The Product Manager: Anthony Macasaet, MD, FACEP

[0:00] Like everything you know either we see adversity as something that is going to leave us damaged or adversity as something that is inevitable and often results
in more positive than negative so I mean it’s not like we’re going to seek out adversity but I mean clearly adversity,
is a path to betterment.

[0:24] Music.

[0:29] Paging dr. cook paging dr. cook dr. Turk you wanted in the OR.

[0:36] Music.

[0:59] Hello everyone and welcome to prescription for Success I’m dr. Randy cook your host for the podcast which is a production of MD coaches.
Providing leadership and Executive coaching for Physicians by physicians to overcome burnout transition your career.
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.

[1:27] Well my guest today is not only a busy and highly respected emergency medicine physician he’s also a successful entrepreneur.

[1:37] One of his more recent projects is an app to streamline the transfer of critically ill patients to facilities where they can get proper care.

[1:46] So let’s hear my conversation with dr. Tony macasaet.

[1:52] I’m really excited today to be.
Speaking with dr. Tony macasaet up in the more rural area of I guess it’s Northern Wisconsin is that right tone and it’s kind of.
You know certain Northern Midwest but like Southwest sounds so fancy Southwest Wisconsin.

[2:17] So all of those streams that you were telling me about probably make their way out to the lakes of Minnesota right so
well that’s an interesting question because it’s it relied solely it’s the flow what you know of the aqueous elements here and where do they go and it’s just fun and noteworthy even I mean guess in my own little personal sense because those
bodies of flowing water all essentially end up in the Mississippi you know so the Gulf of Mexico and out into the world but.
And they all empty first into most of them I think into the Wisconsin River so that’s like the big input.
I just south of us except literally for this little stream which I’m looking at right now this tiny little Brook called the bad Acts
which is another endearing name and the maid that the bad acts empties is the only our claim to fame on my little Valley here is it’s one of the only streams that empties directly into the Mississippi without first going to the Wisconsin.
Well that’s terrific this is the very first time that I have ever opened this program with a discussion of geography but it is fascinating.
So anyway back to dr. Tony macasaet yes an emergency room physician in Viroqua Wisconsin,
some really interesting stories to tell Tony and I’m.

[3:40] Really looking forward to the conversation but as is always the case I like to begin with your origin story so your path to Medicine did you did you start your.
Medical career in utero or the idea come to you later or how did that work out yeah well I’ll probably like for many of us I think it was a little bit of both you know multifactorial path to Medicine.
Got to go back to deep but my mother’s dad was an Army psychiatrist back in the day so kind of an interesting like genetic in utero element there and then my.
Father,
the senior Doctor macasaet Who just retired a few years ago near 80 as a general surgeon like why I know in the belly it,
75 or whatever like Dad you’re setting the bar too high here so that’s a lot of stamina i-it’s and he still you know so now he’s in his 80s and some of the things we’ll talk about you know where.
Founders cofounders of these some of these businesses that I’m involved with your outside of Medicine.
You know I mean he’s he was just the Classic role model growing up with him just the unquestionable,
resiliency and like sense of Duty without any recognition you know answering stat to the o.r.

[5:04] Pages from home for a crash C-section.
His neighbor you know baby in distress kind of thing and it was just like that was normalized
the way I grew up so maybe it’s no wonder I ended up in you know first in pre-hospital stuff and air Medical
hems type type actions and then you know as an Emergency Physician and Emergency Physician educator and so on and
so you had a really early exposure to what it’s what it’s like to yeah,
to work when Duty called I think I may be remembering this wrong but I mean I’m certainly there was a period of time like he moved us here in 1973 he literally was.
You know a little younger than my son who’s 11 now during World War Two.
During the Japanese invasion just outside of Manila and a Tiny Town that’s very analogous to Viroqua which we mentioned you know with like the brutality of like an invasion Army,
in your little tiny town I mean as a little boy I mean,
really interesting you know to kind of contemplate that kind of thing I bet it is yeah you know and then Finn did med school there he did med school and the pee in the pie and then emigrated here.

