Dr. Diana Blum is a board-certified neurologist who completed her medical school training at the University of Chicago, Pritzker school of Medicine and her Neurology Residency training at Stanford University Medical Center. She is currently in private practice in Silicon Valley, California where she focuses on the chronic management of Parkinson’s Disease patients. When not practicing clinical medicine, Dr. Blum is a fierce patient and physician advocate, defending Hippocratic oath medicine and the sanctity of the doctor-patient relationship through education and activism. She enjoys mentoring medical students and residents interested in pursuing direct care medicine and is a founding fellow of FAIR in Medicine.
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Dr. Blum’s Prescription for Success:
[Editor’s Note: Dr. Blum provided her prescription for success as an essay, of which, these bullet points cannot do justice. If you have not listened to it already, I would highly recommend you do. The section starts at 39:24]Number 1: Have a daily self compassion and gratitude practice.
Number 2: Know your worth.
Number 3: Be Kind. And don’t let your kindness and compassion be mistaken for weakness.
Number 4: Breathe.
Number 5: Allow yourself to be vulnerable.
Number 6: Admit when you are wrong. Admit when you don’t know something.
Number 7: Learn how to forgive.
Connect with Dr. Blum
Dr. Diana Blum on LinkedIn.
Notable quotes from Dr. Blum’s interview:
I think the field of medicine is probably engrained in my DNA.
Take the time to really get to know what the issues are with the patient.
You can’t properly diagnose and treat someone in 10 minutes. It’s not sustainable.
Good, Quality care, people will seek out.
This is the problem. We are not practicing medicine, we are practicing healthcare.
I don’t like the term “Burnout” Burnout is gaslighting the victim.
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Access the Show Transcript Here
Transcript
[0:00] The lived experience Mantra and end justify the means attitude makes open and honest debate impossible.
Physicians self-censoring has become the norm if you want to keep your paycheck and increasingly your medical license.
[0:16] Music.
[0:21] Paging dr. cook paging dr. cook dr. cook you’re wanted in the o.r. dr. Koh.
[0:29] Music.
[0:52] 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.
And don’t forget you can earn CME credit just by listening today so check the show notes for more information about cmf.
[1:31] My guest today is a very successful neurologist in Menlo Park California she’s got some great ideas on how Physicians can get back to taking care of patients
instead of jumping through hoops for insurance companies so let’s hear my conversation.
With dr. Diana Blum.
[1:54] It’s my pleasure it’s my pleasure today to be speaking with dr. Diana Blum who is coming to us from.
Tom Miller Park California I think is that right Diana actually I just moved to Palo Alto or did you really yeah okay well now I’ve got you in the right place but what about what a pleasure it is to have you here I’m really looking forward to hearing your story.
[2:17] Thank you thank you for the opportunity well Diana as we always do we’re going to begin with your.
Beginnings I’m always interested in how people became interested in medicine and decided to make.
The decision to make it a career how did that work for you did that happen early in your childhood or how did that come about.
Actually I was a little bit dissuaded to go into medicine both of my
parents used to be Physicians back in the former Soviet Union yeah they they gave all of that up to come to the u.s. and
well for freedom but unfortunately at the time they could not
you know basically starting the whole process over you have to do residency after passing boards again and they didn’t even speak English so really that’s fascinating
yeah they ended up
being nurses so they worked actually my mom retired after being a nurse for over 25 years at UCSF and my dad he started off being a nurse but.
I think it was it was difficult for him after being You Know Chief of Staff of his lost fiddle so I could they could get credentialed
as nurses in California but.
[3:38] But not Physicians or did they have to do any additional education before he even before they became nurses how did that work so they had to pass a test but you know.
First physician the nursing test was pretty easy to pass at least for them so they they.
They passed both tests and then they just started working the problem with if they wanted to pursue medicine as they have to redo the residency and at the time the priority was
putting food on the table so there it was just not an option and their English was so poor that.
It just would not be feasible at the time.
So they yeah they worked and I it was nice because I got kind of that perspective both.
From the nursing perspective and then also from the doctor’s perspective because they would tell me stories about how you know
medicine should be and what it what their experience and seeing things so so I was kind of discouraged away from it
yeah and when I started college I was not pre-med I actually was a psychology and Russian literature made yeah I noticed that so at that point medical school wasn’t really.
[4:55] No on the radar not really until I really started learning a lot of my psychology classes was were cognitive Neuroscience classes and when I started learning about kind of
the brain and
the brain’s connection to the body and you know how diseases and then I started learning about some diseases like Alzheimer’s and Parkinson’s and that was kind of what triggered my interest in
in going into medical school because I realized to be able to
treat the patients with those diseases I have to go to med school for that so that’s kind of a roundabout way of how I got there and luckily with the batch the BS in Psychology I did do some of the basic science work
but certainly not.
[5:47] You know enough and so I actually ended up taking a year off between college and medical school to you know apply finish of do all the things I didn’t have a chance to do one really interesting story.
We’re your parents pretty excited when you made that decision probably yes and no I think I think.
The field of medicine and taking care of its kind of ingrained and probably my DNA going back and and part of it is probably related to you know my Jew I’m Jewish so you know there’s
there’s certain Jewish values where you know you
is the sanctity of life and you know the he who saves a life Saves the World entire so that that kind of.
Was always I think part of my growing up and valuing life and valuing you know caring for people and so they weren’t too surprised.
Part of it was a little bit of I think worry knowing what it.
Takes to become a doctor so that there are some of that but no once I made the decision they were supportive they were.
They weren’t going to stand in the way of that and it looks like as I look at your CV.
[7:04] You actually wound up going to two different medical schools is there a story there yes so I went so I was dating at that time he was just my boyfriend and I
when I was applying the medical scores you know he’s like well what’s your criteria and I said well you know I really don’t do
well in cold weather so he’s like what you definitely don’t want to apply to any schools in Chicago that’s where he went to college and so I didn’t I applied I avoided Chicago because you know he.
[7:35] Told me that it was really cold so we ended up I ended up in LA and of course at that point.
P move down with me to La and we got engaged and what does he do it gets into business school in Chicago oh my goodness so there was kind of a choice of
us being apart for a couple of years or me trying to transfer and and so that’s literally I had to apply to med school
for a second time so where’s the transfer process difficult it was literally applying to medical school a second time so like as I’m
doing my you know Gross Anatomy final exam I’m providing my secondary applications and flying out for interviews it was literally all over and that the time University of Chicago is the only school in Chicago that would even
entertain a second-year transfer and at that time there were no spots so they still encouraged me to apply saying you know you never know spot to open up but
what I did it like I was applying for no spots and obviously obviously it all worked out.
[8:43] And was it your internship your your transitional year did that happen in Chicago the will that was in Chicago yeah we decided my husband was finishing up his job and we decided to stay for for my intern year
and then we moved out to California and that was basically the four years of Chicago was.
