رونوشت کامل Emergency Break: A Doctor's Case for Rebuilding the System, Not Just Treating the Symptoms [Replay]

of you that you have to choose between. Are you going to address the blood pressure or the heart rate, or the pain, or the trouble breathing. There's also [00:03:00] distractions. Somebody's always asking you, Hey, there's somebody on the phone. Here's a consultant. The next patient's in the waiting room. Startups are not that dissimilar in some ways. Like they're very different, but you [00:03:10] do have to make a lot of decisions. Are you going to invest in marketing or mm-hmm a new product revolution? Who do you work with? You know, there's a lot of decisions and [00:03:20] so my discernment is finding signal in that noise and figuring out what is the one thing that is going to kill my patient first. And then I just say [00:03:30] locked in on that. And while there are downsides to that, that means that there are other things you can't do because you're focused on this one thing. My ability to figure out what is the [00:03:40] most pressing, proximate issue is sort of my skill, and then it gives me a level of calm, like, okay, here's the button we can never push. [00:03:50] Let's figure out is this that. Wow. You know, let's make sure that it is not this problem and then I can let the rest go. Doing that, you know, 30 times in a shift or every day when [00:04:00] you're building something new, just figuring out what's gonna kill my patient and make sure that we stand in the way of that. That's what I do. Well, **Speaker 5:** that's huge. That's not only a [00:04:10] superpower, it makes you a superhero, you know? Gosh, it really does. It's amazing. Amazing. Well, I will say I have a lot of **Speaker 6:** colleagues that up to emergency medicine doctors around the country, we've gone through a lot [00:04:20] who learn this and teach this, but I'm proud of my ability to do that. **Speaker 5:** So before the er, before you are running for Congress, which I cannot wait [00:04:30] to talk about. I wanna talk about how you grew up and where you grew up. Sure. You grew up on the south side of Chicago. Can we just rewind to that [00:04:40] early part of your life and Yeah. And what that was like. **Speaker 6:** Absolutely. I grew up the kid of middle class drivers on the south side of Chicago. I grew [00:04:50] up in a neighborhood called Hyde Park, which is a little bit of a. Diverse middle class enclave that is anchored by the Museum of Science and Industry and the University of [00:05:00] Chicago. It's just an incredible community of people who are working and walking and taking public transportation to jobs all over the city [00:05:10] who are curious and loving. I went to high school with. Bougie kids who were concerned about their polo gear and were headed [00:05:20] to Morehouse and Harvard and also Yeah. Kids who were trying to figure out where their next meals were coming from. It was a cacophony of life. Mm-hmm. I felt very fortunate [00:05:30] and I don't think I fully appreciated until I got much older. What a unique and interesting community it is because of how many people were in community from all different [00:05:40] walks of life. That sort of gave me an early perspective on the many ways to live and to live normally [00:05:50] from having neighbors who are very different from me on either side, to having neighbors who are very much alike, me in community all the time and recognizing, yeah, all as [00:06:00] kids are the same. We all are trying to figure out how to deal with our parents, how to be successful or figure out what our future's gonna look like in a way that honors us. And so yeah, I felt very [00:06:10] loved . I felt very fortunate. Yeah. It was risky at times. There was also danger on the south side. Mm-hmm. There was a component of my brain that was always being occupied by either avoiding [00:06:20] police or avoiding violence. Mm-hmm. Not because I was doing anything wrong, but because it was city and there's stuff around that you can't completely avoid even if you [00:06:30] try. **Speaker 5:** Okay. So your mother was a social worker in Chicago Public schools. Yep. Your father? Became a physician despite your grandparents never attending school. [00:06:40] Can you talk a little bit about just the influence from both of your parents and their careers growing up as well? **Speaker 6:** Yeah. My dad grew [00:06:50] up in Kansas City, Kansas, not Missouri. Okay. So the more rural side on the other side of the river. And neither one of his parents, as you mentioned, finished high school. **Speaker 8:** Yeah, **Speaker 6:** [00:07:00] but they were geniuses. It's not that they weren't intelligent, but there wasn't a return on an educational investment at that time in rural Kansas. So they worked and