Dr. Alyssa Burgart on Ethical Challenges and Healthcare Inequities

Have you ever wondered how bioethics shapes healthcare decisions? Join us on the Jack Hopkins Show Podcast for a compelling conversation with Dr. Alyssa Burgart, a pioneer in clinical bioethics and pediatric anesthesia. We unpack the complex interplay between biomedical sciences and philosophy, guiding you through the thorny ethical dilemmas that healthcare professionals face daily. Dr. Burgart brings her vast experience to the table, shedding light on the critical need for standardized ethical guidelines and the nuanced ways bioethics must respect diverse cultural and moral viewpoints.

Our discussion goes beyond the corridors of the hospital to tackle pressing issues like healthcare regulation and access inequity. We uncover the often unseen emotional weight carried by medical professionals, struggling against insurance limitations and economic disparities that hinder their ability to deliver optimal care. From the bureaucratic maze of insurance restrictions to the stark contrast in healthcare access between rich and poor communities, we expose the systemic faults that affect the well-being of children and the long-term health consequences of inadequate care.

In the latter part of the episode, we shift focus to the deeply personal and emotionally charged challenges faced by anesthesiologists, particularly those specializing in pediatric care and organ transplants. Dr. Burgart offers invaluable insights into the ethical and emotional burdens of caring for critically ill children, stressing the importance of understanding each patient’s unique needs. We also explore broader societal issues—from gender-based violence prevention to the impact of corporate healthcare systems on worker well-being. This episode is a must-listen for anyone interested in the ethical, emotional, and systemic complexities of modern healthcare.

Transcript

Speaker 1: 0:01

Welcome to the Jack Hopkins Show Podcast, where stories about the power of focus and resilience are revealed by the people who live those stories and now the host of the Jack Hopkins Show Podcast, jack Hopkins.

Speaker 2: 0:18

Hello and welcome to the Jack Hopkins Show Podcast. I'm your host, jack Hopkins. Today, my guest is Dr Alyssa Burgart. Dr Alyssa Burgart is a distinguished figure in clinical bioethics with a career spanning over two decades dedicated to addressing ethical issues throughout the human lifespan. Recognized internationally, she has become synonymous with advocacy in children's and teens' rights, disability justice, reproductive justice and the ethical dimensions of vaccination. Her unique blend of medical expertise and ethical insight positions her as a leading authority available for speaking engagements, lectures and interviews. Dr Burgart also specializes in pediatric anesthesia and pediatric abdominal transplant anesthesia. She's been published well over 25 times in multiple medical journals. She's been featured in Forbes magazine, medpage Today, business Insider, wired and Medscape.

Speaker 2: 1:34

There is so much more background info available on Dr Burgard and you can find that at alissaburgardcom and I'll list that in the show notes so you can easily find that. The thing that stood out most to me about Dr Burgard is just how sweet of a human being she is. You know, when you are talking to somebody who teaches at Stanford, who has the credentials that she has and does the life-saving kind of work that she does almost every day of the week, it can be a little like ooh boy, this is, on a whole nother level right, but as soon as we started speaking it was as clear as could be. She's as down to earth, as kind, as sweet and yes, as smart as you would expect her to be, and just somebody that's enjoyable to talk to.

Speaker 2: 3:03

I think you are going to come away from this episode knowing so much more than you know now about bioethics and for some of you you may not know anything about bioethics right now. Things right now, you're in for a treat. It is my pleasure to introduce Dr Alyssa Burgard. Okay, I am excited beyond belief to have you on, and a lot of the excitement comes just from going to your website and reading about all of your accomplishments, all of the hats that you wear, all of the things that you do, your teaching, the committees you serve on. I think it's fair to say you are a very busy woman.

Speaker 2: 4:00

That's true, yes, a very busy woman, that's true, there are so many areas that you are knowledgeable about and can talk to me about, so I think what we'll do. I've got four or five different areas that are all unique, that we can talk about, but I'm just going to start with one of them and we can talk as little or as much about that as we need to, and if we don't get to all of the rest, we'll do it again sometime, but we'll give each one of them the credit it deserves. Bioethics for those who might not know what bioethics is and I'm assuming there will be quite a few people who maybe have heard the term but aren't certain what it's all about at its most basic level, what is bioethics?

Speaker 3: 5:06

is bioethics. Yeah, I love that question because that's exactly the question I had when I first heard the word bioethics when I was in junior college. I was thinking about where to go to college and somebody was saying, oh, there's this bioethics program and I was like, what is that? And it's this awesome combination of sort of biomedical sciences, science and philosophy sciences, science and philosophy and how do we think about what's right versus what's wrong and how do we deal with so many of the things that are in that space in between, where it depends.

Speaker 3: 5:35

And so the role that I have I spend a lot of time doing biomedical ethics, which is really in a hospital setting. I work with a lot of patients and families. I work with a ton of different kinds of people in hospitals and clinics where I work to really try to help them think through complicated issues that come up in our work and in our lives a lot of end-of-life decisions and other kinds of serious decisions about medical treatment and try to help people think about what does this decision mean in the setting of their own personal goals and values, their moral compass, what are the things that are coming up for them. That's just one branch of it. There's certainly lots of other things related to research and, you know, research related to animals and transplant ethics, and even so many of the things that are coming up in AI ethics that are specifically related to the biosciences. Those are all things that I would say fit within bioethics.

Speaker 2: 6:35

Am I correct in saying that part of bioethics, or at least a goal within the realm of bioethics, is to develop some standards in terms of what a right or wrong decision is? And I would assume, if something like that existed, it would be for the purpose of eliminating the situations that occur when you have, let's say, 50 different doctors working on similar issues but having 50 different opinions about what's right and wrong. Is that kind of on the money?

Speaker 3: 7:16

That's a great way to think about it, because you might have 50 different people who are really smart about a bunch of different things, who may have opinions that are fairly uninformed in terms of the philosophy of care or what are our different obligations, and certain folks may be more focused on duties to one party over duties to another party, and so really trying to make sure that when we create things that are policies or guidelines, that we're really trying to help bring people to the same table with the same set of information so they can think about problems and get those perspectives.

Speaker 2: 7:54

How do you work with a situation that involves a culture, an ethnicity, a group of people who have radically different beliefs than, say, we do? Knowing that, with this person at least, it's unlikely that they are ever going to see it as being right, just simply because it's so radically different than what their beliefs say is all right.

Speaker 3: 8:37

Yeah, and I'll take this first from the perspective of a patient. It's really common for me to hear from clinicians who say, hey, this family or this patient has some really unique beliefs related to their religion or their upbringing, or information they read on the internet. It all depends on who we're talking to, but when we're making a decision, it should be with a patient, and so oftentimes what clinicians are trying to do is say, can you help me understand who this person is and how they have reached these decisions? Because we want to make sure that they understand the decisions they're making. You know, we want people to be able to make, whether it's informed consent for a treatment or a procedure or an informed refusal. So if somebody is going to refuse a treatment, we want to make sure that they're making that with accurate information, as opposed to, let's say, you know there's a lot of misinformation and disinformation that folks have access to now, and so, you know, when I'm talking with families, I'm really trying to understand what matters to you, what matters to your family, how does your family think about this situation? What are the things that are important to you? What matters to your family? How does your family think about this situation. What are the things that are important to you when you're dealing with? You know the risk of suffering or the risk of harm. How do we think about those things together? And so I try to create, you know, bridges so that they can work better with their team and the team can better understand their goals and values.