It I could not handle another winter I love the city oh my goodness as described yeah so clearly your
your memories of Russia must have been
kind of fuzzy or were you even in Russia well that you know technically nowadays back then it was Soviet Union technically it was the Ukraine so and this is quite interesting well a little bit now right because because what’s happening and I grew up I never
I never spoke Ukrainian I always spoke Russian because actually at the Soviet Union
you spoke Russian of course and so growing up I kind of considered myself Russian it wasn’t until recently that.
[9:51] You know people started asking about
what is your identity of like you know back then we were all and then forgive me I hope I’m not but this is just the reality we were all considered dirty Jews right so did was the name so I never Associated myself with
being Ukrainian or Russian I was even my passport said Zhu you know it didn’t say yeah one or the other so um.
[10:17] Yeah that’s honestly why I wanted to study a little bit more because I grew up speaking the language but I really did not
appreciate much of the Nuance of that culture and it’s it’s definitely a complicated culture especially for any parents sure it is
yeah so what goes through your your mind as you.
[10:43] Sort of look at what’s going on there today if anything I mean you maybe you were so young you can’t grasp it but do you have any feelings.
[10:53] I mean obviously the bigger picture of a sovereign country being attacked by another
country that like that big picture and of course human suffering that goes along with all of that that hits home and on multiple levels
you know obviously seeing refugees knowing I was a refugee not in those circumstances but you know my my grandfather.
He just passed away in February he fled from Romania during you know the halt the WWII and and so you know that whole when he passed away in February part of me was like.
[11:33] Thank God that he wasn’t around to see this because it’s obviously triggering a lot of a lot of wounds so
so for that it’s more of Just For Humanity and the suffering that’s involved but not I can’t say I have a personal connection because I don’t have any family there right now yeah I’m standing when we left it was kind of
yeah saying goodbye more permanently to to a life we didn’t really feel like we belong to in any way.
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[14:09] And now let’s get back to today’s interview alright well let’s move your professional development along a little bit.
After that transitional year the internship year you had somewhere along the way made a decision that neurology was for you want to get back to.
[14:30] A warmer climate and and it was back to California right
yeah you know as I listen to some of your other interviews and a lot of people say they go through medical school and
it’s really hard to decide because they love everything well for me it’s like the opposite because I really even before med school I kind of knew I wanted to do neuro and then going
through it like it was like yep don’t like that don’t like that so I went through all the other rotations kind of
saying gosh unfortunate that I know what I want to do and none of nothing else is kind of pulling me into a different direction which is nice and so yeah neuro just seemed like
Q is the best place for me and because I knew that
back then I mean this is going back now almost 20 years neuro was not even the required rotation in third year I
that’s changed so it was considered like an elective in your fourth year well how do you apply to neuro
when you haven’t done it yet right and it was an early match so I was fortunate enough to you know kind of create my own elective Enduro with one of them.
[15:40] The Grandfather’s of Neurology back then I don’t even know if he’s alive anymore dr. Barry arneson
and he made me fall in love with diagnosis right he always talked about like you’re a puzzle you know
maker you you’re Gathering all this information and you’re going to with all your critical thinking skills come up with an answer where you know many of your colleagues may not.
[16:08] Be able to even get ask the right questions like that was the whole point was like I’m going to teach you how to ask the right question so that by the time you exit the
the room you know 95% of time you already know what’s happening you shouldn’t need to order tests and you know do the stuff if you’ve taken a good history so that’s kind of how I was taught as you take the time to really get to know what the issues are with the patient
and 90% of the die 95% of the time you know the exam obviously is very helpful in neurology I think we’re probably the last people that touch patients because our exam really.
It gives us a lot of information to either rule in or rule out what’s on our
differential diagnosis but at the end of the day he was absolutely right even today I mean I spend the time with my patients and I kind of know what’s going on by the time they’re you know leaving the room like.
There’s very little that I have to order in order because I’m still stuck and I have no idea what this patient is dealing with but I’m still just a little bit puzzled.
And you bring up a very good point when I was in medical school back at about the time that the Earth cooled neurology rotation was not.
[17:26] Required rotation at all you know there was some exposure if you had
patients on the General Internal Medicine services that needed a neurological consult you were going to get sort of experience that from afar and.
[17:45] If you can
I’d be interested to know how you think you were able to tease out from all that that this is where you needed to go and if the answer is it was just
the luck of the draw I’ll take that but I really am curious about how people find their way into Specialties that they get no exposure to whatsoever
as a junior medical student so what do you think
so I actually grew up with a couple of ants with Parkinson’s so I had
some pretty early on exposure to at least what and I think that’s why I when I was in college I was I got fascinated by the brain as you know because I’m growing up I watched this disease manifests itself
physically you know and so I had that and then that year that I took off between college and
medical school I actually worked at UCSF in their research Department with multiple sclerosis patients so I got hands-on experience as a research assistant working with Ms patients and
again that kind of peek into what happens to the body when you know the brain.
[19:04] Has some issues yeah so so going in I kind of had already that and then when I was going through the other rotations it was more realizing you know like I thought if anything was going to
keep me you know or pull me away from neurology it may have been Psychiatry because that was also you know obviously.
[19:27] Brain emotions but I really loved the neurological diseases like I
you know the the neuro plasticity of the brain so some of my research was how do you rewire the brain right how do emotions affect you know our memories like.
That was some of my college research that I did and so.
For me that I don’t know if for whatever reason the rest of medicine kind of was necessary evil to get through but not necessarily something that I would be doing.
Well the rest of us are fortunate that there are people like you who have the courage and the tenacity to go into that territory because it is as you say profoundly important
it remains so mysterious to me throughout my 44 years in practice when the neurologist would come and.
[20:22] Tell me things that I that I would never have guessed so I must tell you that I’m awestruck by what the neurologist to at the bedside and otherwise but I want to move along and
find out what your post residency career has been like you find yourself you actually established
the practice that you have right now is that correct that’s right so I briefly worked for about four years and one of the big box kind of
Healthcare organizations right well there’s a lot of that unfortunately throughout
the country having a private practice these days is more rare and with the pandemic unfortunately we fell actually below 50%
for the first time so but for me you know I realized that
to be able to really give these patients the medical care that they really deserve that takes time there’s just no.
[21:31] There’s no way around it you cannot you know properly diagnose or treat someone and you know 10 minutes it’s just not it’s not sustainable inevitably things are going to get missed and so I felt like the only way to do this is to go out on my own so back in
the end of 2013 so I say this because now this whole direct specialty care direct.
[21:59] Primary care where you kind of get rid of all the third-party middlemen it’s really starting to pick up since the pandemic I think Physicians have
why isn’t out of little bit and are starting to take control back but
you know seven eight years ago when I went out on my own.