raised a [00:07:10] family and were industrious and built community. And then when the Civil Rights Act made college available, my father and all of his siblings went to school. **Speaker 5:** [00:07:20] It's amazing. **Speaker 6:** It's a reminder of how many generations we throw away because we, yeah. Don't give opportunities to people who could thrive. Right. Which doesn't mean college is for everybody, [00:07:30] certainly not. Mm-hmm. But we're not distributing it in a way that reflects the genius that exists across communities. Yep. My mom grew up in Detroit. My [00:07:40] grandfather, her father was in a black regimen in World War II and benefited from the GI Bill when he got back in order to go mm-hmm. To law school. He was [00:07:50] the only black person in his law school. Wow. He died when my mom was 13, so I never met her. And so my mom then stepped up to be sort of helping my grandmother, [00:08:00] who was a school teacher, rear her, three younger brothers, but on both sides, education was really valued. It was just really important. It was something that they [00:08:10] saw as not only a way to live, but as an opportunity to move forward. And they came here together to Chicago. And so I grew up in a household of

middle class [00:08:20] drivers. They come from the first generation that was beyond sort of the terror of lynching and were the first generation that had the opportunity to [00:08:30] fully participate in a multiracial democracy, and they raised us with the knowledge that this is new. Hasn't always been like [00:08:40] this for us. You're a part of something bigger and longer. You are a part of a struggle that has been going on for a very long time. Hard times will come. You can't trust that. It's [00:08:50] always gonna be this good. **Speaker 5:** Yeah. I love the stories in your book about your mother and how she insisted that during [00:09:00] school you would write all of your assignments, your essays, your profiles on amazing black Americans, like every single thing, like, oh, I have this assignment I've come home with. She's like. [00:09:10] You are gonna pick an amazing black person to write about. **Speaker 6:** So cool. She's an incredible human being, but was like, you're gonna learn the other stories because those are gonna be in your history books. But [00:09:20] if you have an opportunity to write a book report about somebody famous and you can freestyle it, look something up. I remember in seventh grade [00:09:30] we had to pick a hero or something like that, and she was like, look up Ralph Bunch. I was like, who? You know, look up Lorraine Hansbury. Look up these folks [00:09:40] who may not be in your history books. Mm-hmm. Write about that. 'cause not only will you learn about it, but now you make a contribution to the classroom that wasn't already gonna be there. Totally. She was thinking two [00:09:50] steps ahead and I was like, oh, why are you making this hard? **Speaker 5:** That's pretty incredible insight though, from your mother and how it shaped you and so. You [00:10:00] went to sort of, it sounded like a private elementary school. That's right. But then went back to public school for high school. What was that sort of back and forth and that change like [00:10:10] for you? **Speaker 6:** It was really revealing and gave me a lot of lessons on the breadth of society and the sorts of resources that are [00:10:20] available in private school. We're studying. Poetry and English is about reading many of the great books and sort of trying to understand the lessons from them, even when we're [00:10:30] young. Public school also gave me a great foundation in the sciences, in AP biology and in physics. Mm-hmm. Some of the lessons were outside of class, [00:10:40] however, like what does discipline look like? Where pranks in the public school were just boys being boys? If it was some of the wealthier kids. Throwing, you know, shaving [00:10:50] cream pies in the classroom or whatever the case may be. Yeah. But that got you in trouble in public school that got you suspended. Yeah. That went on your record. Mm-hmm. It was much more, mm-hmm. [00:11:00] Of a strict boundaries. And I think some of that was probably to protect us from a society that was gonna be unforgiving. And so like, get ready. [00:11:10] It also encouraged many of the wealthier kids in private school to recognize, it doesn't matter what I do, I can't really get in trouble. And so they learned early on they have a freer hand. Yeah. [00:11:20] And so getting close to looking at that difference as a kid. Mm-hmm. I'm not sure I fully appreciated it then, but I see how society can [00:11:30] track you in very different ways. **Speaker 5:** Yeah, I think that's such a fascinating point. I was a public school kid growing up outside