[6:19] To eventually go back to please his mother.

[6:23] To his little town and be the town surgeon you know so a little bittersweet because he then did a multitude of different
Surgical subspecialty fellowships and this and that you know kind of as a means to sort of stay here because he got the America bug
which we could all imagine and then you know fortunately or unfortunately met my Jewish mother in Milwaukee during a cardiothoracic fellowship or some crazy thing that he did
and then little bit unusual man right so now there’s my my Catholic,
Filipino fresh off the boat the day I had you know with this this awkward you know Jewish gal from from the walkie
needless to say the you know the mothers and in-law were
not pleased for quite some time but everybody got over it real magic so you know a year later I am conceived and you know in the in the Summer of 69 literally.
And you know he ends up,
through this and that in Viroqua this Tiny Town which is not that different than it is today and for years was the only surgeon and you know so he’s on
what was that QQ day call yeah really the qod like he’s a daily call for decades essentially you know so he delivered this is just crazy to think about like.
He delivered more babies in this town by C-section then probably every other.

[7:51] Family Practice you know /ob provider combined and of course with his longevity he delivered the babies of babies.
And you know crazy things like that so so I go I want to enter a room now if I don’t know the person or whatever they’re not necessary expecting you know who the doc is going to be I’ll say I’m dr. macasaet.
You know say it’s an older person or whatever and they’ll look at me and they’ll see instantly their expression like version 2.0.

[8:20] And then everybody starts laughing oh that’s your dad I get it so that’s pretty cool kind of an endearing thing the atmosphere that you grew up in was the medical world and it sounds like that there was.

[8:35] Never a point where you would where you would say I never want to be part of this if I ever get out of it you just committed from the beginning well actually you know and this is like
again you know the common narrative almost a cliche I was like I’m not going to do what my dad does I respect him I love him but I have to do my own thing so you know I was in you know an entrepreneurial
type of pathway for the first bit of time and until,
I can’t remember how I decided or why but I started to volunteer with the local EMS service now first is like a volunteer right along you know
EMT in training
and this was prior to college this was about the time I started college so this would have been and I I finished school a little early just because
circumstances so I think I was started maybe messing around I was about 17
as I can ride along and then get the training and was able to go as crew after a while but I remember rounding the ban on our first call,
and it was a rollover MBC with people in trapped and it was.
People like probably kind of new I mean obviously this is a tiny rural area and just the immediate.

[9:50] Like whole body whole soul knowledge.
That I was like meant to be there.

[10:01] I mean part of it is course you know dopamine and adrenaline and you know shirt of that kind of thing but.
Beyond just the the immediate like Rush of adrenaline and dopamine it was like I mean I guess I’ll getting too sappy I mean it wasn’t it was an oxytocin thing to you know so well it sounds like it was a really informative moan yet
there was that age anyone with any.
Sensibility at all would have understood if a teenager looked at that and said I don’t want any more of those and that was not the case with you so yeah I think it was an informative moment for you,
and you mentioned that an undergraduate school you only spent.
Three years now I don’t know if you want to get into why that why the rush but gosh right why the rush exactly but why the rush yeah well I mean it goes to that thing you know the whole deep living thing where it’s just like it’s not about the
the short-term Sprint but like the life long pursuit of you know the dope oxytocin thing and.

[11:07] Yeah I mean in retrospect it’s like okay it is whatever it was good and bad but you know I just was so driven I remember thinking and it was embarrassed when I thought it but like that Alex Keaton.
Was my role model like
and like he’s not supposed to be a role model you know the type 8 Jets from Family Ties I know it’s like what the heck you know and so it’s just like yeah like you said I mean it was it was just rush to
get into med school but I mean the good part was also a hack I mean
at that time which is also probably different now this would have been you know 88-89 era where I went to school
I’m reading through the prerequisites and you know sort of checking things off and trying
packing scheme of how to best get in it was like where does it say there’s either no where in the thing did it say
these list of criteria did it say you needed a degree
which maybe still the case and maybe there’s you know there’s other models obviously where this is moot but you know it was such a big deal he got to get your biochem degree and I was like oh my gosh I fi hate biochemistry like there’s just something about it I just.