That wasn’t the case so so I literally had zero patience when I opened up my practice and slowly over time I one patient at a time
hi built it up to my practice is actually closed and I have a waiting list now so yeah good quality Care people will seek out.
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Forward slash live you know Diana you bring up a very interesting point and that is.
How many Physicians.
Nowadays without really giving it too much thought and I think it’s largely because they feel like they don’t have a choice but people graduate from medical school.
[24:14] And they have so much education debt that the notion of.
[24:22] Being a part of.
Private either starting a private practice or being in a private practice where they have to pay into the system before they can become a partner seems just unapproachable.
[24:37] When here is somebody over here that says look you don’t have to worry about anything except taking care of sick people.
[24:42] And we’ll send you a paycheck and life will be great and that sounds pretty good.
But I think that we’re beginning to see that people are wising up to that and they realize that if you work for anybody other than the patient.
[24:58] That you’re going to.
Come into some roadblocks to you does that ring a bell with you at all yeah I mean this is I think the fundamental problem practicing medicine and it’s not even.
You know practicing medicine these days we’re all practicing health care so so this is the fundamental problem is that there’s too many
entities in between the doctor and the patient and there’s really very little autonomy when the doctor is employed because suddenly they got to you know follow the rules of
their employers so you know is there.
Loyalty to the Hippocratic oath and the patient in front of them that they swore to prioritize or is it that they.
You know need a paycheck to pay bills and and like you said there’d at and it if there’s a conflict of interest there that
can absolutely arise and negatively impact patient care and I.
[26:03] I think a lot of people coming out of training appreciate that and I think that in itself is also
changed over the past decade I think that the demands on you know following protocols and algorithms are
increasing and the message for a lot of these employed Physicians are well if you’re not going to follow it then you know
we’ve got we’ve got other people standing in line ready to do it and guess what we can call them doctors now too because I know our government just legislating away the practice of Medicine
I mean that’s just a reality and you’ve had some amazing guests you know some of my inspiring.
Warrior you know Advocates on here I think kind of touching touching to some of these topics.
Yeah we have we’re always looking for people like that and I’m certainly glad that that you turned up
in that search because you know the the word burnout is on just about everybody’s lips and the healthcare world and I can’t help but think that this.
This enforced treatment of Physicians as employees that have to.
[27:30] Little by a certain set of rules regardless of how they feel about the patient might be
a causative factor in that would you agree with that or not absolutely I personally.
Don’t like the word burn out to be honest I think this yeah I’m kind of with you on that kind of been overworked but right now I don’t know what else to call it yeah I think burnout is gaslighting the victim.
Basically I’m burnt out because I couldn’t handle it you know that’s so I that’s very insightful where where is you do Physicians are probably the most resilient.
You know Bunch that you’ll find I mean.
Just going through the process of the pre-med you know curriculum and then med school and then residency and all the emotional roller coasters you know that go we are resilient human beings that’s not the issue the issue is when we’re faced with this
dissonance of I took a note this is what I know is right and yet here I am being told no I gotta do it
this way and.
I know that my actions doing it this way is going to harm somebody and so that’s where a lot of Physicians find themselves is how do we practice medicine
honoring the oath we took while keeping our jobs I mean that’s ultimately what.
[28:55] I think what’s leading to this quote burn out or what I’ll call is moral injury I spent most of my career.
Whining about the fact that it appeared to me.
That the majority of Physicians that I work with and around spend more time fighting with each other.
Then they did fighting disease and I don’t even want to try to get into a discussion about.
How that came about but it did and it seems to me that that disagreement among what should.
Amongst those that should be colleagues created a great opportunity of weakness so the stronger forces.
Could take over and they did if we had if Physicians had behaved more cohesively.
Over the last 50 years would it have been less likely for medicine to have been taken over by the corporate interest.
The headed today that’s a great question you know I obviously was not around to know how.
[30:10] You know the field has evolved 50 years ago but but I’ve had a front-row seat to the last 15 years
and I would say the biggest challenges for Physicians came in the last 10 years shortly after the ACA past and I think it’s one of those things where good intentions can have negative consequences and it’s unfortunate
that
even Physicians who who recognize a lot of the should I say it a lot of the.
[30:52] Negative consequences are often in positions where they just can’t speak up about them going back to the whole you know.
Conflict of interest I need to keep my paycheck kind of thing and so I would say
what I observed was when the EMR became a mandated.
[31:14] Entity which really you know was was billed as look at how amazingly we’re going to be able to communicate with one another and this is going to unite Physicians over better patient care
but I saw in reality it was the destruction of the physician note so now when I get records they’re completely uninterpreted mean it’s copy and paste of.
I don’t know 1010 notes and it’s so interesting because it could be different providers through different
Specialties and yet this it’s the same history you know because it’s all copy and paste it and really it became a billing machine so the hole.
Point of the EMR was checking boxes for optimization of billing and had nothing to do with actually improving.
You know patient care or you know communication between Physicians or actually it was a barrier because now
it’s even hard to like the phone numbers I used to have four doctor’s private offices those are no longer working because doctors don’t even have private offices we’re all in these big you know conglomerations.
It’s just the so I don’t know about the 40 years before I can say the biggest change was in the last 10 years and I do see the ACA as being you know the fuel for for that.
[32:37] I’m going to take an opportunity to tell you exactly how correct you are because I was there.
You know for a period of 44 years and what I saw was that there was considerable enthusiasm for electronic medical records.
In the beginning in the 80s and when the architecture of.
The EMR was being conducted by physicians for Physicians they were coming up with some really good products and I don’t know.
[33:11] Personalize the interview too much but I will tell you that I saw a system on my hospital was looking for an MRI saw system
there was built by a company that I won’t name but in any case high in some offices and colleagues went to sample it and I was just astounded
we were able to sit down and I was able to open this physician order entry system and I was able to use it.
[33:33] Without any instruction whatsoever and do
what I needed to do and subsequently made a contract with this company to buy their electronic medical record it took two years to get everybody in agreement but
finally happened in by the time it got to us the physician order entry system had become so.
Foreign and so complex and so obtuse that I was never able to use it and what I’m pointing to is exactly what you’re talking about.
The I think what happened with the Affordable Care Act is because it put a deadline on when it had to.
[34:11] To be online it took all the choices away from those of us who are being affected we couldn’t stand up and say hey this doesn’t work.
[34:19] We’re not going to use it we just had to do it.
So all I’m trying to do is emphasize exactly what you just said and that is they gave us.
[34:31] A system of record keep record-keeping handbilling that turned out to be not a Record Keeper at all it was just a cash register.
[34:39] That’s right that’s right sounds like we’re in agreement on that yeah yeah and and that’s why you know in this new practice I
want you know because it didn’t stop at the ACA then there was me
stand there was maps I mean there’s like regulation after regulation basically making a bureaucratic nightmare to practice medicine unless you’re employed and have a whole division you know doing that for you so in my current practice it’s easy.