of Boston, and now I live in [00:11:40] California with my family and here in Silicon Valley in particular. Right? It's like all these private schools. I was so uncomfortable with it because I was like, oh, what [00:11:50] is that gonna teach them? Is that really real life, right? Mm-hmm. All these things. Mm-hmm. But I think what you're getting at is so fascinating because it is. The definition of [00:12:00] where precedent starts, right? Like these invisible precedents, these lines are set up in our schools, in our systems from the [00:12:10] time we're five years old, right? Yeah. And I love that you not only experienced it in the way that you did, but you're able to put words around it. And in fact, I [00:12:20] think there's so many parts of your book. Where you've been able to explain really complicated systems in a way [00:12:30] that is so simple and so clear, and talk about a superpower. I think that's also one of your superpowers, is being able to kind of [00:12:40] show these invisible threads, these invisible precedents that hold us all in a system. **Speaker 6:** Yeah, I didn't fully appreciate some of [00:12:50] these things when they were going on. Yeah. And so I worked really hard to try to specify them as I went. Yeah. I tell a story about going to the field [00:13:00] museum. Twice. Yeah, once when I was with sort of the private school and once in a public school setting and how different the experience was, depending on who I was with. I [00:13:10] loved the field museum. They've got the dinosaur bones, they've got like this preserved seal camp, which is like an ancient fish. They've got dioramas of whales. It's incredible. I love [00:13:20] the future. Sounds amazing. **Speaker 5:** I wanna go. **Speaker 6:** I'm thinking about it now and I can't believe I haven't been in a long time. You know when you're with the private school, they're talking to you. Much more about [00:13:30] the depth of understanding around what was going on in these dioramas. In the lives of the butterflies that you see in all of their [00:13:40] evolutionary permutations. Kids are acting wild. 'cause kids are wild. Right. Everywhere. Kids are just kids. **Speaker 5:** Yeah. That **Speaker 6:** was sort of just glossed over, but in the public school setting, [00:13:50] they were like policing us. Like it was our discipline that was as important as what

was going on in these dioramas. Mm-hmm. And mm-hmm. I'm like, I'm the same kid. [00:14:00] Seeing it on both sides. **Speaker 7:** Mm-hmm. Is **Speaker 6:** revealing and it was revealing to me then, and it's the difference between joy riding and grand theft Auto. Same action. Yeah. [00:14:10] **Speaker 5:** What a gift too for your parents, you know? I don't know if it was intentional and they had that insight to give you those experiences, but certainly the breadth of your [00:14:20] experiences there has certainly shaped you. Oh, for sure. Which I think is amazing. Yeah. You then went on to Dartmouth and I'm curious about it. I was reading it in the book. [00:14:30] And you talk about ending up in sort of Norman Rockwell's painting, right. And in Hanover, New Hampshire. And I was like, is he talking about Dartmouth? I have to like Google it just to make [00:14:40] sure. And I've been there and it's beautiful and it's amazing. How did you decide that you wanted to go to Dartmouth? What was that process like as you were graduating high [00:14:50] school? **Speaker 6:** You know, you're 18, so you know what you know. Yeah, yeah. When I was 18, there was a very prominent alum who went from Kenwood, my high school to [00:15:00] Dartmouth. Okay. Who created a program to sort of expose some of the top students to that opportunity, an opportunity he had and led him to be quite [00:15:10] successful. And so it was a handful of us who gotta, you know, we're gonna take you up there and you're gonna see the other students and the classrooms. [00:15:20] It looks like how a college is supposed to look in some ways. Yeah. It's beautiful in your mind's eye, right? It's beautiful. The people I met up there were like sharp, [00:15:30] cool. They didn't lock their doors. They walked around at night, right? Yeah. There was great food options. It just kind of [00:15:40] felt a certain way. So I was thankful to have that opportunity. Mm-hmm. He was a Kenwood alum, just like me. He grew up in this environment, black man. Mm-hmm. Got up there, had this experience, and was [00:15:50] like, you can have this too. And then he was very successful. I was like, okay, yeah. This is how it can work. And keep in mind, in 1992 when I graduated, okay, I'm dating [00:16:00] myself, but bad when I graduated, that was the peak of murder in Chicago. We talk about like the 2010s when it was sort of rising. [00:16:10] Again, never reached back to where it was when I was a senior in high school where people were getting shot over having their, Jordan stepped on, getting their starter jackets stolen. It was [00:16:20] an ever present menace. One of my classmates in high school who I ran track with was killed when he was supposed to be in. Track practice [00:16:30] with us. He just had senioritis and was out being a senior, but some small altercation ended his life and so he went from [00:16:40] tangible to stories and memories in a flash. Mm-hmm. And that kind of thing