[12:18] Just idea just hate it so
I asked you know Admissions and made calls and this and that and just eventually realize that yeah I could if I did well for the first two years you know I’m an in-state
kid Madison
you know they want in-state people like lot of State sure ghouls I mean that’s a part of their mission and it was there were a lot of favorable elements you know I did well academically and all these other kind of things I tested well
so I did the prereqs I got you know at a 4.0 blah blah blah perfect letters and applied after 2 years and got accepted
and then you know you have to complete your third year.
No expectation you’re going to necessarily get a degree and then they let me take a year off which was you know one of those other impactful years which we can get into but it was you know it wasn’t it was a crazy year in EMS before.
I started med school.

[13:13] Well I was in fact I was going to ask you my next question was going to be looking at it in hindsight would you have done it any differently yeah but
but you kind of did I mean it’s not it’s not like you did three years of undergraduate and then you were in medical school right that’s true actually got,
some experience dealing with what you might be dealing with.
But I hate if I could go back and do it all over again would you do it differently after you think you picked a pretty good
plan no I mean for some reason I have never really framed it that way because you know back then it was the was it what things were so Reggie seemingly were more like culturally regimented
like you know of course you’re get your degree and you get you know you do all these steps and it was it was less about you know hacking life which is now
like almost a necessity expectation versus you do something neat shit detian and cool so yeah I mean back then it was
it was like this important thing to consider not going through the pathway but then to reframe it like you said into the fact that
you know what I have rather had enough oh my goodness you know a fourth or fifth year of biochemistry level stuff like.
Goodness gracious verse is this year which ended up being unbelievable I mean what happened during the year that I happen to be in the in on st. Croix in the United States Virgin Islands as a medic
you know yeah what what where would I be without that year.

[14:41] Yeah really and then I think the next question that should be obvious or it certainly obvious to me.

[14:49] I’m wondering what was it like for you to leave that environment of really intense,
boots on the ground experience with sick and injured people
now you go back to first year of medical school and you’re back to biochemistry and cellular physiology and in that stuff yeah how did that work out for you right right I mean and and filled with less.

[15:14] Checked machismo and all that to yeah it was it was really hard at times
just with some of the subjects I was less passionate about or they were less well taught or you know all this variety of things that were subject or course isn’t as stimulating as you would
as another one might be to you personally and those were those are really hard because I was let’s go let’s go out in the streets you know we could we crack this person or fixed
stupid things like that that made you impatient but you know it’s I guess that’s life right there we need to seek out a like learn to
bring those things down and I think I did and I ended up doing fine and that was there ever any doubt that you were going to go into emergency medicine
the answer to the question is when I rounded that curve and there was the rollover and there’s just
I just knew that’s what I would likely do and and other words I went to med school not to be a physician but to be an Emergency Physician but at the same time I do you know of course it’s like well get keep an open mind here who knows so.

[16:14] But I realized for myself and I again I think this is true for a lot of Emergency Physicians is that when you go through when you kind of like or love everything
then you know maybe you know he’s pretty either do Family Practice if that’s sort of your temperament or if you know if you’re more the add ish type of thing then
you know she do emergency medicine you know if you’re if you’re successful as an Emergency Physician as I think some you know listening to some of your prior guess at what it could we could easily use as examples it just an interesting,
like without blowing a horn too much but just you know you have to really be able to think like holistically about patience I think you you’re more successful when you do I mean that’s true every.

[16:54] Specialty but in something is like in-your-face and immediate a ZM that certainly is an asset so let’s move your education log a little bit I’m interested you seem to be
very tied to your roots and.
In Wisconsin and yet when it came time to look for a residency you you left the state for a little while what how did that decision come about.
I ended up being fortunate enough to train it the University of Chicago and emergency medicine I started more or less the year that the show e.r. came out.