Speaker 3: 10:03

You know, from the perspective of clinicians.

Speaker 3: 10:07

You know we've heard a lot in the media lately around things like conscientious objection.

Speaker 3: 10:11

You know there are certainly folks who are medical professionals who have very strong opinions and strong personal beliefs or religious beliefs that impact what kind of treatments they feel comfortable providing or not providing, and so that's another great place where kind of your policy question comes into play. We want people's strongly held beliefs, religious beliefs, et cetera, to be things that can be honored, and so, in general, those policies will ask people hey, can you tell us ahead of time, you know, if you're not willing to provide abortion care. We need to know that so that we can make sure that we staff our areas appropriately so that we can provide the care that our patients need, even though you yourself are not willing to do that, and so trying to make sure that we have systems in place so that patients are not harmed by these beliefs of certain healthcare professionals is really important, because we don't want a patient to not have access to treatment that is evidence-based treatment that we believe would be helpful to them, because the provider themselves has an objection to that.

Speaker 2: 11:18

And part of what you said near the end of that kind of answered to question that I had coming up, which is fair to say that there's a strong link between bioethics and patient safety.

Speaker 3: 11:36

Yeah, I actually tell I usually say that all bioethics is quality improvement work because it has to matter for you to need to think about it so hard improvement work, because it has to matter for you to think about it so hard, right?

Speaker 2: 11:51

So you're not just coming up with guidelines and rules for the sake of having something new to put in the policies. The end goal is to improve the quality for the patient or the safety profile for the patient.

Speaker 3: 12:02

I certainly think that should continue to be our driving factor. I'm not sure you know, and we'll see when this ends up airing, but yesterday I was listening to the oral arguments at the Supreme Court for the EMTALA case in Idaho and you know I really worry because EMTALA the Emergency Medical Treatment and Active Labor Act is a major protection that we really rely on in hospitals to say like, hey, even if a patient doesn't have insurance, the right thing to do is to take care of that patient, and we don't want hospitals to be able to turn people away, whether it's because of their lack of insurance or lack of money, or because they need a specific kind of medical treatment that some district attorney doesn't want us to provide. And so I really worry about the impact of laws like this impacting the ability of hospitals to say you know, we're going to do the right thing.

Speaker 2: 13:01

How much do you think the government should be involved in the decisions that doctors make, not just with what's really in the media a lot now with women's health care, but with anything?

Speaker 3: 13:21

Yeah, it's a challenging situation, because there are certainly lots of areas where we say, well, we don't want people love to say, oh, we don't want the government to get between, constantly in between us and our patients, and there are lots of things about the law that we that we need in order to support the aims of keeping patients safe. And the reality is that, like doctors are human beings, nurses are human beings, just like everybody else, and so a certain amount of regulation is really important. I wish that ethical guidelines and moral compasses were the only things that were needed to really help people understand what they need to do. The reality is, it's a very practical, you know, running a hospital, running a clinic. There's a lot of practical things involved there, and so you want to be able to have some role for governments acting in good faith to say, hey, we want to make sure that your facilities are kept clean and there will be, you know, consequences if you don't do those things. And hey, we're going to have regulations that are going to make sure that you don't turn away patients because of their race or because of their gender.

Speaker 3: 14:35

So I think it's a complex question and I do think it also gets to that dynamic tension of when you've got a lot of human beings who are taking care of a lot of human beings and in a society that has a lot of financial and other issues that impact care, how do we keep people safe? How do we have a robust health system? And I think a lot of times people don't really think about the fact that having a robust health care system is an important part of things like national security. Like you, want people to be healthy and well cared for in order to be able to be good citizens.

Speaker 2: 15:14

I point out to family members quite often or remind them when they're going to see their doctor, because I feel the need to do so, because I know by default where people go. If I don't remind them of this by default, a lot of people think whatever's best for me, whatever medication is out there, that's best for me, that's what they'll do me, that's what they'll do. And, as I sometimes remind people, there's a process in which your treatment, at least in part, will be decided on by what your insurance will pay for or not. So just because you've jumped on Google the night before you've gone and you've discovered these two medications that are relatively new but that have proven to be the most effective for your situation, that doesn't mean that that's what you'll be prescribed. Your doctor may very well want to prescribe those to you, but can't because the bottom line is they have to keep in mind. Will we be reimbursed? So is that part of bioethics as well?

Speaker 3: 16:34

Yeah, I mean almost anything that has to do with a patient and anything with medicine has some element of bioethics and I can probably turn anything into a bioethics question of bioethics, and I can probably turn anything into a bioethics question.

Speaker 3: 16:46

And this is a real source of moral distress for clinicians because you know if a cardiologist you know a heart doctor says well, I really want my patient to have access to this medication because I've looked at their you know their echocardiogram, I've looked at their EKG, I've done my physical exam, I've gotten these tests and I am confident that this is the best treatment that will give this person the best long-term outcome. But insurance won't pay for that medication, so I am actually required to put that patient on to maybe a less effective medication for some period of time. It's incredibly frustrating, and this is an area where many people who will argue, for example, against ideas like Medicare for All will say oh well, you're going to destroy American innovation. But the reality is that American innovation primarily benefits people who have an immense amount of money already. It's not necessarily going to benefit people who need it most. It's not necessarily going to benefit the people who need it most.

Speaker 2: 17:46

Yes, I was just going to mention I've had a couple of what I would consider extremely wealthy clients in the past. In my mind, if you own your own private jet, you're probably doing okay, and both of them, just through conversation, have told me they both rely on what I think the kind of standard name is concierge medicine, where essentially you can pick up the phone, call your doctor, who already understands insurance is not how you pay. You pay cash and therefore they can prescribe you as long as it's within the boundaries of what the law allows them to. Whatever you, if you want the best, no problem, that's what we prescribe. If you want the best, no problem, that's what we prescribe.

Speaker 2: 18:44

Now, while that's great for someone who has the money and can do that, I often think about the tragedy of the family who because, like 99% of the families in the nation, because they can't just whip out the checkbook and get what is needed, they watch a loved one or perhaps even a child die who perhaps could have been saved if money weren't an issue.

Speaker 3: 19:21

And even if it's not, you know, death is always a very and appropriately so a very dramatic outcome.

Speaker 3: 19:29

But the reality is there's decisions being made you know to your point about children. There's families avoiding getting regular medical care for children every day because they are trying to make the decision between do I make the car payment so I can get back and forth to work? Do I make the rent payment so I can get back and forth to work? Do I make the rent payment so that we have a place to live, or do I take my child to have whatever the visit is that they may need and the kind of care that they may need? And those are really the seeds of how, you know, those children are going to be at more risk potentially for long-term consequences of just not having access to regular care. And certainly children are not the only folks who are being impacted by that. We know lots of people who are adults who you know they don't go and seek health care because they know that it's expensive. Health care continues to be a major source of financial strain for families. We know that many families will go bankrupt with just one medical bill.