just sits with you? **Speaker 8:** Yeah. **Speaker 6:** While you're young enough to believe, ah, [00:16:50] this will never happen to me. You know, there's that teenage invincibility. Yeah. You also have experiences around you on a regular basis that. No, you could get touched. [00:17:00] Then on the other side of that, when we were riding in cars, we were careful to take our hats off so that the police wouldn't pull us over. Who knows what could happen in those interactions, and so there's a part of me that was [00:17:10] welcoming the opportunity to find a different experience, not have that 15% of my brain that is constantly occupied with how do I stay safe? **Speaker 5:** Right? [00:17:20] Just have some reprieve. Yeah. **Speaker 6:** What if I can use that part of my brain to do something else? Yeah. So I welcomed that opportunity. That's how I sort of ended up in the woods. **Speaker 5:** That's amazing. You ended up in the woods, you [00:17:30] spent four years there, and then you went back to University of Chicago. What drew you into medical school after that [00:17:40] experience? **Speaker 6:** I am the son of a doctor and a social worker. And I think there's a component of this where if [00:17:50] you go to school and you're labeled as a smart kid. You're supposed to do something with that lawyer. Mm-hmm. Engineer, doctor. I don't [00:18:00] think that we were generally encouraged to do something entrepreneurial that's risky, but you can use your education and end up somewhere good. And so, you know, I had this role model of [00:18:10] doctoring that seemed possible. Yeah. I grew up on the south side of Chicago, so I knew other doctors. My pediatrician was a black woman who went to [00:18:20] Howard Medical School. My orthodontist was a black man who went to the University of Illinois. Like there was precedent, there was a lot of middle class, upper middle class black folks around [00:18:30] me. I knew this was something that was possible. I did well enough in school and I got in. Mm-hmm. Yeah, I got in. **Speaker 5:** You're like, woo-hoo. I'm going. Yes, I got in. Of [00:18:40] course. It's amazing. **Speaker 6:** I got in, so that meant a lot. Okay, here's a journey, here's a pathway. And I didn't wanna do it exactly like my. Father, he has his [00:18:50] yearbooks. Keep in mind, he grew up in Kansas. **Speaker 8:** Yeah. **Speaker 6:** His generation was the first to finish high school, let alone go to college. Let alone go to medical school. He took a massive leap, right? [00:19:00] Massive. And he did alone. He didn't have coaching. Right. There weren't mentors around who were like, oh, I've got this uncle. He did it. Let me talk to him. Although he did have an uncle as a [00:19:10] role model. But when you look at his yearbooks. There were no black people in his classes at ku. Mm. He landed in the role he did trying to [00:19:20] provide stability for his family and for himself. Mm-hmm. Right? Mm-hmm. I benefited from that stability and here I had an opportunity to figure out how do I then go [00:19:30] back to this social justice agenda that I was taught at home. That you're a part of something bigger. Mm-hmm. You're a part of this lineage. How can medicine be a part of [00:19:40] that? Where you're serving your community, where you're using that understanding and a platform to create not only better health, but a better [00:19:50] understanding of how health is created or not created. And so when I got to medical school, I had a chance to do more than just create stability [00:20:00] for myself, for myself. And I also had the recognition that maybe there's no such thing as stability, **Speaker 7:** right? **Speaker 6:** I mentioned, I already lost a friend in high school. Yeah. I lost [00:20:10] another friend in college due to a car accident. **Speaker 7:** Mm-hmm. **Speaker 6:** And so I didn't really know how to grieve any of that. Mm-hmm. You know, you just, you know, we had collective grief. [00:20:20] I don't know that I truly believed at that time that like, the future's gonna be fine. It's just how do you want to do it? It was more, if you don't know how the future's gonna turn out, [00:20:30] what do you invest in? Yeah. Like what do you then care about? If it's not