There’s no there’s no insurance there’s no Medicare there’s there’s nothing there is me and my patient and we have a direct contract
and the way you know my practice works is
patients pay me a monthly fee and I take care of them so if I have to see them every week just to fine-tune their medicines until we get it right.
[35:28] Then it doesn’t matter because that’s the monthly fee and if I you know normally I see my patients either way every 6 weeks but my point is
that the getting back to get rid of all the third-party middlemen and getting back to this Direct Care model is how we take back medicine and I hope overall intention purposes your functioning as a single specialty hmm.
Well I don’t know about that will be an insurance and that I can’t yeah that’s my that’s exactly my point you don’t you don’t need insurance you don’t have to deal with insurance that that’s that’s.
Out of the way you’re paid by a monthly fee.
And and there’s no arguing about what test you can order and.
[36:17] Drugs you can order and all those kinds of things well so here’s here’s the thing is all the tests and all the meds and all that
those still need to be covered right so patients still use their insurance for all those things so it’s not like patients can not have insurance and.
Yeah we’re not in Shangri-La yet but very very faint but you’d be surprised a lot of uninsured patients
love this model because they know that
otherwise they good luck seeing you know a neurologist in a big ghetto collaboration with the facility fees so so it actually does.
Fill an unmet need for the uninsured the
the funny thing is is that I’m able to argue with insurance companies more because I have nothing to lose right they want to deny something I’m gonna peel it I even my office manager will get on the phone be like you plan on denying this hold on the doctors here she’s ready to do the peel so because
again.
There’s I’m not worried about anything they’re not going to cancel a contract for me they’re not going to raise my or decrease my reimbursement rates for next year I know these are all the things that even when doctors don’t want to admit.
[37:33] You know influence their decisions when they’re taking care of people it does you know I’ve talked to enough people where they’re like you know
I am not supposed to look and see if the patient has an HMO or a PPO but I know that I’ll get dinged if
what did this test for an HMO patient but not a PPO patient you don’t some hearing that.
[37:55] To me and like well then you’re not practicing Hippocratic Oath medicine you’re not putting the patient in front of you and what their needs are you know you’re so this is fundamentally the the.
Biggest problem I see right now and that were not providing individualized patient care
and especially in neurology how do you how do you practice if you’re not taking the individual patients needs especially in a disease like Parkinson’s which is what I manage right
the brain is connected to the body in a way that it’s wired one way here and
another patient it’s wired in a different way and there’s just no cookbook for what
you know comes into your office that’s going to be a plus b equals c and yet that’s what they’re trying to have people practice medicine
this way Diana this is really been fascinating.
You are the I’m not sure I was about to say you are the first person who is dealing with
hey self-pay model I’ve talked to a number of
family practitioners you know that do direct primary care but to see it in a specialty is very encouraging to me and it leads me to think that perhaps there really is a light out there at the end of this tunnel
and I’m fascinated with the way that you’ve brought it about and I’m really excited for what your.
[39:24] Future might be like and I’ve enjoyed talking to you today but what I want to do at this point is kind of get out of your way.
And give you an opportunity to speak on your own and I’m going to pause and dr. Diana Blum is going to offer her personal prescriptions for success.
Thanks Randy I wrote this as a letter to my pre-med self.
Reflecting on what I’ve learned over the last 20 plus years and.
Kind of some of my prescriptions for making this journey a little easier so here goes dear me
please take a deep breath before reading this letter from the year 2022.
The unfortunate reality is that practicing Hippocratic Oath medicine has become near obsolete since you apply to medical school in 1999
in fact defending the oath itself has become a tremendous Challenge and the resultant moral injury has caused a mass Exodus of physician colleagues from clinical practice
you will wonder why you gave up your 20s and early 30s to study and train as hard as you did only to accrue hundreds of thousands of dollars of debt and to learn that much of the public has very little appreciation much less value.
For your rigorous education training or experience.
[40:48] These days an online degree with barely any clinical prep gets you the title doctor and a government sanctions license to Kill.
The Humble mentality you were once taught in medical school first Do no harm because you don’t know what you still don’t know that’s long gone.
Confidence has replaced competence because in today’s Healthcare Purgatory all providers appear to be interchangeable.
[41:15] Critical thinking skills are now a liability for employers who prefer that patient care be delivered based on productivity optimization algorithms and that pesky oath Physicians took that just keeps getting in the way.
You will witness government-sanctioned corporatization of your one sacred profession destroy the doctor-patient relationship
by creating bureaucratic barrier after barrier
you will report examples of patient harm caused by the prioritization of profits over patient care only to realize those with power could care less about the human suffering.
And just when you didn’t think things could get any worse you will discover that in 2020
scientific method principles and informed consent are no longer respected
instead the lived experience Mantra and end justify the means attitude makes open and honest debate impossible
Physicians self-censoring has become the norm if you want to keep your paycheck and increasingly your medical license
I don’t mean to be a downer but the house of medicine is sadly divided at this critical moment in history why ideological political agendas ensure that the crony status quo remains and physician dissidents are silenced.
[42:34] On a more personal note you will lose close friends too long battles with cancer and empathy for their inhumane Journeys through the medical industrial complex will motivate you to speak up
and demand meaningful change
you will proudly join a Grassroots movement that calls for transparency and accountability for the conflict of interest which have captured and destroyed our ones trusted institutions
you will be fortunate to meet other inspiring Hippocratic Oath Advocates and many of these fellow Mama Bear Warriors will become some of your closest friends.
[43:10] The Learned helplessness you once felt being a cog and a broken system will be replaced by empowerment growing your own direct Specialty Care.
Actis the appreciation regularly expressed by your patience for the individualized care you provide will fill up your bucket with joy and strengthen your resolve to.
Back the house of medicine one day you may even be invited to share your story in the wisdom you discovered while pursuing this calling.
May the following words of advice help you navigate the inevitable challenges you will face embarking on this arduous but extremely rewarding Adventure.
Number one have a daily self compassion and gratitude practice this will make the darkest days feel a bit brighter know your worth.
Be kind don’t let your kindness and compassion be mistaken for weakness breathe.
No really pause and focus on your breathing at least a few times a day for a minute your nervous system will thank you recognize that.
You may not cure many diseases but you can Comfort all patients.
Default to assuming good-faith intent but understand how conflict of interests Drive decisions and behaviors this is especially important when evaluating the business side of Medicine.
[44:31] Allow yourself to be vulnerable understanding we are all a work in progress and that is a necessary step towards growth.
Admit when you are wrong.
Admit when you don’t know something you can’t build trust any other way and this is critical for healthy relationships especially ones between doctor and patient.
And lastly learn how to genuinely forgive forgiveness is a healthful life lesson for Physicians to teach and model for their patients.
[45:01] He’s as much suffering and this has a healing effect on the body imagine our society if more people were able to forgive.