Speaker 2: 20:29

And I would assume that you've seen evidence of this that when children are not able to get routine checkups, immunizations, routine care, based on economic factors, my guess is that probably creates children who then, as adults, don't have the importance of regular checkups as part of their thinking and therefore, even if they do have good insurance, it didn't get established early on in their life that hey you know, every six months, every year, whatever you need to have this done, so make the appointment and just do it. Is that a factor that you see?

Speaker 3: 21:17

Yeah, for sure. And you know for myself, we did not have health insurance for a huge portion of my childhood and we did not go to the doctor during that time and we did not go to the dentist because we could not afford to go to the dentist right and even for myself it wasn't really until, uh, you know, and then you're a medical student and a resident.

Speaker 3: 21:34

You don't have any time off to go anywhere anyway, and you know I've had to train myself as an adult. Hey, you deserve care and you have the ability to access it, and I can't help but have guilt that everybody else doesn't have access to it.

Speaker 2: 21:50

Yeah, I know exactly what you're saying because I'm in a routine with mine, but only because my wife is the one who always makes the appointments for the family.

Speaker 3: 22:06

Women are often the health manager in their households.

Speaker 2: 22:08

That's definitely the case here. I have to question were I a single guy, you know, living at home by myself? Actually, I don't have to question. I know it is something that I would always be pushing over. You know I'll do that next month because something else becomes more important. It's stressful to make it to the appointment.

Speaker 3: 22:42

You know physicians and nurse practitioners and physician's assistants who are all just run ragged in these clinics trying to have these 15 minute appointments and all it takes is one person earlier in the day to come in with like chest pain and their entire day. Obviously, that patient needs urgent emergent care, sure, but it pushes everything back and you know there's so much anxiety around even going in and talking about these things. You know, as a physician, people tell me all sorts of things that they've never told anyone else in their entire life. Right.

Speaker 3: 23:12

It can be a really intense and vulnerable time. You know you're in that paper gown and you know it's a tough situation. Because I think we would also all like to be invincible. Yes, because I think we would also all like to be invincible. Yes, we would prefer that we did not need these things, that our bodies would just function no matter what.

Speaker 2: 23:31

And to that point I have found that thinking creeping into my life. I just turned 58. Happy birthday, thank you. And there are small things. But just like when you hit a certain age and then you start to see a few liver spots that's probably not a you start to have some chest pains to say, no, I mean, I'm not that old yet. I probably just pulled a muscle and that is dangerous.

Speaker 3: 24:39

So you know, and on top of that you know, there's this for folks who have been lucky enough to have excellent health and have not needed to have health care, or at least didn't know that they needed to have health care, but of course, for millions and millions and millions of people in America who have disabilities, you know, skipping going to the doctor means they might die you know, not getting access to those medications that they need to stay alive or access to those devices that they need to stay alive, and so these issues in the health care system that prevent people from getting just that regular care really can make those conditions really exacerbated and make them worse.

Speaker 2: 25:19

Could we see a significant difference in the number of lives saved in this nation just by implementing programs that allowed people to get that routine checkup care?

Speaker 3: 25:31

Absolutely. I mean the. You know I was in medical school when the all the debates were going on around the ACA and I remember feeling so very hopeful at that time, like I'll see medicine's going to be better. I'm going to go into a different generation where we don't have these same issues because everyone will have access to healthcare. And while the promise of the ACA I think was great, you know it was gutted in many ways that have just made it so it isn't as effective and and it is always interesting to hear people who are opposed to having health care for everybody in our society, who people kind of forget, like that is that is a branch of you know. This is why people talk about Medicare for all, because that is a system that works really well. Is it perfect? Absolutely not. It doesn't have issues, absolutely. But you know also things like the Children's Health Insurance Program.

Speaker 3: 26:41

You know millions of children rely on public aid in order to get just basic health care. I work at a tertiary care hospital. I do really intense, very, very specific types of procedures. I do transplant. The vast majority of people are never going to need care from me, but all those kids need to be able to see a pediatrics expert. They need to be able to see somebody who can make sure they have regular care, because this is how we set up to take good care of people.

Speaker 3: 27:08

And it's really challenging for, especially, there's certain resources that are available for people who become pregnant, but a lot of times you have a whole huge section of young men in particular, where they're too old to get the children's health care funding and they're too sorry. They're too old to get children's health care funding and they're too young to qualify for things like medicare and may make just enough money that they don't qualify for things like medicaid and, um, you know, those are folks that are being harmed as well. We we need people to have good access to care. This is we're of the few very, very wealthy societies we spend so much money on health care and we are not getting anywhere near the kind of benefit from it that we should.

Speaker 2: 27:52

Right, let's talk about something that you mentioned. You are a board-certified anesthesiologist and a lot of your work focuses on the very young and those who are receiving an organ transplant. What are the inherent difficulties and dangers present in that situation, as opposed to somebody that you are taking care of in the OR for all bladder?

Speaker 3: 28:29

Oh, you mean like an adult.

Speaker 2: 28:30

Right.

Speaker 3: 28:31

Yeah, well, so I'm a pediatric anesthesiologist.

Speaker 3: 28:34

I'm trained to take care of pretty much people of all ages, but I mostly spend my time now taking care of children and young adults.

Speaker 3: 28:42

Children are a little more fragile for the most part, and especially we take care of a lot of children with disabilities that can impact their anesthesia risk.

Speaker 3: 28:53

So part of what I do, you know, in my clinical job as an anesthesiologist is really, you know, read through patients' charts, talk with their parents, talk with the patients, depending on how old they are, and really get a sense of what are the things about this patient that may place them at some sort of an increased risk during anesthesia, and really doing everything I can to help them be as safe as possible. And that's something that I'm really proud of in my profession that we've done a lot of work to try to make anesthesia as safe as possible for patients, because we have really powerful medications that make it so that you can't take care of yourself, you're not going to be able to breathe on your own, necessarily, you're not necessarily going to be able to, you know, swallow. So we are really taking over all of those body functions and making sure a patient is safe is really the most important thing that I do every day.

Speaker 2: 29:43

And with children, I would assume when you are deciding on the amount of a given drug that you are going to administer, things like age and weight, for example, are a big part of that process. But have you found that in people who are critically ill or are dealing with some of the issues you're talking about, are there also differences in individual metabolism that impact that?

Speaker 3: 30:12

Yeah, that's a great question and we do for kids. Well, all of our medications, the vast majority of our medications are dosed by weight. So depending on what size a person is, we will adjust our medications and then we also do something called titrate to effect. So, depending on what size a person is, we will adjust our medications and then we also do something called titrate to effect. So some patients for example, a very small dose of a pain medication is going to be effective. Some patients have been exposed to these medications more often, or they have different metabolism and may need higher doses. So it's our job to kind of help figure that out while a patient's having surgery. And then, in terms of metabolism, you know critically ill patients they can also be more fragile, and so we have to really be thoughtful about trying to figure out what the right dose is and then modulating what we're doing for that.