[17:29] It was also the year I remember looking at some of these graphs where homicide numbers were up at this crazy Peak.

[17:37] Looking at hit the numbers it was I mean this is all sad and crazy for civilization but it was like you look at the at the spike at the time I was in training.

[17:46] And then you know you look back over time and it was like oh wow there was another spike in like prohibition days that was similar,
you know what it’s like wow this is a crazy time to enter into emergency medicine as this baby doctor person and I was given that opportunity in part by,
dr. David house who stole one of my mentors who is the program director he.

[18:12] Was from Viroqua so good admittedly a little bit of nepotism there how about that but you know he saw my.
App come in and you know he was like he’s like I don’t care what happens we gotta get this guy here he needed less one person for Viroqua so.

[18:35] Yeah I ended up you know matching there and dr. house.
Was my mentor then and still is as I said and you know the rest is history and.
Hi I’m Rhonda Crow founder and CEO Forum D coaches here on our X for Success we interview a lot of great medical professionals on how they grew their careers how they overcame challenges.
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[19:49] 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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[20:52] And now let’s get back to today’s interview.

[20:54] Music.

[21:00] Felt like Chicago was.

[21:02] The place where you belong that the time and I’m wondering how you came to the decision to go back and embrace the small town life again yeah that’s a big change,
yeah well right it was well it’s I mean it’s painful to even describe.
What happened I mean in my you know this is certainly in proportion to many other people’s struggles which are way worse than mine but.
So I’m happening along kicking but just loving life and boom I get served.

[21:37] And the glow dear yeah so the gut-check of.
Somebody’s you know in my mind I mean you know again it’s I may be created my own react we all create our own realities but you know my reality it was like I’m doing good and I’m serving people and I’m helping and you know.

[21:56] And light love and selflessness and and I’ll send well here’s your pay back pal years served and you know and then and then it’s a there it’s a case that.
It was so removed from my actions as far as the eventual outcome is as it is so many of the times you know it’s basically like didn’t document as much as I normally would plus a bad outcome.
Without a clear explanation.
Low probability but boom you put the two together and and then thirdly in a very very litigious,
environment as many people know hmm and you know here you go here’s your now down the hellscape rabbit hole.
Of being named and you know having to emotionally navigate all of that and just really question everything and.

[22:52] Come to this realization that my.

[22:55] Infatuation with Chicago and the you know the social parts of it and the cultural parts and the friendships and the work.
Were an incomplete understanding and that I’d now forevermore had to balance the pain of knowing that in the best-case scenario I’ve got to sit up at night and get up in the morning and think about the stupid case.
And.
If nothing else just to go to your original question that allowed me to see the true reality of Chicago the good and the bad and.
Rethink everything I mean I thought I’d practice are forever you know there’s no reason I wouldn’t it was like you know I’m,
moving up the academic ladder and Leadership of the hospital you know million different things that were all male mostly favorable and Wham-O you know the realization that you can do.
Unacceptable job.
If not Excel or what you’re doing and you’re probably still going to get named at some point and to think about going through it again it just became untenable.
Especially when I had an alternative and that is going rural you know Tony I’m really surprised that we don’t.

[24:13] Talk about this more than we do and I’m really happy I can’t thank you enough for bringing this up because
as the statistics show the great majority of physicians in the US have been accused of malpractice from something at least once and sometimes multiple right
times and your willingness to share it is very generous of you because it has a profound effect.
More on how you see yourself and how you make decisions yeah and you have really done a beautiful job of bringing that to the delight and I thank you so much for sharing that with us it does.
Have a huge impact and it’s a shame that we don’t talk about it more than we do but yeah but that’s a great answer to the question right it obviously had a.
Profound impact on you I guess the follow-up is going to be once you were back and the more Serene environment were you able to.
Eventually to
back off a little bit and give yourself a break and not be seeing lawyers in your dream things brighter what exactly now that’s so well stated I mean ya know that that’s all.
Very insightful as well and it’s true I mean and because.