That’s it dr. Diana Blom I don’t know what to say that was so powerful and I am so grateful that you took the time to join us today and share those thoughts.
I just don’t know what to say other than.
Thank you thank you before we go I want to give you an opportunity to let our audience know where you can be contacted and any other
information that you’d like to share so mainly on LinkedIn I when the pandemic hit I basically decided to give my.
Privacy I guess and for the first time you know being here in Silicon Valley I was very much anti social media is so so I resisted but with the pandemic I felt like you know there’s there’s a message I could
get no help and so that’s where you can find me just Diana Blum neurologist on LinkedIn.
This has been a lot of fun dr. Diana Bloom thank you so much for being with us thank you.
[46:17] Thank you so much for joining us today remember we really appreciate a review from you and a five-star rating helps us a lot.
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[46:55] Thanks also to Ryan Jones who created and performs our theme music and remember.
Be sure to fill your prescription for success with my next episode.
[47:06] Music.
Physicians self-censoring has become the norm if you want to keep your paycheck and increasingly your medical license.
[0:16] Music.
[0:21] Paging dr. cook paging dr. cook dr. cook you’re wanted in the o.r. dr. Koh.
[0:29] Music.
[0:52] 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.
And don’t forget you can earn CME credit just by listening today so check the show notes for more information about cmf.
[1:31] My guest today is a very successful neurologist in Menlo Park California she’s got some great ideas on how Physicians can get back to taking care of patients
instead of jumping through hoops for insurance companies so let’s hear my conversation.
With dr. Diana Blum.
[1:54] It’s my pleasure it’s my pleasure today to be speaking with dr. Diana Blum who is coming to us from.
Tom Miller Park California I think is that right Diana actually I just moved to Palo Alto or did you really yeah okay well now I’ve got you in the right place but what about what a pleasure it is to have you here I’m really looking forward to hearing your story.
[2:17] Thank you thank you for the opportunity well Diana as we always do we’re going to begin with your.
Beginnings I’m always interested in how people became interested in medicine and decided to make.
The decision to make it a career how did that work for you did that happen early in your childhood or how did that come about.
Actually I was a little bit dissuaded to go into medicine both of my
parents used to be Physicians back in the former Soviet Union yeah they they gave all of that up to come to the u.s. and
well for freedom but unfortunately at the time they could not
you know basically starting the whole process over you have to do residency after passing boards again and they didn’t even speak English so really that’s fascinating
yeah they ended up
being nurses so they worked actually my mom retired after being a nurse for over 25 years at UCSF and my dad he started off being a nurse but.
I think it was it was difficult for him after being You Know Chief of Staff of his lost fiddle so I could they could get credentialed
as nurses in California but.
[3:38] But not Physicians or did they have to do any additional education before he even before they became nurses how did that work so they had to pass a test but you know.
First physician the nursing test was pretty easy to pass at least for them so they they.
They passed both tests and then they just started working the problem with if they wanted to pursue medicine as they have to redo the residency and at the time the priority was
putting food on the table so there it was just not an option and their English was so poor that.
It just would not be feasible at the time.
So they yeah they worked and I it was nice because I got kind of that perspective both.
From the nursing perspective and then also from the doctor’s perspective because they would tell me stories about how you know
medicine should be and what it what their experience and seeing things so so I was kind of discouraged away from it
yeah and when I started college I was not pre-med I actually was a psychology and Russian literature made yeah I noticed that so at that point medical school wasn’t really.
[4:55] No on the radar not really until I really started learning a lot of my psychology classes was were cognitive Neuroscience classes and when I started learning about kind of
the brain and
the brain’s connection to the body and you know how diseases and then I started learning about some diseases like Alzheimer’s and Parkinson’s and that was kind of what triggered my interest in
in going into medical school because I realized to be able to
treat the patients with those diseases I have to go to med school for that so that’s kind of a roundabout way of how I got there and luckily with the batch the BS in Psychology I did do some of the basic science work
but certainly not.
[5:47] You know enough and so I actually ended up taking a year off between college and medical school to you know apply finish of do all the things I didn’t have a chance to do one really interesting story.
We’re your parents pretty excited when you made that decision probably yes and no I think I think.
The field of medicine and taking care of its kind of ingrained and probably my DNA going back and and part of it is probably related to you know my Jew I’m Jewish so you know there’s
there’s certain Jewish values where you know you
is the sanctity of life and you know the he who saves a life Saves the World entire so that that kind of.
Was always I think part of my growing up and valuing life and valuing you know caring for people and so they weren’t too surprised.
Part of it was a little bit of I think worry knowing what it.
Takes to become a doctor so that there are some of that but no once I made the decision they were supportive they were.
They weren’t going to stand in the way of that and it looks like as I look at your CV.
[7:04] You actually wound up going to two different medical schools is there a story there yes so I went so I was dating at that time he was just my boyfriend and I
when I was applying the medical scores you know he’s like well what’s your criteria and I said well you know I really don’t do
well in cold weather so he’s like what you definitely don’t want to apply to any schools in Chicago that’s where he went to college and so I didn’t I applied I avoided Chicago because you know he.
[7:35] Told me that it was really cold so we ended up I ended up in LA and of course at that point.
P move down with me to La and we got engaged and what does he do it gets into business school in Chicago oh my goodness so there was kind of a choice of
us being apart for a couple of years or me trying to transfer and and so that’s literally I had to apply to med school
for a second time so where’s the transfer process difficult it was literally applying to medical school a second time so like as I’m
doing my you know Gross Anatomy final exam I’m providing my secondary applications and flying out for interviews it was literally all over and that the time University of Chicago is the only school in Chicago that would even
entertain a second-year transfer and at that time there were no spots so they still encouraged me to apply saying you know you never know spot to open up but
what I did it like I was applying for no spots and obviously obviously it all worked out.
[8:43] And was it your internship your your transitional year did that happen in Chicago the will that was in Chicago yeah we decided my husband was finishing up his job and we decided to stay for for my intern year
and then we moved out to California and that was basically the four years of Chicago was.
It I could not handle another winter I love the city oh my goodness as described yeah so clearly your
your memories of Russia must have been
kind of fuzzy or were you even in Russia well that you know technically nowadays back then it was Soviet Union technically it was the Ukraine so and this is quite interesting well a little bit now right because because what’s happening and I grew up I never
I never spoke Ukrainian I always spoke Russian because actually at the Soviet Union
you spoke Russian of course and so growing up I kind of considered myself Russian it wasn’t until recently that.
[9:51] You know people started asking about
what is your identity of like you know back then we were all and then forgive me I hope I’m not but this is just the reality we were all considered dirty Jews right so did was the name so I never Associated myself with
being Ukrainian or Russian I was even my passport said Zhu you know it didn’t say yeah one or the other so um.
[10:17] Yeah that’s honestly why I wanted to study a little bit more because I grew up speaking the language but I really did not
appreciate much of the Nuance of that culture and it’s it’s definitely a complicated culture especially for any parents sure it is
yeah so what goes through your your mind as you.