Speaker 2: 31:02

That's interesting because, gosh, the whole concept of transplanting an organ in somebody who's healthy and strong is still a pretty dicey situation about, and you know where I'm going with this, I think. Do you find that it's an intuitive thing to find yourself more emotionally invested in the work that you're doing, or how do you deal with?

Speaker 3: 31:36

that it's such a great question. I'm really emotionally invested in being a good doctor and taking really great care of my patients, and I take care of kids, especially a lot of babies and toddlers who are having liver transplants. And, to your point, most people who need a liver transplant need it because they are going to die without a liver transplant and so they generally are not healthy when we are, when we are lucky enough to get access to an organ that's a good match for them. So part of how I kind of deal with the emotional aspect of it is that one it's not about me, it's about taking really excellent care of a child. And when I'm consenting a family for the anesthesia for a transplant, you know I have to tell them like I'm going to do all of these things to try to help keep your child as safe as possible. But this is an exceptionally risky surgery and there's a risk of death during the surgery and I have to tell every single family that and I see it as my role to be honest, to be calm and to be clear, and that those are the ways that I can make sure that I'm having that informed consent conversation, knowing that I have to tell families things that they really wish weren't true, that they wish I didn't need to say, and because we take care of patients who are so sick, you know, sometimes our patients do die, whether it's in the operating room or in the ICU afterwards, and it's devastating. It'll never be as devastating to me, of course, as it is to their families. But we're very wrapped up in this work and this is part of, you know, beyond me personally. But you know, during the pandemic we were already, I think, as healthcare workers, very, quite burned out and feeling somewhat afraid, and the pandemic made things a lot harder and I just think we still have not recovered from that. There's so much moral distress and moral injury that clinicians are still trying to figure out how to deal with.

Speaker 3: 33:54

In my ethics role, I do a lot of interventions to try to help support clinicians who are going through difficult experiences. Sometimes there's ethics-related issues, other times it's primarily around, you know, just a really terrible situation. And so, as healthcare providers like, trying to help support each other is a huge part of what we try to do, and I always joke with my trainees that when I'm telling them, like, listen to this thing, I'm about to tell you it's because I'm trying to prevent them from experiencing the pain that I've experienced from something that's happened in my career, and so it's a for me. The emotional stuff. I have to balance that with the academic, the clinical, and being able to know that I can do a great job with the education and the tools and the medications that I have is part of how I'm able to kind of go from day to day.

Speaker 2: 34:52

I was going to say do you, in those tragic situations where you lose a patient, do you find as part of the recovery process, as it were, whether that lasts hours or days or longer, is part of that reminding yourself that most of what you do is saving lives, that most of what you do is saving lives and that losing them is a part of it, but that on other days someone only lives because of you? Is that part of your thinking?

Speaker 3: 35:33

Yeah, you know it's always an immense amount of grief when a patient dies or even if there's just a bad outcome of any kind. I think we always want our patients to be safe, so it can be really disorienting and just like grief for anything else. It comes and goes and sometimes it's really intense and sometimes it gets better and sometimes it comes back and bites you in the ass when you least expect it.

Speaker 3: 35:55

Sure bites you in the ass when you least expect it, and I will say that when you have a bad outcome, it can be really difficult to remember the fact that you took care of a thousand other patients in the last however many months who are doing great. It can be really hard to remember that. And so, having I'm very fortunate to work with a group of folks who are incredibly supportive and they will help we try to help remind each other about you know, I think our patients are lucky to have us because we're so well trained and because we care so deeply.

Speaker 2: 36:28

Right, that's such a great way of looking at it. Heard a lot of the reports and seen the articles and the documentaries, in some cases about the number of nurses who, because of COVID, left the profession, but less spoken about is the number of doctors. Is this something that you have seen or are aware of as well? Doctors who say I don't, I can't.

Speaker 3: 36:59

Yeah, there's definitely a lot of physicians who either retired earlier than they intended to or who left the profession who kind of, you know, tried to reinvent themselves in a different way, and unfortunately, physicians have a high suicide rate.

Speaker 3: 37:19

There's about 400 physicians a year last I recall the numbers about 400 physicians a year die by self-harm, and people in my profession anesthesiology are kind of known as being more at risk, probably because we have access to medications that are very effective at having you not wake up. So, and I think, in addition to you know folks who've just left the profession, I think a lot more people are saying to themselves can I stay in this job and what does longevity in medicine look like, when I see that my role as a physician is to be complicit in so many aspects of healthcare that I have no control over but that absolutely are harming my patients? And this gets back to the things we've talked about before in terms of folks not having access to medications, folks not having access to health insurance, folks being really financially devastated by medical bills and the fact that it's hard for me to know how much something that I provide is going to be charged to a patient, because these things there's just not a lot of transparency.

Speaker 2: 38:36

Are there things we learned that, as tragic as it has been, that could only have been learned in a tragic setting like this, that we've been able to take that and make implementations so that healthcare in certain areas is better because of it?

Speaker 3: 39:05

Do you mean COVID?

Speaker 2: 39:07

Yes, yes, yes.

Speaker 3: 39:10

I think we are still trying to figure it out.

Speaker 2: 39:13

That's what I was wondering.

Speaker 3: 39:15

Yeah, I think especially when I think about the work that I do with clinicians around moral distress, around moral injury. Corporate health care this is not conducive Like paying people to take good care of themselves so that they can come back and care again, is not something that is built into the system. And there have been a lot of wellness and well-being programs that have been developed over the past number of years and a lot of those have a tendency to sort of be set dressing, you know, something really performative that looks nice. They can say, oh, it's so great we have this program, but we're going to need a lot more creativity and time.

Speaker 3: 40:06

You know there have been many times in my career where you experience a severe situation in an operating room, whether it's, you know someone dies or someone's going to die very soon, and you just go back to work.

Speaker 3: 40:20

You know you go drop off your dying patient, for example, and then you're expected to go take care of you know, a whole parade of other patients and you're still supposed to be your best. And we really do expect inhuman things from healthcare workers, who are all human beings. And I think this is part of where you see as well the real rise in unionization. Many nurses already had unions, but we've definitely seen a bolstering in that. We're seeing more physicians who are unionizing and other healthcare professionals, and part of this is, I think, because healthcare organizations have not taken a lot of those concerns seriously enough in order to mitigate those. And folks are saying well, I've tried doing it through the system, I've tried doing it through my employer and I can't seem to get anywhere. Maybe if we organize, we can do something different. And so I think we're seeing this real experimentation of using organized labor in the health care sector in ways that we haven't seen with as much vigor in the past.

Speaker 2: 41:27

That's good to know what could be done to expedite the process.

Speaker 3: 41:40

You mean in terms of moral distress?

Speaker 2: 41:42

Yes, in terms of addressing moral distress in a more urgent manner.