[25:38] You know you alluded to this but I mean there’s there’s the stigma of even talking about it like you feel sort of feel embarrassed or their shame like you’re you know a failure after years of you know we tend to be successful people obviously and
sure you know and then and then you can’t talk about it during the case
like what a crazy thing that is you know like yeah oh my gosh you know they might if you talk to somebody they might actually have to testify against you theoretically
you know whatever and then like you said you know we know anecdotally and from the evidence that these
actions do affect us like everything you know either we see adversity as something that is going to leave us damaged or
adversity as something that is inevitable and often results
in more positive than negative so I mean it’s not like we’re going to seek out adversity but I mean clearly adversity.
Is a path to betterment I want to move along I want to I want to get back to life in Viroqua was the eye,
once you got there was were you sure that you’d made the right decision or did you ever
thing from time to time G this was a mistake how was it to readjust it was as impactful as that you know rounding the bend on that
roll over I mean wow yeah it was I remember the first few shifts and to be so.

[27:08] Appreciate it for being there like not occasionally but almost always was.
Such an unbelievable you know feeling for an urban emergency doc it is true and it’s still true so that was you know 2006 as you mentioned and you know my last shift day or a few days ago.

[27:28] I was just thinking myself again like still even with covid and just Division and all this crap in the world why people are still.
So overtly appreciative genuinely appreciative yeah and it you know and again it’s not like that’s not the reason you do it.

[27:46] But it sure the heck helps it further you know the practice along as far as like your longevity in it
I want to ask you one other thing about life in Viroqua before we move on to some other things and that is covid has been
an incredible burden for
not just this entire country but the entire planet and you were dealing with it in an emergency room and a place where resources are relatively limited so I’m wondering if you can
tell the audience in less than a couple of hours
what what was the experience like what have you taken away from the covid experience and small town America oh my goodness
yeah and I just I feel like I can’t do anything just this because like you said like we’re just one tiny shop amongst,
4600 others that are dealing with the same thing just in America let alone the rest of the poor world so for us
I mean it’s been another Incredible Journey and then you know to be charged with like oh
I’m the medical director this is like partly my responsibility and of course to this day we don’t we still don’t really know exactly what we’re doing understandably so just kind of making things up as we go along and
you know maybe just focusing on the positive of it like coming up with Solutions and an hourly basis.

[29:14] And then testing them and implementing them and then retesting them Andre looking at them and revising them and just regenerating everything that we do.

[29:24] As we go along and then trying to network with others that are doing the same thing so that we can kind of crowdsource activities and.
Use social media for something good which is how do we share all these hacks and and workarounds and workflows I mean it really was
an adventure as much as it was this
harrowing journey and I just feel like it well you know retrospect at some point we’ll all look back and as hopefully and see that this phase
and sequence of adversity will also hopefully lead to a slight net positive in ourselves and in.
The systems that were charged with overseeing so.
Yeah like you said that’s that’s a two-minute version there is a 2 hour version available if anyone wants to call me I love you know chatting about things so please do yeah.
Well this is a perfect opportunity in a great segue into something that I’m really interested to know about and I got a feeling that you’re probably
looking forward to talking about it but that’s the the
invention of yours called the NTR app and I want you just to go ahead and give us an explanation for what that is and what it does and why we should be grateful to you right it is it’s pretty.

[30:45] Pretty fun to talk about just because it was such an interesting incredible first ever series of actions
and it’s still going on to so so yeah the NTR and stands for the national transfer registry so what what happened was there was a day
when I was we’re working in the Ed and it was fairly busy and we had one transfer and like ice really sick,
not intimated yet I’m not invasive we had a patient I think we had just intubated a different one that wasn’t that wasn’t even covid and retrospect and then
a unobstructed jaundice ascending cholangitis who was extremely sick and I remember thinking the first transfer knowing that this point you know again a few weeks ago where we knew we might not actually get a bed
and then to have to others and then you know this is Tiny shop like there’s a few nurses one doc you know what a pee-pee and
a couple tax and a registration person and you know that’s that’s it and just the act of making these calls to look for hospitals where you know you’re calling not five or even
10 but possibly 50 different places till to even know who to call
like we’re everyone’s pretty familiar with you know the X number of hospitals within 10 miles of them.