promised, isn't it worth doing something meaningful? And I had that experience relatively early on, and [00:20:40] that's kind of what led me to emergency medicine from the beginning. **Speaker 5:** Yeah, I mean, it seems like the emergency room, the emergency department you write in your book, you [00:20:50] really get all of these different fractures of society, like everyone shows up there. **Speaker 7:** Mm-hmm. **Speaker 5:** And it strikes me listening to you talk about your [00:21:00] path to studying emergency medicine. Just how many fractures and pieces of your life sort of equipped you to be [00:21:10] able to absorb sort of all of that chaos and all of that weight. at what point, I guess in your studies of medicine did you [00:21:20] realize. Okay, this is it. The ER is where I wanna be. You talk about social justice and injustice. Did you see the ER as a place where you [00:21:30] really felt like you could take a stand and make a difference? **Speaker 6:** Oh yeah, that's exactly why I chose it. I took time after my third year of medical school to get [00:21:40] a public health degree. Medical school teaches you like, how do you take care of an individual and public health school teaches you how to take care of a population. The [00:21:50] emergency department at that time, this is pre Affordable Care Act, was the only place in healthcare where you could provide services to everybody. **Speaker 7:** Mm-hmm. **Speaker 6:** Regardless of their ability to pay. [00:22:00] Yeah. Kids and adults, men and women. Wealthy and poor, everybody, right? That was the only place where there was no filter and [00:22:10] it spoke to me. Was this. Common

sense matters. Like there are not a lot of places in society even now where [00:22:20] you have interactions with people dissimilar from you across every domain. **Speaker 8:** It's pretty amazing. I mean, it used **Speaker 6:** to be riding on public transportation was sort of a common denominator. **Speaker 8:** Yeah. **Speaker 6:** Now wealthy [00:22:30] people don't do that. Wealthy people don't go sit on public transportation. It used to be like flying on planes, uhoh, here's a bunch of everybody. A lot of people don't travel. **Speaker 8:** [00:22:40] Yeah. **Speaker 6:** Everybody gets sick. Everybody gets in car accidents. Yeah. Everybody slips on ice and hurts their wrist. Everybody. It's the one place where you can [00:22:50] talk to everybody and so mm-hmm. It just really felt like, if I'm going to understand society, here is a window, but it also gave me the [00:23:00] kind of skills that are fundamentally useful no matter where you are. **Speaker 7:** Mm-hmm. **Speaker 6:** Right? Mm-hmm. Zombie apocalypse. I got skills [00:23:10] you would be on on an airplane. Yeah, I got skills. You're at a party. Yes. Somebody slipped. It's like a tangibly useful thing to have. And so [00:23:20] all that came together and was like, okay, got it. Let's go. Yep. **Speaker 5:** You would be my pick in a zombie apocalypse. I would call you up and I'd say Me and your buddies.[00:23:30] **Speaker 7:** Yeah. **Speaker 5:** Yeah. I mean, it is really incredible. So your book is called The Emergency. You make the ER sound both like a battlefield but also [00:23:40] a mirror. I mean, you talk a lot about how these inequities. Play out in brutal clarity. I found that it also reads like a love letter to your [00:23:50] patients. Mm-hmm. **Speaker 7:** Yeah. **Speaker 5:** And I just loved the format of the book where it alternates between, here's the day in the life and here's the letter and here's all the things [00:24:00] and all the reasons I didn't have time to say to you and why the system is so broken. I wanna know what compelled you to write this book [00:24:10] and. Convey these stories and write these letters to your patients. **Speaker 6:** I mean, if you get the hardcover, you'll notice that there are flowers in the cross [00:24:20] because mm-hmm. I wrote it as a love letter. I think it's a love story. I think that, mm-hmm. Being a physician, being a caregiver is one [00:24:30] of the most tangible expressions of love, of caring for one another, of seeing our humanity, of seeing in somebody else that, which is. You, [00:24:40] right? Yeah. And I wanted my book to capture that, and I wanted to capture that because I was just frustrated, right? I wrote the book during the middle of the pandemic. By that time, I'd [00:24:50] spent more than 15 years at the bedside taking care of people. Mm-hmm. And an equal amount of time working on academia or policy or [00:25:00] organizations trying to. Alleviate suffering or the traps