Speaker 3: 41:52

I really think we need more systems in place that really help people to work through these issues. You know, we've seen a rise in things like peer supporters, where you'll have folks in an organization who are trained to be basically good listeners, but the reality is I think we need a lot of trauma therapists. You know, and that's just one example but you can't, I will never say that what I do in healthcare is the same as going to war. It's not. It's a comparison that a lot of I've heard a lot of folks in healthcare use. I don't think knowing people in my life who've been to war and who've had those experiences. I just think it's distinct and it's different and there's no reason to say that they're the same and it's different and there's no reason to say that they're the same.

Speaker 3: 42:40

But there's a lot of PTSD involved in doing this kind of work.

Speaker 3: 42:46

You know, when you're taking care of somebody who is bleeding to death in front of you or is dying from an infection or you know, whatever it is that's happening, that deep human connection is so important and for many of us we have never been supported in a real robust, systematic way to say those experiences matter and recovering from those experiences is, in fact, part of the work of this job, and so until and again this gets to you can really tell what matters in a healthcare system when they decide what they're going to pay for.

Speaker 3: 43:19

And so so long as we continue to be in this corporate version of healthcare that we're in right now and we've got a lot of private equity issues until organizations are willing to say we are going to dedicate an immense amount of money to this, where it is literally part of your job is built in to make sure that you have the care that you need, that we make sure that our employees have great health insurance, for example. It's really awful when you work for a health organization and you'll talk to folks and the healthcare that they get through their healthcare organization sometimes doesn't even cover care at that organization's facilities.

Speaker 3: 43:56

It's sort of like where am I?

Speaker 2: 44:04

Right, and that's something I think probably escapes most patients in terms of the thought process, because there is this assumption that, boy, it'd be nice if I had the healthcare you had, but unfortunately I've got, and not even dreaming that their primary care physician may be experiencing some of the same struggles with their health care.

Speaker 3: 44:28

Yeah, and you know this is again where you know clinicians are trying to figure out how to take care of themselves as much as they're trying to help figure out how to take care of everybody else. And the amount of work you know, for example, primary care doctors are doing so much work after hours. You know they're doing these exceptionally long clinics where every single patient has a series of things that need to get done. They need a plan for every single patient and then they're spending hours and hours after work doing the documentation so that that person's you know bill makes it to insurance, so that the clinic can stay open, and so all of these things are really make things a lot more complicated. And it's really dramatic, when you know, when I talk, for example, with clinicians who are in countries that have robust public health care systems, where they're we, when we explain to them what it's like to practice here, they're like that makes no sense. Why do you guys do it? Why do you do it like that?

Speaker 2: 45:30

I'm like money, I would. I'm going to say I guess one thing that we would be looking at is when our system is set up in such a way where you have physicians in other countries saying why would you do that? Does that reduce the number of over time? Does that reduce the number of applicants to medical school?

Speaker 3: 46:19

number of applicants to nursing programs. Is there any information? Medical school and that means that it takes a very long time to be able to then be able to if you're lucky, to purchase a home and to be, able to save for your retirement.

Speaker 3: 46:38

I think folks oftentimes don't understand that most physicians in the United States, unless they come from an incredibly wealthy background, really are starting in a big financial hole when they begin their journey in their first real job. One of the things that we've seen recently is a number of medical schools saying, like we're going to offer free tuition. You know there will be no more tuition because they have somebody who makes a massive donation and makes that possible. But that's not necessarily going to drive more people into simply taking away that financial risk isn't necessarily going to drive people to specifically go into things like family practice and pediatrics and obstetrics and gynecology, because you're still going into a system that is very extractionary.

Speaker 3: 47:26

You know, if you're working for and or if you're trying to again make a living in this very extractionary system, it's very challenging for people who are in those kinds of jobs system. It's very challenging for people who are in those kinds of jobs and so I think being, for example, a family medicine doctor or being a general pediatrician, I think those are some of the hardest jobs that you can do being an internal medicine doctor, doing outpatient work because you have to know almost everything about everything, and you also have to know enough to know when somebody needs something more complicated. And you're working in this system that makes it so that your life is incredibly exhausting, and so how do we expect people to be able to do those kinds of things for you know, 30 years, day in and day out, it's exhausting. So I don't think that. I think there are many different things in the system that we'll have to course correct. If we are able to have access to healthcare for everybody, certainly there will be impacts in who decides to go into training, certainly.

Speaker 2: 48:27

Let's shift gears because, as you know, I think any of these issues we are talking about we could talk about for hours, literally, and I really want to give people a look at all of the different facets of you. Gender-based violence prevention, that you teach a course at Stanford on law politics and policy of campus sexual assault what can you tell me about the importance now, in 2024, of that class?

Speaker 3: 49:02

Well, first of all, I just I love teaching that class. I uh I've I co-taught it previously with professor Michelle Dauber, um, who started that course, and um, you know, sexual violence is just, it's part of being a woman in America and in many other parts of the world as well, certainly not just in America. There are so many things about being a woman in the world that are incredibly dangerous and they shouldn't be that way. They're not dangerous because I'm a woman. They're dangerous because there are people who perpetuate dangerous things against women in particular, and men as well. So sexual violence is something where it very much impacts women. Oftentimes, perpetrators are men, but certainly there are also many men who experience sexual violence, and so it's important to not exclude them. And then as well, in particular, if you look at the data on folks who are transgender and non-binary, often experience immense violence, not just sexual violence, but also just street-based violence.

Speaker 3: 50:01

Simply existing out in the world is dangerous, and when you talked earlier about you know, trauma and like, what kind of experiences are people having and how is that impacting the rest of their life? You know for many folks whether they're. If they experience, for example, a sexual assault, many women will ultimately lose their jobs, may not be able to work anymore, and so there's immense financial complications. In addition to you know, who is it that you're able to talk to A lot of times, folks. We know that most sexual assaults are not reported because people don't believe that they will be taken seriously. They may believe that police will not believe them, even though there's been a lot of work trying to change that in terms of police training and really a sense that you know, is it worth it to go through the additional trauma of trying to go through, whether it's the legal system or for students going through the school system, where they're going to relinquish a lot of control and have a lot of their private experiences and incredibly traumatic experiences on display?

Speaker 2: 51:08

How damaging is it to the goal of educating people about the need to come forward? How damaging is it when we see politicians, celebrities who are in the spotlight and so it becomes 24-7 news coverage and we see either just pure denial or trying to explain it away? How damaging is that, overall, to the progress that you seek to create?

Speaker 3: 51:47

Yeah, it's. You know, we live in a culture that's full of rape mythology. People want to believe that they will know a rapist when they see them, that it will be so obvious that we will be able to tell who the bad guys are. Like life is a Disney movie and in reality, we know that the vast majority of people are assaulted by someone that they know, assaulted by a family member, assaulted by someone who they thought was their friend, and so it is incredibly damaging when we perpetuate those myths.

Speaker 3: 52:24

It's damaging for people who don't know any better to then be led to believe that this is regular Folks. Also, there's a common rape myth is that it's unsafe to walk outside at night because that's the time that you're most likely to be assaulted by some stranger. And that does happen. It's not the most common kind of assault. Most assaults are by someone that the person knows and are in, you know, in a familiar location. And so when we perpetuate those kinds of myths, when we dismiss what's happened to survivors, we perpetuate harming future people. So for every perpetrator where you know, a survivor comes forward and says this person did this terrible thing to me that has changed my life forever, and they say I don't want that to ever happen again, which is, by the way, the reason that most women will come forward. They don't want this to happen to somebody else.