[10:43] Sort of look at what’s going on there today if anything I mean you maybe you were so young you can’t grasp it but do you have any feelings.
[10:53] I mean obviously the bigger picture of a sovereign country being attacked by another
country that like that big picture and of course human suffering that goes along with all of that that hits home and on multiple levels
you know obviously seeing refugees knowing I was a refugee not in those circumstances but you know my my grandfather.
He just passed away in February he fled from Romania during you know the halt the WWII and and so you know that whole when he passed away in February part of me was like.
[11:33] Thank God that he wasn’t around to see this because it’s obviously triggering a lot of a lot of wounds so
so for that it’s more of Just For Humanity and the suffering that’s involved but not I can’t say I have a personal connection because I don’t have any family there right now yeah I’m standing when we left it was kind of
yeah saying goodbye more permanently to to a life we didn’t really feel like we belong to in any way.
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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[14:09] And now let’s get back to today’s interview alright well let’s move your professional development along a little bit.
After that transitional year the internship year you had somewhere along the way made a decision that neurology was for you want to get back to.
[14:30] A warmer climate and and it was back to California right
yeah you know as I listen to some of your other interviews and a lot of people say they go through medical school and
it’s really hard to decide because they love everything well for me it’s like the opposite because I really even before med school I kind of knew I wanted to do neuro and then going
through it like it was like yep don’t like that don’t like that so I went through all the other rotations kind of
saying gosh unfortunate that I know what I want to do and none of nothing else is kind of pulling me into a different direction which is nice and so yeah neuro just seemed like
Q is the best place for me and because I knew that
back then I mean this is going back now almost 20 years neuro was not even the required rotation in third year I
that’s changed so it was considered like an elective in your fourth year well how do you apply to neuro
when you haven’t done it yet right and it was an early match so I was fortunate enough to you know kind of create my own elective Enduro with one of them.
[15:40] The Grandfather’s of Neurology back then I don’t even know if he’s alive anymore dr. Barry arneson
and he made me fall in love with diagnosis right he always talked about like you’re a puzzle you know
maker you you’re Gathering all this information and you’re going to with all your critical thinking skills come up with an answer where you know many of your colleagues may not.
[16:08] Be able to even get ask the right questions like that was the whole point was like I’m going to teach you how to ask the right question so that by the time you exit the
the room you know 95% of time you already know what’s happening you shouldn’t need to order tests and you know do the stuff if you’ve taken a good history so that’s kind of how I was taught as you take the time to really get to know what the issues are with the patient
and 90% of the die 95% of the time you know the exam obviously is very helpful in neurology I think we’re probably the last people that touch patients because our exam really.
It gives us a lot of information to either rule in or rule out what’s on our
differential diagnosis but at the end of the day he was absolutely right even today I mean I spend the time with my patients and I kind of know what’s going on by the time they’re you know leaving the room like.
There’s very little that I have to order in order because I’m still stuck and I have no idea what this patient is dealing with but I’m still just a little bit puzzled.
And you bring up a very good point when I was in medical school back at about the time that the Earth cooled neurology rotation was not.
[17:26] Required rotation at all you know there was some exposure if you had
patients on the General Internal Medicine services that needed a neurological consult you were going to get sort of experience that from afar and.
[17:45] If you can
I’d be interested to know how you think you were able to tease out from all that that this is where you needed to go and if the answer is it was just
the luck of the draw I’ll take that but I really am curious about how people find their way into Specialties that they get no exposure to whatsoever
as a junior medical student so what do you think
so I actually grew up with a couple of ants with Parkinson’s so I had
some pretty early on exposure to at least what and I think that’s why I when I was in college I was I got fascinated by the brain as you know because I’m growing up I watched this disease manifests itself
physically you know and so I had that and then that year that I took off between college and
medical school I actually worked at UCSF in their research Department with multiple sclerosis patients so I got hands-on experience as a research assistant working with Ms patients and
again that kind of peek into what happens to the body when you know the brain.
[19:04] Has some issues yeah so so going in I kind of had already that and then when I was going through the other rotations it was more realizing you know like I thought if anything was going to
keep me you know or pull me away from neurology it may have been Psychiatry because that was also you know obviously.
[19:27] Brain emotions but I really loved the neurological diseases like I
you know the the neuro plasticity of the brain so some of my research was how do you rewire the brain right how do emotions affect you know our memories like.
That was some of my college research that I did and so.
For me that I don’t know if for whatever reason the rest of medicine kind of was necessary evil to get through but not necessarily something that I would be doing.
Well the rest of us are fortunate that there are people like you who have the courage and the tenacity to go into that territory because it is as you say profoundly important
it remains so mysterious to me throughout my 44 years in practice when the neurologist would come and.
[20:22] Tell me things that I that I would never have guessed so I must tell you that I’m awestruck by what the neurologist to at the bedside and otherwise but I want to move along and
find out what your post residency career has been like you find yourself you actually established
the practice that you have right now is that correct that’s right so I briefly worked for about four years and one of the big box kind of
Healthcare organizations right well there’s a lot of that unfortunately throughout
the country having a private practice these days is more rare and with the pandemic unfortunately we fell actually below 50%
for the first time so but for me you know I realized that
to be able to really give these patients the medical care that they really deserve that takes time there’s just no.
[21:31] There’s no way around it you cannot you know properly diagnose or treat someone and you know 10 minutes it’s just not it’s not sustainable inevitably things are going to get missed and so I felt like the only way to do this is to go out on my own so back in
the end of 2013 so I say this because now this whole direct specialty care direct.
[21:59] Primary care where you kind of get rid of all the third-party middlemen it’s really starting to pick up since the pandemic I think Physicians have
why isn’t out of little bit and are starting to take control back but
you know seven eight years ago when I went out on my own.
That wasn’t the case so so I literally had zero patience when I opened up my practice and slowly over time I one patient at a time
hi built it up to my practice is actually closed and I have a waiting list now so yeah good quality Care people will seek out.
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Forward slash live you know Diana you bring up a very interesting point and that is.
How many Physicians.
Nowadays without really giving it too much thought and I think it’s largely because they feel like they don’t have a choice but people graduate from medical school.
[24:14] And they have so much education debt that the notion of.
[24:22] Being a part of.
Private either starting a private practice or being in a private practice where they have to pay into the system before they can become a partner seems just unapproachable.
[24:37] When here is somebody over here that says look you don’t have to worry about anything except taking care of sick people.
[24:42] And we’ll send you a paycheck and life will be great and that sounds pretty good.
But I think that we’re beginning to see that people are wising up to that and they realize that if you work for anybody other than the patient.
[24:58] That you’re going to.
Come into some roadblocks to you does that ring a bell with you at all yeah I mean this is I think the fundamental problem practicing medicine and it’s not even.