that keep us from alleviating suffering. And what I'd learned by that time was [00:25:10] that I was on the wrong side of this issue as often as I was on the right side, and I realized I was naive. Right. This is a big misunderstanding. Once we get in there with good [00:25:20] ideas, we'll just fix it. It'll be over in five years. **Speaker 8:** Yeah. **Speaker 6:** These are systems, right? Yeah. These are durable, entrenched systems [00:25:30] that are creating exactly what they're designed to create. Yeah. So they're bigger than one person. They're bigger than a leadership team. These are things that are generations long. [00:25:40] Mm-hmm. And what I wanted to do was at least two things. One vent, right? Mm-hmm. Look, here's what I've learned. This is not going to be one of those things you can fix with. [00:25:50] A startup with a big idea with a quarterly report. This is going to take long work. That's one. Yeah. Two. I want it to reveal the [00:26:00] stakes. Like this is our lives that we're talking about. Mm-hmm. And I wrote letters to patients. 'cause I wanted to let them know, we see you. Yeah. We see you. [00:26:10] Yeah. Like once you put that badge on, you're a part of the system. Even if you care. Even if you really, really give a damn. **Speaker 8:** Yeah. **Speaker 6:** Once you put that badge on. [00:26:20] You are part of them. **Speaker 5:** I love when you said in the book, the system is working as designed. **Speaker 6:** Yep. **Speaker 5:** It's really hard to break the design [00:26:30] of a generations, centuries old system. Right? **Speaker 6:** Yep. I also wanted my colleagues to see themselves and to see these issues. If I wrote this [00:26:40] book and my colleagues were like, that ain't really how it is, I failed. **Speaker 7:** Right? They **Speaker 6:** needed to say, yep, this is exactly how it is. And I needed my patients to see [00:26:50] themselves. I de-identified, but I wanted my patients to be like, okay, I see why this is happening. **Speaker 7:** Mm-hmm. **Speaker 6:** They're trying, we are [00:27:00] all trapped together. Yeah. And when it comes right down to it, the we is literally everybody. 'cause if you're not a patient, you will be. **Speaker 8:** Yeah. **Speaker 6:** And just because you're well [00:27:10] off, you might have a couple of back doors you can use, but if the system is designed to harm, you're likely to get harmed. **Speaker 8:** Yeah. **Speaker 6:** And we need to do better. And so that's why I [00:27:20] want it to really explicate like what is happening and why? What are the stakes? Mm-hmm. And how do we, the collective we like, there's no [00:27:30] distinction. We are all in this. How do we make a decision to get ourselves out of it? **Speaker 5:** What's a story from the book that still keeps you up at [00:27:40] night? **Speaker 6:** In one of the later chapters, I talk about being on shift and a guy comes in who can't breathe. Now in 2020,

most of the people who [00:27:50] can't breathe were COVID patients. Like I saw a lot of death and suffering that year. **Speaker 8:** Yeah, **Speaker 6:** this patient was diagnosed. [00:28:00] We had planned to send him to the intensive care unit, and so, you know, the waiting room is bulging. You know, at that time we expanded our space to [00:28:10] cover. All kinds of areas where people didn't usually take care of patients. Like the ambulance, parking lot, baby clothes, parking. The parking lots. We had people everywhere so that we could do the best [00:28:20] we can to serve as many people as we could. And so, yeah, once somebody was like, okay, they're gonna go to the ICU, we like start going elsewhere. **Speaker 8:** Yeah. **Speaker 6:** But he started to decline before he [00:28:30] got to the ICU. So I go and see him and he's now having more trouble breathing, and his vital signs start to get a little unstable. I call the unit and we start readdressing. Okay, let's get some more [00:28:40] resuscitation in here. Maybe you need some fluid, maybe we've missed a diagnosis. He continues to decline. The ICU comes down working their butts off too. They're busy spilling over into [00:28:50] other units, and then he codes and he dies in front of us and we do everything like we do chest compressions and give medications, and [00:29:00] we work on him until all of us are sweaty and tired and we can't save them. Yeah. First of all, when somebody is talking to you and then six hours [00:29:10] later they're gone. **Speaker 7:** Mm-hmm. **Speaker 6:** You carry that. Right? It's not abstract. This is a person. Yeah. You had conversations, you looked in the eye, you held [00:29:20] hands. Mm-hmm. You talked and now he's gone. Mm-hmm. And despite everything you did, you couldn't save him. And it wasn't just that you couldn't save him, the system [00:29:30] was keeping him from being safe. Like why wasn't he in the ICU already? Why is the ICU full, **Speaker 8:** right? Yeah. **Speaker 6:** Why is the emergency