Speaker 3: 53:20

And there's a pervasive myth that women are liars, that women are making these things up because, you know, whatever, they thought it was bad sex or they didn't want to admit that they had sex with someone. But rape is not about sex. It's not about pleasure. Rape is about power, and when somebody has done that to you, you want folks who are able to be brave enough and to be courageous enough to take on that extra burden to then be dismissed and gaslit, whether it's in the media or by people in their own family Of course it's damaging Sure or by people in their own family of course it's damaging.

Speaker 2: 53:59

Sure, you brought up something there that I used to teach a course called the psychology of violence, and one of the first things I would talk about was the fact that most of us go through life with this image of what a bad guy looks like, and it's kind of. For a lot of people it kind of fits the 1940s Bluto on Popeye he's got the dark five o'clock shadow, big, burly, clearly mean-looking individual like you better get out of his way. And, as you pointed out, the truth is it's almost always somebody that we know. Often it's even a family member. So that inner, that internal image that we carry around, creates this false sense of security. We're like, okay, I'm screening for this, I'll be okay, I'm not going to go around somebody like this, which opens the door to anybody who doesn't fit that template. What are some of the suggestions you have for people to expand their awareness of who potential bad guys?

Speaker 3: 55:31

are. Yeah, you know the most evidence-based sexual assault prevention program is called EAAA. It's also called Flip the Script. It was developed by a sexual violence researcher named Charlene Sen, who's up at the University of Windsor in Canada, and you know it is a training that is designed for women and I know they're in the process of developing an adjusted training for folks who are trans and non-binary, because we don't maybe need some some tweaks to it. But that's an actual evidence based tool and it has. The training is really robust. This is a training that's developed for college campuses and I know Charlene's working on developing this as well for younger, like high school age, students, which will need to have some tweaks as well for age appropriateness and all of that.

Speaker 3: 56:26

But part of what this comes down to is teaching people these rape myths so that they can recognize them. You know that whole knowledge is power idea, that if you understand these rape myths, then you notice them when they're happening to you and you say, oh, that's actually not true. Helping people understand where it is that they do have increased risk. And part of this training is also basic self-defense making sure that you can protect yourself. Now what's really important about this training is. It's not victim blaming, which is something that I think a lot of times folks get confused about because they say oh well, if you're training women, then you're blaming women. The reality is I should be able to, you know, drink as much alcohol as I want. I'm not at risk of being sexually assaulted, unless there's a predator who's near me. It's the predator who's the problem, but unfortunately, we have yet to reach a state in this society where we can trust all the men. Right.

Speaker 3: 57:26

And that's just the reality of what it's like to walk through the world as a woman.

Speaker 3: 57:32

And for women who are in marginalized identities, they're going to have different risks or heightened risks that are really important and are even less likely to be believed, for example, than people who are white. And so, and to your point as well, I just wanted to make a comment. You know the whole idea that you're going to know a bad guy when you see them.

Speaker 3: 57:50

There's also a ton of racism that's built into that, and so if you think about the history, for example, of you know not only all the eugenics, movements and the Nazism and all those things in terms of you know phrenology, that we were going to measure people's faces and we were going to identify who the bad guys were, and really it was a way to categorize people who were ethnically considered other, or intellectually disabled people, physically disabled people, and saying, oh, those are bad people and you'll know a good person when they look a specific way.

Speaker 3: 58:21

So I also wanted to bring that out, because this whole concept of threat perception, and who is it that we look at and we think you might be a threat it's tough because you're raised your whole life, you know, and even the concept for many of these rape myths, you know, the whole concept that you can't go out alone at night. You know, somebody came up with that, like our parents and our grandparents and the people before that, because they were trying to keep us safe. But some of those are ways that it actually ends up reinforcing the very things that it's supposed to prevent.

Speaker 2: 58:53

Right, one of the statements that I often use and I said the knife thrust into you that severs your aorta, that comes from a good-looking college graduate with a stable job kills the same as it does coming from somebody who's been in prison most of their life. When we take the visual aspect out of it and all of the associations we've got to those visual aspects and ask ourselves the question ultimately, does that matter? If you are held down and penetrated by force, it doesn't matter whether it's your cousin that you've known and hung out with your whole life or whether it's a guy that just broke out of jail and came in and to the degree that we can have that understanding. Look, there are good-looking, handsome, beautiful, well-educated, intellectual any other description you want to use. People who do bad things.

Speaker 2: 1:00:19

Any other description you want to use people who do bad things. But there are also people who fit the description of a dirtbag you need to avoid, who are law-abiding citizens. So we really get into a dangerous thing when we start looking at those opposites and then those gradients in between and thinking that we are so good at being able to detect who's dangerous and who's not. The work you are doing and I'm sure this course focuses on so much more than that, but I'm sure that's a healthy part of it that you can't. You aren't as good of a bullshit detector as you think you might be.

Speaker 3: 1:01:07

Yeah, which is hard right we want to be able to believe that we are good judges of character. We want to believe that we have those skills, character. We want to believe that we have those skills. And you see that as well. For example, when someone has been found to have done something incredibly egregious, that oftentimes folks will rally around that person and go well, I know him and he's such a good guy and he wouldn't hurt a fly.

Speaker 3: 1:01:31

And it is very disconcerting, of course, if you're that person and you don't want to believe that this person that's your buddy did something terrible.

Speaker 3: 1:01:42

But the reality is that the risk of someone false reporting a sexual assault is actually far, far lower.

Speaker 3: 1:01:51

Folks oftentimes assume that that is the vast majority, but it's actually quite a minority. And the other thing that you made me think of, which is the other betrayal that happens, is actually after the assault, and so there are many folks who will say you know, it was bad enough that I was sexually assaulted when I was in college, but the thing that was actually worse is when I reported it to my school and I went through all the proper channels and it actually they gaslit me and they made it worse that that betrayal, especially when you know universities will say like, oh, your home, we want, this is your home, we want you to be, you know, part of this community. And then to really treat someone incredibly poorly and and say, oh well, we don't believe you and we're not going to do anything to protect you is actually something that many survivors say is actually the, the deeper wound, um, that the physical assaults, the, the harms of the institutional betrayal often outweigh the harms of the assault itself.

Speaker 2: 1:02:57

Yes, I agree with you wholeheartedly that if we did nothing else but change the perceptions of who I am, if I report of who I am, if I've been sexually molested, been raped, if we can shift the perceptions of what it means to be that person, what it means to report that crime and perceptions, while sometimes can be very stubborn, they are easier to change than to eliminate all the criminals in life. You know, in a perfect world we just do away with all of the rapists. It's not a perfect world and we can take that approach. But we know from past attempts we've not been real effective at either scaring people into the idea that you don't want to commit rape because you will go to prison. That hasn't seemed real effective.

