well tell us about those first few years.
So the health center was,
across the bridge from a housing project and that was how we described it but it literally was a cross a little Bridge you can walk across from I think it was probably the biggest housing project in Charlotte at the time and,
no longer exists so we got patients from there and we got patients from another housing project that we’re nearby as well as,
patients face could come from anywhere most of them are low income
many of them were Medicare and Medicaid many of them were uninsured,
we had a sliding scale that was probably pretty minimal at the time I mean there were probably people who paid zero or one dollar to to come see us and.

[36:23] We didn’t have it was pretty much we didn’t have a lot of other support in the hospital system like we didn’t have a lot of Specialists that we could refer patients to
we had some and and
some of them were on the basis of like relationships that we developed with other doctors who were willing to do a little of what they consider charity work,
and I believe they were probably were some clinics at the hospital though because the hospitals are teaching via was Charlotte Memorial Hospital Bennett it was a teaching Center we probably had access to some clinics but
we saw everything.
And we saw really sick people I bet you did yeah yeah I mean you said another thing that used to make me laugh is that it Tufts people used to say well what do you want to go into family medicine for all you’ll ever see are runny noses and.
You know and we we saw all these people who were really sick who hadn’t had medical care who walked in.
And I really liked it does it take you by surprise at all.

[37:47] Yes and yes and now I mean I saw a lot of things that I shouldn’t have seen I don’t know whether.

[37:57] I was surprised.
You know I kept on saying more that you know I would think I’d seen everything and then I would see something else I mean I remember a woman who walked in with a huge tumor in her face.
And it had just gone you know she just hadn’t sought Medical Care.
And we would see people like that people with Advanced illnesses because they hadn’t felt like that they had a source of care or anywhere that then they could go.

[38:34] Yeah a lot of that was very sad yeah but.

[38:39] But we also felt like it was good that we were there taking care of them so tell us how things.

[38:49] Progressed you eventually became the medical director of prevention and Community Wellness for Carolinas Healthcare System happen how did you make that transition.
Well I had always been interested in prevention.
And that was something in my first couple of Decades of practice that became a big big interest in me and that mean the way I talk about it is.
That you know I got there and I thought that I was.
Going to solve all kinds of problems in the community that I was gonna Stamp Out teen pregnancy and poverty and alcoholism and who knows what else and.
I worked hard and my colleagues worked hard and.

[39:41] Why after I’ve been there I don’t know 20 years or so one of those things that I realized was that the health of the community around me was worse than it had been when I got there really.
Yeah progress at all.
Well you know progress and some things but there are certain things like it was a lot of substance abuse when I got there that I think was mostly alcohol.

[40:07] I’ve got there in 1980 that was right before AIDS took off it was you know before we had an AIDS test so when when AIDS Came Upon Us.

[40:21] We were usually impact of we had a lot of AIDS patients and.
There were a lot of drugs and then the other really big thing that happened was the.

[40:37] Burgeoning so to speak of obesity.

[40:41] That was not nearly as bad in 1980s it was 15 or 20 or 25 years later and with that came things like more people with type 2 diabetes or hypertension more heart disease
and I remember,
seeing a young woman who was about 20 whose mother was also my patient mother and maybe her grandmother was on patient to man anyway she’s about 20 years old and she weighed about 240.
£20 or something and I thought to myself I think her grandmother may be had heart disease but I thought.
She is at risk for having even earlier hypertension and heart disease than the generations before her.
And this just this is just not moving in the right direction here yeah so I got very interested in prevention and.
Lifestyle kinds of issues talking to my patients about better nutrition and bowel or physical activity and.
Generally taking care of their health.

[41:55] So that they wouldn’t be in the position since so many of my patients who would come in and figure out whether they needed a tie you know a tenth drug.
To deal with other chronic conditions.
Well it’s pretty easy to see where the inspiration came from and particularly anyone,
who has lived in the southeastern United States like you and I have have perhaps seen,
a different view of it but it sounds like it was a very.
Rewarding practice for you and it is also very clear that even though you retired from active practice I think.
Like back in 2015 is that right or was it that’s right yeah that’s right you have still remained very active as an advocate for the.
Underserved and I want you to tell us a little bit about Healthcare Justice North Carolina or Healthcare Justice in see I guess is the proper.
Trademark of it what’s the story of those those are those are both fine so I had.