[32:07] What do you do you know all the hospitals that are 20 miles away 30 40 50 miles away do you know how big they are do you know what their telephone number is do you know if Chippewa Falls is closer than Wisconsin Rapids.

[32:19] Because it by emtala you have to go to the closest facility so it would all these like weird issues came up so where I Google.
You know Chippewa Falls hospital you know like this is a freaking crap you know we’re calling the state is there a list you know and no I don’t have a little what do you mean list and
were so we develop a spreadsheet and like oh wow what an innovation you know a Google spreadsheet.
That we can have the contact numbers and but we don’t know what we’re missing.
And you know I remember 11 State well who shall go nameless but you know who you are gave us a list of give us a list of hospitals in their state didn’t put the town.

[32:59] Just the county and you know so so we’re like hey Betty is Polk County closer than Harrison can die you know it was just like.
Is this really happening so we went through this exercise and we’re calling these places and
then I remember it being on on a social media site and was talking to other e emergency physicians about it and they said I asked if they had a list and they didn’t and like all we have a list and they were not that far from us I’m like I’ll email you the list
and they were so thankful to have the list
because we are already done the work so why should they do the work so that I absolutely remember looking at one of my you know colleagues there and we were like
we should build an app it ought to give it almost gives you chills you know and then it’ll like the cliche like does anyone know how to build an app.

[33:52] It was again yo so comically would I mean it would be comical if it wasn’t so tragic so that led to you know that was the the kind of like real world situation with
where I think it’s Mark Randolph is you know one entrepreneur Who highlights the fact like you know solve a problem for yourself first you know and then if it is you know right and then if it’s like hey,
that could be used by others while you know maybe have a project or a business or whatever so you know we literally set out to solve it for ourselves thinking well you know instead of just emailing the spreadsheet let’s just give them a link to a nap
not knowing how hard an amp you know building an app can be and that was you know that was a whole nother thing which is still ongoing of like how you actually get an functioning app onto.

[34:38] Apple App Store and Google play but you know but we got the first version out
I found a web do you know an app coder who would actually do the coding which was really cool we contracted with a group is a small start-up actually overseas using Fiverr.
Which was in great experience you know I’ve had mostly good experiences using those kind of gig sites to find a virtual
partner essentially to do the work and I’m sore still working with them and the app was a lot we launched the app after from conception of the idea
to publishing it on the App Store I think was I think we had the first version out like within a few weeks.
That’s pretty unbelievable yeah it was it was so incredible to act the first time you actually see it on the store and know that you were part of a team that helped create something that.
Even if just a few people.
You know even if it just slightly unburdens them from that part of the work of finding a bad during like catastrophe.
It’s worth it.

[35:47] And so if you can be a little bit more granular with it so the usefulness to this is for the practitioner who is in need of a referral center.
Yeah and what and so what you need to know is where is the closest place.

[36:06] Has availability Rand so clearly the user is in the position of knowing exactly what they need.
How does the app know where the availability is right okay so just to be clear we’re still working on that and we’ll go and that’s you know if I could rate fair enough yeah and well and if I could rate the app you know on a scale of like one to ten word like ten is like
Earth changing you know type.
Product or innovation or something I’d say it’s kind of like a two right now like it’s pretty cool and it has some function and it has some really
great function if that’s what you really need which is like you said you know you’re you’re one of the couple thousand you know whatever it is smaller critical access type hospitals that doesn’t have a unit or specialized a lot of specialized things
transform out you’re going to need those receipts you know larger receiving centers and that itself,
has already you know have already had numerous anecdotes of how much that has helped people including our own team you know so that’s level one
level 10 just afford to the end is a system which remains to be seen because there’s still a lot of
elements that we need to confirm can actually happen but our goal with that.