Speaker 3: 1:04:14

Well, the reality is that even if you do report somebody for rapes that happened, even if there's a ton of evidence, they still might not go to prison Absolutely. And this is where I would love for us to be able to raise young boys into men who treat other people, other human beings, with dignity and respect. And I think we've got these big generational problems that are contributing to the fact that we have men who probably started off as very sweet little boys who've turned into serial perpetrators who assault people that they claim to care about.

Speaker 2: 1:05:00

And I would say to that that's the exception to just a moment ago I said you can't make rapists go away. Yet the approach that you're talking about you can, because you can prevent them from becoming that person in the first place, and that may be as easy to do as changing perceptions, and there would be the changing of perceptions involved in that approach.

Speaker 3: 1:05:32

Actually, Well, and this? Is part of where you know to your point about. Is it harmful when we hear in the media the repetition of rape myths or the reinforcement of those beliefs? And these, I believe, are the ways that they continue to harm generation after generation.

Speaker 2: 1:05:50

They continue to harm generation after generation, right? I so agree that it starts at home and it starts young, that in what's commonly referred to as locker room talk, as we saw when the Donald Trump tapes came out and it was written off as oh, that's just locker room talk. That locker room talk is the kind of thing that normalizes it.

Speaker 2: 1:06:20

When you have people in a locker room talking about women as an object or a possession or something almost subhuman, then there's this normalization that takes maybe some of these urges that you've had but thought that's probably not a good thing. But now, all of a sudden, you've reached an age where you are in an environment and other people your age are talking about some of those things and laughing and joking, and it forms this tighter bond with the guys that are there and they begin to have this feeling of well, I mean, surely it can't be that bad if we're all laughing about it. Is that kind of thing part of the process that starts early that you address, or do we have to go back way farther than that?

Speaker 3: 1:07:27

I mean yes and yes and yes. You know like. And the other issue related to you know both folks who are sexually, folks who are sexually assaulted, for example when they're in college, are likely to have been assaulted or nearly assaulted when they were children. And so you know, even when we talk about where do we start in the home. You know if you've got an uncle who's handsy, it can't be a secret. You got to tell everybody when they come over for that. You know that festival dinner Don't let uncle so-and-so. You know he's handsy, don't touch him and don't make it a secret conversation. Make it the expectation that that's not the kind of behavior that's tolerated. And you know this is also part of where you know how do we talk to our children about being safe and you know I've always talked to my kids about you know no one loves you as much as we do if anybody tries to get you to keep a secret from us.

Speaker 3: 1:08:30

A secret is different than a surprise Secrets. Secrets oftentimes are to cover up something bad. If it's a surprise, then there's a time when you're going to tell me, and it's usually soon. That's different from a secret where someone says, oh, don't tell your parents because something bad will happen to you. And you know that's something that we've talked about very consciously with our kids.

Speaker 3: 1:08:51

I grew up Catholic, very, very religious Catholic family and back when I was in Catholic school I remember my parents sitting me and my brothers down and telling us like you cannot be alone in a room with a priest and we were altar servers, like we were really deeply involved in our church, and that was before all the reporting came out of the Boston Globe really showing the vast conspiracy, but it was sort of this open secret in our community. We didn't stop going to church, we didn't stop participating in religious life, but we knew that we were in an area where we were not safe and I think about that all the time, that the whole concept of separating from an environment where we weren't safe didn't seem to be considered.

Speaker 2: 1:09:44

Yes, I'll tell you about an experience that I had. I was sexually abused as a young boy and I didn't tell anybody about it until I was probably in my 30s, right. And when I did, a couple of months later, it's Christmas Day, right. And one of the people that I did I don't think I revealed this it was an extended family member, okay, a much older extended family member.

Speaker 2: 1:10:31

I had revealed this to some close family members On Christmas Day one year, a couple of months later, I knew this other person was going to be there and there was something that emboldened me by sharing it. I had reached a point where you know what? Now I've got clear lines of demarcation and part of my rebellion, I guess you could call it. At that time I said you know what, fuck it, I'm not going to Christmas this year. I'm not pretending anymore as I have for all of the years leading up to that.

Speaker 2: 1:11:18

And probably the most hurtful thing was that the person I had shared this with, who was a very close family member, was upset with me that I wasn't going to go and how it was going to look. And you know you're going. I just told you something that I had kept a secret for, you know, close to 30 years. So I understand it doesn't take hearing too many stories like that for people to go. You know what. It's not worth it If my own family may I don't, I've never really looked at that as my own family having turned on me.

Speaker 2: 1:12:07

Look at that now as someone who was not really tuned in and was also probably in a bit of denial, because to acknowledge what I told them would really. Now I'm responsible for all of these other relationship problems that have happened. So there's that tendency to always feel like you're the one it's your fault, like you're the one it's your fault. So how do you and I know you have to go relatively soon how do we do a better job at raising children who don't have those fears? And how many of those fears are just built in?

Speaker 3: 1:13:15

Well, first of all, thank you for sharing your story. Oh, absolutely, and you know, shame can't live in the dark, and I think that's one of the biggest issues around. You know, sexual violence and other kinds of serious betrayals that happen is we are taught be ashamed. You're the one who's the problem when really it's that someone did something to you and, um, you know how do we raise kids so they don't need to be worried about those things. We have to hold our families to account. We have to hold our community leaders to account. We have to hold our leadership to account in whatever domain that happens right because if we continue to stay now, now listen, you were a child.

Speaker 3: 1:14:08

It wasn't your fault that any of that happened to you, of Of course, you know that now, of course, but there are kids all over the world right now who don't know, you know, and they think it's their fault that something happened. You know, was I a bad kid?

Speaker 2: 1:14:21

Right.

Speaker 3: 1:14:23

And those cycles of violence then continue. And so you know, really having these sort of public conversations is one step towards that. Helping people understand that you know this is an issue is incredibly valuable and incredibly important, because these issues are all connected. Our society is not like you know. It's all, it's all big old Venn diagram, right?

Speaker 2: 1:14:52

That's. I like that. I mean Venn diagram Right, I like that. I mean it really is. Yeah. Yeah, I think you're so right, and there's a big chunk of my childhood that if I had to describe it with one word, I would just say it was just shame. You know everything you do.

Speaker 2: 1:15:14

So as a result, of course, my self-esteem sucked, you know, as a teenager, and I've thought about this so many times, about what would I have needed to have heard that would have kind of bullied me psychologically and I think to have seen like a celebrity or somebody that's pretty well known and had a lot to lose by coming forth, somebody you admire, if somebody would have come out and said this is what happened.

Speaker 2: 1:15:53

I felt this shame.

Speaker 2: 1:15:55

Just if we can communicate with the young people in a way that builds the credibility of saying I know exactly what you are feeling, because I felt it because of that as well, but to hear them talking about it out in the open without having to point it out, it implies that you come out the other end or that you can come out the other end because it happened to them.