[43:12] Always been in favor of Universal Health Care and of and of the single-payer healthcare system and I.

[43:20] I think that I’ve been a member of Physicians for a national health program almost since the beginning which was in the 1980s.

[43:29] But I had never been active and
what actually happened is that in 2009 when there was discussion of Health reform the in and I was chilling
practice in the very act while you practice at the time there was
a lot of people talking about how doctors were opposed to house reform and I had not been politically active but I said to myself it’s time to take a stand at the time and the summer
2009 and look like they might sink the whole thing and I thought well
if it doesn’t happen at least I will have said something about it so I got together a group of doctors and
who were in favor of Health reform and we basically took a position in favor of it and weep,
talk to people talk to legislators were letters and so on we were just kind of an ad hoc organization of the time
but after it passed in March of 2010 we decided to stay together and to continue to try to work on health reform and after about another year we got a presentation from,
someone who was in.
Health care for all North Carolina which is a chapter of Physicians for a national health program came and talked to us about single-payer healthcare and at the time we voted.

[44:54] That we also would support single-payer healthcare which basically is the same as Medicare for all,
and a couple of years after that we formed our that we actually kind of formally formed our own organization Healthcare Justice North Carolina,
in 2013 and have been.
Supporting it ever since which we do in the community by wherever we can we do it by.
Giving talks and going to festivals and parades and talking to people they are of course those are all the things we did before the pandemic and also talking to our legislators and lobbying them and so on.

[45:40] I feel very strongly that people need health care and better fordable Healthcare
really is Health Care without any cost sharing without any co-pays because what I saw in practice was we operated on the sliding scale and we were set up.
For.
People who are low income and including people who were uninsured but every single day I saw people who can get Healthcare they need it because they couldn’t afford it even if their copay was.
$10 or $5 you know sometimes they didn’t have that money in their pocket for a further copay or they didn’t have the co-pays for their drugs and I really saw people’s suffer from that,
so I have been working on that and and promoting it ever since are you.
Seeing any movement of the needle at all I don’t think I have to point out to you that it’s hard to find a physician who doesn’t break out in hives when they hear.

[46:53] Single-payer healthcare so have you.
Have you seen some places where you’re fairly confident that you’re making a difference.
Oh yeah good I’m so good no no actually polls show generally that over 50 percent of Physicians are in favor really.
Yeah I kid you not and they and they have for several years now it divides by specialty and like you happen to be a surgeon right correct
used to be sad right so
Primary Care not surprisingly primary care and Psychiatry are generally more in favor and the the the Physicians that are opposed.

[47:42] Part it currently.
I’m trying to think of a tack away to say that senior it partly divides along so it’s partly did well then I won’t be it largely divine’s along the line some premium duration
yeah that makes sense soda high-paying sub Specialty Physicians are the ones who are more most adamantly opposed.

[48:08] And.
Primary care doctors psychiatrists to tend to be more in favor but polls show over fifty percent in favor so that’s one thing and something I could tell you you asked about.
Signs of moving the needle there are several things one is that.
Ten years ago if I would tell people that I was in favor of a single-payer Health Care System people’s eyes would roll and they would say
is that still around anymore isn’t that dead and or they would say oh
no doctors are in favor that but now when you bring up medicare-for-all which again is basically the same thing it’s or
just to say it’s one form of a single pair
subsystem when I bring that up with people people take it as a serious topic and so that I take that as progress that is encouraging that you can at least have a conversation about it and and and and
you know my feeling you know you just heard me say that most of the doctors I here.
Talk about it or just the Emily opposed and the truth is that you know I’ve never.