[37:18] Which I think again would me this like game-changing type of option would be that receiving Center let’s say Hospital operations managers Transfer Center you know.
Like leads for example yeah whoever kind of has the whoever owns that moment by moment precious knowledge which is really only no will by knowable.
By a human being.
Often just run is a sense of how many additional patients can we take in this realm at this facility right now.
And it’s kind of a funky thing you know you think about that and so our goal our Dream our drive is to get this app.
In that person’s hands they would have a different interface obviously they’d have an admin interface
but they so they would see this is where it gets kind of fanciful but imagine your the hom and,
you know let’s just keep it simple you’ve got like one big big hospital and you’ve got sort of three ICU beds left
but you know that Rob just called in and now you’re down two or three beds or whatever you know and so right then before anything is even on a dashboard or this or that because some of this does exist,
you know you cannot take another unit patient you literally cannot take one additional unit patient.

[38:45] Right so you jump on the NTR instead of you don’t log in a computer you don’t put a number in you know you all these things that are currently exist that nobody really uses to be honest.
And you open the NTR it’s right on your homepage it goes right to let’s just say.

[39:01] Like a swipe right swipe left type thing for ICU med-surg you know whatever categories makes sense and you swipe right
and the phone Jiggles a little bit and there’s like a tone or you know some some little tiny micro we reward for doing the action for the for that user
now imagine you’re standing at the doorway of the call center you got your five or six you know transfer nurses there and the phone’s ringing off the hook.
And they’re saying no no no no no sorry and their souls are dying a little bit every time they do because they’re so good at saying yes and.
All sudden again theoretically the call stop because you have just signaled.
That you have a lower probability of availability and then as soon as you know the ICU calls and like oh you know Sal is going to cover.
We’re back up to three beds you jump on the app you flip the switch now the little haptic feedback and boom the world knows like.

[39:58] You know whatever number 100,000 people who might be looking for a batter.

[40:03] 10,000 people thousand people 500 people all know that you’re back as.

[40:11] Normal probability of availability mhm something like that.
That makes a lot of sense and is quite brilliant it’s obviously as valuable if you’re standing in the emergency room it’s as valuable.

[40:26] To you to know who’s full as it is to know who is available because if you know their full then you can take those off the list well and no reliably.
For anyone that’s participating you know maybe everybody that they’re full right now not like two hours ago.

[40:47] Because I mean you know as you know I mean these Dynamics change literally on a minute-by-minute basis sometimes exactly so what system could possibly address that plus the other huge thing.
Is that these places don’t they don’t want to share data that way I mean and I get it you know what I mean because they mean they don’t want to put out what we have five ICU beds and you know no way we’re not even going to ask for that information.
You know this is just it’s a service it’s information it’s a little bit of a nudge that have two equally distant hospitals
are you know available potentially that you’re going to go with the one with the you know more of the the red shading.
You know the green shading versus the Reggie you know red shading however that works I mean it’s cool like I think you’re kind of saying like you won in the Ed you could imagine where maybe we’ve got you know a status board up,
in the nurse’s station where you know we have all these kind of monitors and cameras and it’s just you know a lot of situational awareness type things in the best type of EDS one of those boards would be,
this map of area hospitals you know out maybe 100 miles when we’re really when we’re really in it you know and and admittedly this app.

[41:56] In a way we almost hope we don’t need you know like of course so like if we don’t need the app
we’re happy we’re it’s all good but it’s like we probably will at some point you know whether it’s this or that or that or this like there’s we’re going to run into over capacity problems at least.

[42:14] Periods of overcapacity in regions and that’s really where
the app will be a game changer well it’s really a great idea and I think as it continues to develop there’s going to be a great deal of enthusiasm for it and
you know kudos to you and those who participated with you to get it up and running because I can’t imagine that it’s going to be anything other than an incredible
success and I have really enjoyed hearing about this
we’ve unpacked a lot here and I wasn’t kidding it sounds like we’re going to have to have you back at some time to talk about some other things but I want to get us to my favorite
part of the program and that’s where I get out of the way and let you have a chance to say what’s on your mind and on your heart so I’m going to close my mic and
dr. Tony macasaet is going to give us his personal prescriptions for success thank you dr. cook
I guess I just I have to preface this by saying like I’m still trying to figure out everything you know all the time so this is very humbly shared but.