You know practicing medicine these days we’re all practicing health care so so this is the fundamental problem is that there’s too many
entities in between the doctor and the patient and there’s really very little autonomy when the doctor is employed because suddenly they got to you know follow the rules of
their employers so you know is there.
Loyalty to the Hippocratic oath and the patient in front of them that they swore to prioritize or is it that they.
You know need a paycheck to pay bills and and like you said there’d at and it if there’s a conflict of interest there that
can absolutely arise and negatively impact patient care and I.
[26:03] I think a lot of people coming out of training appreciate that and I think that in itself is also
changed over the past decade I think that the demands on you know following protocols and algorithms are
increasing and the message for a lot of these employed Physicians are well if you’re not going to follow it then you know
we’ve got we’ve got other people standing in line ready to do it and guess what we can call them doctors now too because I know our government just legislating away the practice of Medicine
I mean that’s just a reality and you’ve had some amazing guests you know some of my inspiring.
Warrior you know Advocates on here I think kind of touching touching to some of these topics.
Yeah we have we’re always looking for people like that and I’m certainly glad that that you turned up
in that search because you know the the word burnout is on just about everybody’s lips and the healthcare world and I can’t help but think that this.
This enforced treatment of Physicians as employees that have to.
[27:30] Little by a certain set of rules regardless of how they feel about the patient might be
a causative factor in that would you agree with that or not absolutely I personally.
Don’t like the word burn out to be honest I think this yeah I’m kind of with you on that kind of been overworked but right now I don’t know what else to call it yeah I think burnout is gaslighting the victim.
Basically I’m burnt out because I couldn’t handle it you know that’s so I that’s very insightful where where is you do Physicians are probably the most resilient.
You know Bunch that you’ll find I mean.
Just going through the process of the pre-med you know curriculum and then med school and then residency and all the emotional roller coasters you know that go we are resilient human beings that’s not the issue the issue is when we’re faced with this
dissonance of I took a note this is what I know is right and yet here I am being told no I gotta do it
this way and.
I know that my actions doing it this way is going to harm somebody and so that’s where a lot of Physicians find themselves is how do we practice medicine
honoring the oath we took while keeping our jobs I mean that’s ultimately what.
[28:55] I think what’s leading to this quote burn out or what I’ll call is moral injury I spent most of my career.
Whining about the fact that it appeared to me.
That the majority of Physicians that I work with and around spend more time fighting with each other.
Then they did fighting disease and I don’t even want to try to get into a discussion about.
How that came about but it did and it seems to me that that disagreement among what should.
Amongst those that should be colleagues created a great opportunity of weakness so the stronger forces.
Could take over and they did if we had if Physicians had behaved more cohesively.
Over the last 50 years would it have been less likely for medicine to have been taken over by the corporate interest.
The headed today that’s a great question you know I obviously was not around to know how.
[30:10] You know the field has evolved 50 years ago but but I’ve had a front-row seat to the last 15 years
and I would say the biggest challenges for Physicians came in the last 10 years shortly after the ACA past and I think it’s one of those things where good intentions can have negative consequences and it’s unfortunate
that
even Physicians who who recognize a lot of the should I say it a lot of the.
[30:52] Negative consequences are often in positions where they just can’t speak up about them going back to the whole you know.
Conflict of interest I need to keep my paycheck kind of thing and so I would say
what I observed was when the EMR became a mandated.
[31:14] Entity which really you know was was billed as look at how amazingly we’re going to be able to communicate with one another and this is going to unite Physicians over better patient care
but I saw in reality it was the destruction of the physician note so now when I get records they’re completely uninterpreted mean it’s copy and paste of.
I don’t know 1010 notes and it’s so interesting because it could be different providers through different
Specialties and yet this it’s the same history you know because it’s all copy and paste it and really it became a billing machine so the hole.
Point of the EMR was checking boxes for optimization of billing and had nothing to do with actually improving.
You know patient care or you know communication between Physicians or actually it was a barrier because now
it’s even hard to like the phone numbers I used to have four doctor’s private offices those are no longer working because doctors don’t even have private offices we’re all in these big you know conglomerations.
It’s just the so I don’t know about the 40 years before I can say the biggest change was in the last 10 years and I do see the ACA as being you know the fuel for for that.
[32:37] I’m going to take an opportunity to tell you exactly how correct you are because I was there.
You know for a period of 44 years and what I saw was that there was considerable enthusiasm for electronic medical records.
In the beginning in the 80s and when the architecture of.
The EMR was being conducted by physicians for Physicians they were coming up with some really good products and I don’t know.
[33:11] Personalize the interview too much but I will tell you that I saw a system on my hospital was looking for an MRI saw system
there was built by a company that I won’t name but in any case high in some offices and colleagues went to sample it and I was just astounded
we were able to sit down and I was able to open this physician order entry system and I was able to use it.
[33:33] Without any instruction whatsoever and do
what I needed to do and subsequently made a contract with this company to buy their electronic medical record it took two years to get everybody in agreement but
finally happened in by the time it got to us the physician order entry system had become so.
Foreign and so complex and so obtuse that I was never able to use it and what I’m pointing to is exactly what you’re talking about.
The I think what happened with the Affordable Care Act is because it put a deadline on when it had to.
[34:11] To be online it took all the choices away from those of us who are being affected we couldn’t stand up and say hey this doesn’t work.
[34:19] We’re not going to use it we just had to do it.
So all I’m trying to do is emphasize exactly what you just said and that is they gave us.
[34:31] A system of record keep record-keeping handbilling that turned out to be not a Record Keeper at all it was just a cash register.
[34:39] That’s right that’s right sounds like we’re in agreement on that yeah yeah and and that’s why you know in this new practice I
want you know because it didn’t stop at the ACA then there was me
stand there was maps I mean there’s like regulation after regulation basically making a bureaucratic nightmare to practice medicine unless you’re employed and have a whole division you know doing that for you so in my current practice it’s easy.
There’s no there’s no insurance there’s no Medicare there’s there’s nothing there is me and my patient and we have a direct contract
and the way you know my practice works is
patients pay me a monthly fee and I take care of them so if I have to see them every week just to fine-tune their medicines until we get it right.
[35:28] Then it doesn’t matter because that’s the monthly fee and if I you know normally I see my patients either way every 6 weeks but my point is
that the getting back to get rid of all the third-party middlemen and getting back to this Direct Care model is how we take back medicine and I hope overall intention purposes your functioning as a single specialty hmm.
Well I don’t know about that will be an insurance and that I can’t yeah that’s my that’s exactly my point you don’t you don’t need insurance you don’t have to deal with insurance that that’s that’s.
Out of the way you’re paid by a monthly fee.
And and there’s no arguing about what test you can order and.
[36:17] Drugs you can order and all those kinds of things well so here’s here’s the thing is all the tests and all the meds and all that
those still need to be covered right so patients still use their insurance for all those things so it’s not like patients can not have insurance and.