[49:23] Polled representative group and I
it’s hard to know frankly for me when you look at the throw away journals and the way people respond the people that respond are usually the ones that are
opposed and perhaps there’s a huge number of people who are simply not I but I’m very encouraged that that you think your
seeing some progress that’s good news and there are a couple let me just say a couple of other things about progress and,
maybe you shouldn’t use the throw away journals that’s your reference truth,
when you do look at it like for example let me let me throw a couple of examples out the the sorts of things that land in your email like Med page
today and Kevin poem D and those kinds of things those are actually they carry some pretty good information but yet the commentary that you see to the to the
articles that gets that they come published can be
sort of angry so that’s what I’m basing my impression on and I’m glad to be proven Wrong by the way yeah and.

[50:40] I don’t know whether proven but maybe looking at some polls that are a little more randomized than who has time to vent their spleen
you know would be would be one way to go but and actually one of the things that bothers me a lot about the commentary is that it’s so full of.

[51:08] For you princess calling Medicare for all socialized medicine which it absolutely is not it’s not socialized medicine you know that’s one thing that gets thrown at it
another thing that people talk about is well if we have socialized if we have medicare-for-all will have wait times and you know people go.
On and on and on about that first of all it’s not necessarily true.
There are some single pair countries that actually don’t have don’t have wait times some some do and it’s
well publicized in there trying to work on it in some of those countries but you know another for instance you know saying to throw out about that is so my patients who were unfunded
never got on waitlist that you know if they needed elective surgery like if they needed orthopedic surgery if they need a knee replacement.
Um
There was no option for them so they’re wait wait times were infinite’s so you know if we were calculating wait times where would that put us but there are just
w

[52:24] So much it’s not just misinformation it’s disinformation out there and the people who object to it typically say the same things over and over again this you know the same kinds of things that you hear everywhere.
Another thing I just wanted to say about evidence of progress is that there’s a Bill in Congress,
Medicare for all Bill there has been a built since about 2004 there was a new one last year but there were never any more than.

[52:56] Like 80 some co-sponsors in the past and this bill the privilege I pondered has believed 119 co-sponsors so yeah said you know so even while.
You’re thinking there isn’t progress there’s progress being made.

[53:17] And that’s that’s why I think it’s worth it so it obviously requires a bit of patience to deal with that and that’s something that surgeons are not famous for.
So we’re very fortunate that we have family practitioners such as yourself who can keep their shoulder to the wheel and maybe bring about some change and it sounds like you are you sound pretty confident about it.

[53:43] Well I tried to be but you know what I need we all try to look for the openings and and pursue them,
and get to realize that this is something that takes time there’s this famous quote attributed to,
Winston Churchill which may or may not have said but that Americans always do the right thing.
After they tried everything else I’ve heard that one and I think he might have been right if he did say right.
Right well Jessica I have really enjoyed hearing your story and particularly the,
encouraging news about how we can better pay for health care,
and are tortured Nation but what I’d like to do at this point is get out of your way and give you a chance to do,
what we’re here for and that’s here your prescriptions so I’m going to close my mic and dr. Jessica szohr Sachs is going to give us her prescriptions for success.

[54:55] Have a vision of what you think medicine should be and what your place is in it.

[55:01] As you do remember that you walk in the footsteps of giants Hippocrates Osler Rebecca Crumpler.
Arthur relman and many others and by the way if you don’t recognize Rebecca come Crumpler Aurora Mecca recommend you look her up.
She was the first black woman physician and as Brave dedicated Innovative as the people you’ve heard of.
It may sound grandiose to think of giants when you might be feeling beaten down but that is our tradition.
Almost all of us took an oath to put Patients First to practice ethically to respect wife and to treat patients without discriminating.
I do follow your vision make the best choices you can about where you can realize it.

[55:51] If you find yourself in a situation where others are making decisions stay aware when those aren’t consistent with your values.
For instance many decisions in medicine are made on the basis of business and are not in the best interests of patients.
Opposed says when you can but even when you’re not successful don’t absorb them.

[56:11] I had a mantra when these things happen in which I said to myself I’m here for my patients.

[56:18] I’m not working for the administration I’m working for my patients.