[43:27] The things that Guide Me based on experience and what schools and I’m sure a lot of people know the science behind some of this too that’s sort of proving these kind of age-old almost wives tales to be probably the state of reality.
And it goes back to a theme that we followed throughout throughout the podcast today and that is that adversity can leave by choice sometimes and knowing that it’s not always the case but like.
Let me say this again when adversity can leave to something positive allow it don’t.
Seek out adversity but when it descends consider almost welcoming it at least appreciating it.
It’s because and again is that I think some of the latest science demonstrates.
It’s true that adversity does lead to longevity so.
Little bouts of adversity that one recovers from that doesn’t lead to obviously long term.
Stress and elevated cortisol like obviously you have to avoid that
but where it’s these bouts of adversity I mean it’s a remodulating the little machineries that tend to the DNA you know the epigenome how crazy is that.
And so I think use those moments of challenge to question everything.

[44:52] To reassess to remodulate to refresh and to regenerate.

[44:58] Into a path of the tribe Brave like I it’s another kind of area I guess maybe the second one is like I have this like little Mantra you know favor your inner Brave.
And serve without the expectation of compensation for being that brave you know one of the Braves of your of your people.
I mean somebody’s got to do that where you’re just you’re in it you’re really you’re selflessly serving your people.
And I guess the last thing that’s just been ridiculously impactful for me is to develop.
Means to compassionately communicate with people I call it calm calm and that’s that’s simply the notion.

[45:43] That you think about how interactions making you feel and communicate that.
In a way that ask for a positive change from the other person back and forth until you achieve a win-win outcome to the communication.
And obviously this applies to like areas where there is potential for disagreement and so use adversity to your benefit.
Seek balance and deep living compassionately and effectively communicate and favor your inner Brave.
And that’s my secrets as of today
dr. Tony macasaet thank you so much for being part of my podcast today and sharing some really insightful Thoughts with us it has been a great pleasure
before we go I want to give you an opportunity to your own horn about anything that you want to tell us about whether it be email address is.

[46:43] LinkedIn accounts books you want to sell more about the app anything that you want to publicize to the audience the floor is yours.

[46:53] Thank you yeah well if anybody wants more info on the app and again it is available right now for download probably the easiest way is just you can go to like the website which has a link to the,
app stores you can go right on the app store’s the website one version is just the NTR app.
So th e NT R AP p.com vntr app.com and then we didn’t really talk about this but I have another company that is.
Doing Timber harvesting and Timber Frame home.
Construction and like Hobbit Community Development and regenerative Farms another another pretty crazy venture.
And that’s that’s called regenerative Adventures are regen Ven and then the lastly it just.
I mentioned I think my dad and I have this also have a business together with my mom and siblings called the Viroqua Public Market here in Viroqua.
We have an Airbnb there and it’s basically a town covered square with like little micro merchants and a amazing restaurant and Cooperative art gallery.
That we hope we helped found the building we develop the building a number of years ago and it’s another just labor of love.

[48:14] Really a wonderful experience for me and a gift to the community so.
That’s some of the areas where you can kind of find some of these projects and if anyone wants to reach out to me personally just pretty easy to find on the internet and would love to connect.
Well once again dr. Tony macasaet Viroqua Wisconsin emergency room physician it’s been a lot of fun talking with you today and thank you again for being here thank you dr. cook.

[48:41] It’s been great thank you so much for joining us today.
As always we really appreciate a review from you and a five-star rating helps us a lot these ratings give our show much more visibility.
And they help us reach more listeners and if you’d like access to exclusive content head on over to our patreon page.
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And more to be sure you never miss a future episode visit our website at RX for success.
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[49:21] There’s always a very special thanks to Ryan Jones who created Aunt performs our theme music for us and remember be sure and fill your prescription for success with my next episode.

[49:33] Music.