Speaker 2: 1:16:25

They felt this way, but now look, they're on national TV telling millions of people and I think that offers that shred of hope as saying, look, they're on national TV telling millions of people and I think that offers that shred of hope as saying, look, without some direction it might be like this for the rest of your life, but if you get some guidance, it doesn't have to be this way for the rest of your life. It doesn't have to be this way for the rest of your life. So, yeah, I think there's a lot that we can do in messaging and just in, like I said, just in people coming up. I've shared my story before with young people and boy. I know of some cases where it's I didn't transform their life, but the story.

Speaker 3: 1:17:21

They needed the story and they can only have those stories if we will share those stories and, you know, even for folks who thankfully have not had those experiences, even if they're not, you know, famous celebrities or whatever you know, really validating the experience. You know, if somebody shares with you something awful that's happened to them, I support them. Right, I'm so sorry that happened to you.

Speaker 2: 1:17:47

No, it's.

Speaker 2: 1:17:48

Rather than question their reality you rather than question their reality. You know it does shape the rest of your life for better or for worse. My way of dealing with that and, of course, as is usually the case, you're not aware that that's how you're dealing with it. You're just aware that you're living like this now, but not that it's connected to anything in the past. But when I was about 17, I started getting into a lot of fights and I was pretty strong, I had boxed some, I was a pretty good fighter, and so I would get these rushes, I called them. When I would win a fight, I would get this rush, and it took me about 20, 30 years of reflection to figure out what was going on there. And I know now exactly what was going on when I would win a fight, exactly what was going on when I would win a fight.

Speaker 2: 1:18:52

That was a sign that I had dominated, that I had total control of my environment, that this external force confronted me. It was all connected because in the previous situation I described, you feel like you have no control right, and so I had to go through this period of convincing myself. Now I actually have a hell of a lot of control, unfortunately, when you're going through the healing process unconsciously. You don't necessarily choose the best routes of healing and therapy, but that did play a big role for me in kind of creating this empowerment and say, okay, you know what that happened to that kid back then. But that kid was little, he was a skinny little runt, couldn't defend himself. Try and do that shit to me now, because we're going to have a different situation, you know. And I think that if people can, even if it starts out as a sense of rebellion, to channel that anger and channel it into a change in behavior and when you change your behavior your thinking has to catch up. You know, and if you behave, either intentionally or in my case it was just kind of accidentally, in a way that's inconsistent with somebody who's a victim, eventually I started to think differently and then that shame wasn't as big a part of the picture and eventually it faded away.

Speaker 2: 1:20:40

And I'll bet a million dollars you had no idea that this podcast would wind up where we have landed here. But you know what where we have landed here. But you know what I knew going into this and I hope that you will be agreeable I just had a feeling that you were someone I was going to want to have back on multiple times because there are so many layers to you and you can talk about each of them to a great extent. So, given that we long ago exceeded our hour, I'm going to wrap it up with this. I want you to just give me a short definition of and we will use this as a start of a future podcast down the road disability justice. What is disability justice?

Speaker 3: 1:21:42

So well, probably to start off talking about disability, justice is to talk about ableism, which is this idea that people who have typical bodies, that have bodies that do all the things that people want their bodies to be able to do are inherently better, for example, than other bodies, and so, for people who have disabilities, they face immense injustice in accessing the regular care that they need, in having access to jobs.

Speaker 3: 1:22:11

You know, the Americans with Disabilities Act was a huge, a huge boon towards protecting people with disabilities, for being able to have more equity in American society, but it's certainly not enough, and so that's something as a physician, medicine has a lot of ableism in it, and so which is kind of nonsensical, and I think that's an area where we really need to think more deeply about. Where are we assuming that some lives are better than others, that certain lives are better than others, that certain bodies are better than others, and how? What are the different ways that those are negatively impacting the way we take care of our patients, and this comes down to physical disabilities, intellectual disabilities, fat shaming. All of these issues really impact the safety of our patients.

Speaker 2: 1:23:04

So I'm guessing that if I were to get you to agree to come back sometime, that there's probably plenty that we could talk about on that topic alone, to occupy most of an episode.

Speaker 3: 1:23:18

We could and I would be happy to talk about things from a medical perspective, but I would also want to make sure that I connected you with some superstars in the disability justice space who are actually people who have disabilities, because, of course, they are the voices we should center.

Speaker 2: 1:23:34

Oh, yeah, yeah, that would be fantastic. Uh, and, and in fact I just remember today you've already provided me with some names of of some people in some areas that you thought would be outstanding guests on the podcast, and I'm going to try and make that happen because some fascinating areas, and so let's just, let's just assume then that you've said yes, I'll come back it would be my pleasure okay fantastic yes listen.

Speaker 2: 1:24:09

I always tell everybody thanks for making time to be on this podcast, but I really want to say in your situation, when I say I know you are busy, you are somebody who is busy in a way that most people probably don't even comprehend. I cannot. I used to teach a productivity class, including time management. I can't imagine managing your schedule.

Speaker 3: 1:24:43

I'm probably doing it wrong.

Speaker 2: 1:24:47

Well, given all the committees and the boards you serve on. There are people who would disagree with that, I'm sure, because they've asked you or appointed you. Listen, I want to end this by saying this While there are all kinds of things we've talked about today, I want to thank you for the lives that are saved with you in that OR. Thank you, and you know as well as anyone that there are people living, breathing, talking, loving and experiencing the world right now. Loving and experiencing the world right now, right now, because of a process that you were part of, and I don't want anything that we've talked, anything else that we've talked about, to diminish or take away from that that. You are literally a lifesaver, and this world is so fortunate to have people like you. Thank you.

Speaker 2: 1:25:58

You are most welcome. I will see you then on the next episode of the Jack Hopkins Show podcast Deal.

Speaker 3: 1:26:08

Deal. Thanks for having me.

Speaker 2: 1:26:09

Thank you, talk to you soon, all right, the deal. Thanks for having me. Thank you, talk to you soon. All right, I hope you thoroughly enjoyed this episode with dr elissa bergard. A difference every day in the lives of other human beings, and she's also saving lives of other human beings. Please go to her website, dr Alyssa Burgard actually scratch that, it's just AlyssaBurgardcom, alyssaburgardcom, and again I'll put that in the show notes also.

Speaker 2: 1:27:06

Reach out and let me know how you like this episode, particularly the fact that this had to do with medical related stuff and ethics, medical ethics stuff. Because and don't hold me to this, because I'm just kind of batting this idea around but in addition to my regular podcast episodes, I'm toying with the idea of having an additional podcast each week where I feature a physician, a doctor specializing in some particular area, where we can talk about everything from the finances of healthcare and insurance or particular diagnoses or a whole host of things cardiovascular, renal, neurological, you name it. I can reach out to these different, smart, intelligent and incredibly giving and helpful people, feature them in a podcast episode and we can all learn. You gained something from this episode with Dr Alyssa Burgart. Please let me know, and that might be something that I make happen.

Speaker 2: 1:28:42

Please check out jackhopkinsnowcom. That's my newsletter, where I focus on resilience and tenacity and grit and just becoming somebody who can deal with a lot more stress but do so more effectively and efficiently and thrive instead of survive. Thanks again for tuning in. I'll see you again on the next episode. This is Jack Hopkins saying thank you.