[56:24] If you need to and there’s an opportunity find a different job but even if you’re unable to you may still be able to express your principles in a different way.

[56:33] One of the things that was very clear to me and practice was the people need health care they need health care whether or not they can pay for it.
Generally needed even more if they can I couldn’t always make that happen in practice but remembering that is why I do what I do now in retirement.
Which is to work toward Universal Health Care in the form of Medicare for all.

[56:56] Second despite medical advances despite technology it’s still all about the doctor-patient relationship.
Do everything you can to nurture and protect it.
Over the years there’s been more attention paid to the lifestyle of doctors call groups of gotten bigger offices have designated people to see sick patients so the doctors may be unlikely to see their own patients when they’re sick.

[57:21] Setting those kinds of limits is important.

[57:25] But some of the most important and satisfying things you will do are those that are beyond your job description maybe that you’ve been told not to do like seeing or calling your own patients.
When you’re not the one on call I want to share a couple of memories.

[57:42] One Sunday when I wasn’t on call in the early 90s one of my partners called just let me know that a patient whom I was close who had AIDS.
Had been admitted I went in to see her.
And I will never forget her lying on a gurney bald and Frau looking up to see me and saying.

[58:04] Dr. Sachs you came in on Sunday.

[58:09] A while after I stopped doing the hospital medicine I discovered a new form of communication it was called the telephone.
And I’m calm I hospitalized patients to check on them years later.

[58:24] When I talk to one of my patients about my upcoming retirement the first thing she said was when you called me in the hospital it made my day.

[58:34] Institutions often treat doctors as if we’re interchangeable but trust and our relationship with our patients is foundational.

[58:45] Protect it third.
Medicine and Medical Care are powerful but we need to have humility and realize how many other factors are important to the health of our patients sometimes more so than the medical care itself.
These are now referred to as the social determinants of Health when I was in practice I was aware of some of these influences.
The poverty and lack of Education compromise the health of many of my patients.
The discrimination and racism affected the health of my African-American patients but I didn’t realize how pervasive it was.
I wish I realized how profoundly the social determinants affect health.
I encourage you to address these with your patients and also to find a way of doing so with your community including with public officials.

[59:36] We Physicians have stories to tell about the things we say about the ways our patients suffer and legislators often respond to our stories.

[59:47] This all leads me back the first piece of advice.

[59:53] Find your own North Star let it guide you and enjoy yourself along the way.

[1:00:02] And those are my prescriptions for success.

[1:00:09] Well Jessica you have enriched our lives with a good bit of wisdom there and I am really grateful that you were,
willing to join us today before we go I want to give you an opportunity to tell our audience where they can find you and any.
Organizations are websites that you might be passionate about so please go ahead.

[1:00:36] Well I encourage you to see what my organization Healthcare Justice North Carolina is doing.
The website is Healthcare Justice and see when word dot orgy.
And we also have a Facebook page which is Health Care does Justice Dash and City.

[1:00:57] Our parent organization is Physicians for a national health program which has been supporting single-payer healthcare for over,
thirty years there’s a wealth of information there that website is PHP Dot o– r– g–
And I would encourage you to look at it and to join it as well and if you would like to contact me.
You can reach me at my email address which is Jessica got sure SC horr.
Got sacks sa XE at gmail.com.

[1:01:39] Jessica has been a real honor and a pleasure to have you here thank you so much dr. Jessica szohr sacks we have really had a,
great time together at least I have and I hope you have and I know our audience is going to enjoy your our conversation.

[1:01:57] And thank you so much I’ve also enjoyed it very much thank you so much for joining us today.
If you’d like to learn more about today’s guest just head on over to our patreon page where you can access exclusive content including a rapid-fire Q&A session with our guests and more never want to miss a future episode,
visit our website at rx4s success podcast.com to subscribe you can even offer your very own personal prescription for success.
As always we appreciate a review and a five-star rating as well as suggestions for future show.
Finally special thanks to Ryan Jones who created and performs our theme music.
That’s all we have for now so be sure to fill your prescription for success with my next episode.

[1:02:48] Music.