Yeah we’re not in Shangri-La yet but very very faint but you’d be surprised a lot of uninsured patients
love this model because they know that
otherwise they good luck seeing you know a neurologist in a big ghetto collaboration with the facility fees so so it actually does.
Fill an unmet need for the uninsured the
the funny thing is is that I’m able to argue with insurance companies more because I have nothing to lose right they want to deny something I’m gonna peel it I even my office manager will get on the phone be like you plan on denying this hold on the doctors here she’s ready to do the peel so because
again.
There’s I’m not worried about anything they’re not going to cancel a contract for me they’re not going to raise my or decrease my reimbursement rates for next year I know these are all the things that even when doctors don’t want to admit.
[37:33] You know influence their decisions when they’re taking care of people it does you know I’ve talked to enough people where they’re like you know
I am not supposed to look and see if the patient has an HMO or a PPO but I know that I’ll get dinged if
what did this test for an HMO patient but not a PPO patient you don’t some hearing that.
[37:55] To me and like well then you’re not practicing Hippocratic Oath medicine you’re not putting the patient in front of you and what their needs are you know you’re so this is fundamentally the the.
Biggest problem I see right now and that were not providing individualized patient care
and especially in neurology how do you how do you practice if you’re not taking the individual patients needs especially in a disease like Parkinson’s which is what I manage right
the brain is connected to the body in a way that it’s wired one way here and
another patient it’s wired in a different way and there’s just no cookbook for what
you know comes into your office that’s going to be a plus b equals c and yet that’s what they’re trying to have people practice medicine
this way Diana this is really been fascinating.
You are the I’m not sure I was about to say you are the first person who is dealing with
hey self-pay model I’ve talked to a number of
family practitioners you know that do direct primary care but to see it in a specialty is very encouraging to me and it leads me to think that perhaps there really is a light out there at the end of this tunnel
and I’m fascinated with the way that you’ve brought it about and I’m really excited for what your.
[39:24] Future might be like and I’ve enjoyed talking to you today but what I want to do at this point is kind of get out of your way.
And give you an opportunity to speak on your own and I’m going to pause and dr. Diana Blum is going to offer her personal prescriptions for success.
Thanks Randy I wrote this as a letter to my pre-med self.
Reflecting on what I’ve learned over the last 20 plus years and.
Kind of some of my prescriptions for making this journey a little easier so here goes dear me
please take a deep breath before reading this letter from the year 2022.
The unfortunate reality is that practicing Hippocratic Oath medicine has become near obsolete since you apply to medical school in 1999
in fact defending the oath itself has become a tremendous Challenge and the resultant moral injury has caused a mass Exodus of physician colleagues from clinical practice
you will wonder why you gave up your 20s and early 30s to study and train as hard as you did only to accrue hundreds of thousands of dollars of debt and to learn that much of the public has very little appreciation much less value.
For your rigorous education training or experience.
[40:48] These days an online degree with barely any clinical prep gets you the title doctor and a government sanctions license to Kill.
The Humble mentality you were once taught in medical school first Do no harm because you don’t know what you still don’t know that’s long gone.
Confidence has replaced competence because in today’s Healthcare Purgatory all providers appear to be interchangeable.
[41:15] Critical thinking skills are now a liability for employers who prefer that patient care be delivered based on productivity optimization algorithms and that pesky oath Physicians took that just keeps getting in the way.
You will witness government-sanctioned corporatization of your one sacred profession destroy the doctor-patient relationship
by creating bureaucratic barrier after barrier
you will report examples of patient harm caused by the prioritization of profits over patient care only to realize those with power could care less about the human suffering.
And just when you didn’t think things could get any worse you will discover that in 2020
scientific method principles and informed consent are no longer respected
instead the lived experience Mantra and end justify the means attitude makes open and honest debate impossible
Physicians self-censoring has become the norm if you want to keep your paycheck and increasingly your medical license
I don’t mean to be a downer but the house of medicine is sadly divided at this critical moment in history why ideological political agendas ensure that the crony status quo remains and physician dissidents are silenced.
[42:34] On a more personal note you will lose close friends too long battles with cancer and empathy for their inhumane Journeys through the medical industrial complex will motivate you to speak up
and demand meaningful change
you will proudly join a Grassroots movement that calls for transparency and accountability for the conflict of interest which have captured and destroyed our ones trusted institutions
you will be fortunate to meet other inspiring Hippocratic Oath Advocates and many of these fellow Mama Bear Warriors will become some of your closest friends.
[43:10] The Learned helplessness you once felt being a cog and a broken system will be replaced by empowerment growing your own direct Specialty Care.
Actis the appreciation regularly expressed by your patience for the individualized care you provide will fill up your bucket with joy and strengthen your resolve to.
Back the house of medicine one day you may even be invited to share your story in the wisdom you discovered while pursuing this calling.
May the following words of advice help you navigate the inevitable challenges you will face embarking on this arduous but extremely rewarding Adventure.
Number one have a daily self compassion and gratitude practice this will make the darkest days feel a bit brighter know your worth.
Be kind don’t let your kindness and compassion be mistaken for weakness breathe.
No really pause and focus on your breathing at least a few times a day for a minute your nervous system will thank you recognize that.
You may not cure many diseases but you can Comfort all patients.
Default to assuming good-faith intent but understand how conflict of interests Drive decisions and behaviors this is especially important when evaluating the business side of Medicine.
[44:31] Allow yourself to be vulnerable understanding we are all a work in progress and that is a necessary step towards growth.
Admit when you are wrong.
Admit when you don’t know something you can’t build trust any other way and this is critical for healthy relationships especially ones between doctor and patient.
And lastly learn how to genuinely forgive forgiveness is a healthful life lesson for Physicians to teach and model for their patients.
[45:01] He’s as much suffering and this has a healing effect on the body imagine our society if more people were able to forgive.
That’s it dr. Diana Blom I don’t know what to say that was so powerful and I am so grateful that you took the time to join us today and share those thoughts.
I just don’t know what to say other than.
Thank you thank you before we go I want to give you an opportunity to let our audience know where you can be contacted and any other
information that you’d like to share so mainly on LinkedIn I when the pandemic hit I basically decided to give my.
Privacy I guess and for the first time you know being here in Silicon Valley I was very much anti social media is so so I resisted but with the pandemic I felt like you know there’s there’s a message I could
get no help and so that’s where you can find me just Diana Blum neurologist on LinkedIn.
This has been a lot of fun dr. Diana Bloom thank you so much for being with us thank you.
[46:17] Thank you so much for joining us today remember we really appreciate a review from you and a five-star rating helps us a lot.
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[46:55] Thanks also to Ryan Jones who created and performs our theme music and remember.
Be sure to fill your prescription for success with my next episode.
[47:06] Music.