department full? **Speaker 8:** Yeah. **Speaker 6:** [00:29:40] And. There is this really familiar but helpless feeling of being trapped right alongside your patients. Unable to [00:29:50] get them what they need, and what they need is salvation. **Speaker 7:** Mm-hmm. Right? **Speaker 6:** They need mm-hmm. To be protected from the ominous [00:30:00] illness or injury that is beating down on them. Yeah, it's been happening for 20 plus years. I've been doing this a very long time, but it never sits right. [00:30:10] All of my colleagues have experienced it. Yeah. You have to remember during the pandemic, there was a rash of doctor suicides. Since the pandemic, a lot of doctors walked away. We [00:30:20] sort of memory hold that whole thing like mm-hmm. 1.2 million people died. In two years. Yeah. Most of those death happened locked behind the closed doors of our emergency [00:30:30] departments and ICUs. Yep. And nursing homes. And so, look, everybody suffered and most people lost somebody they knew. **Speaker 8:** Yeah. **Speaker 6:** But when you see it, yeah. And then you see it again. [00:30:40] Right. Yeah. That was a tough time. And so that story kind of sits with me in a, as a reminder of not only that moment. Yeah. But that there's so [00:30:50] many of those moments. **Speaker 5:** You do talk a lot in the book about how COVID really. Kind of fast tracked and became this pressure cooker and [00:31:00] really showed a lot of the cracks in the system and the inequities. Do you think that looking back on COVID now that the system [00:31:10] learned anything? Are we back to business as usual? I don't know. **Speaker 6:** I think it's worse. Yeah. Right. Yeah. I think that the misinformation that became [00:31:20] pervasive in society, yeah. At the advent of the vaccines means we're behind. Our public health system has been unwound. Vaccines are [00:31:30] now questioned. Even though the science is settled. We had leadership. That emerged then now in power telling us that Tylenol is not safe for [00:31:40] pregnant women and there's no evidence to support that. The American College of Obstetricians and Gynecologists are like, where is this coming from? We should be talking science and not [00:31:50] right. This other stuff. We also lost perspective on the stakes. Okay. I just mentioned 1.2 million people died. Mm-hmm. From COVID in two years. [00:32:00] HIV aids has been with us since 1981. Do you have any idea how many people have died of that? Americans? I'm just talking Americans, not globally. Globally, the toll for both [00:32:10] COVID and HIV aids is higher. How many Americans have died of hiv aids? 700,000 and some change. But think about all the changes we've made as a [00:32:20] result of that. You know the lessons of condom use? Yeah. The antiretroviral medications, the risk mitigation properties. Fewer people died than in two [00:32:30] years of COVID and already like not look at that. Let's stop testing. Let's get rid of these vaccines. The vaccines ought to be one of the best stories ever told. In less than a year, we [00:32:40] created a vaccine against a virus we've never seen. Right. We figured out how to get it into every community in the entire country in less than a year following a cold chain. [00:32:50] We saved millions of lives and now we're like, eh, that was fake. No, that was a triumph of American ingenuity. **Speaker 8:** Yeah, right, right. Of **Speaker 6:** our public [00:33:00] health system of vaccinations, and I think we're worse off. That's **Speaker 5:** such a good example, and I hadn't heard that comparison before, but you're right. And. How depressing we are. Worse off. [00:33:10] I can see that. And I agree with you. I wanna talk a little bit about sort of the way the American medical system is run right? And hospitals [00:33:20] are run, and I know very little about this, but I know that there

are contracts. I know that there are metrics. I know that there are incentives that are set right between [00:33:30] hospitals. And groups of physicians. **Speaker 7:** Yeah, **Speaker 5:** and I think a lot of times what I've heard is that when these contracts are set up and [00:33:40] these metrics are set that these physician groups have to meet, like in the emergency department. What ends up happening is you end up kind of treating the metric instead [00:33:50] of actually treating your patients and treating the problem. Right. And as someone was telling me this story about this emergency room department had a contract and the [00:34:00] SLA that they had to deliver was to like give antibiotics when needed within four hours, right? Yeah. **Speaker 7:** So **Speaker 5:** what they did is they basically. Any [00:34:10] patient that came in, they put like topical bacitracin on them and check the box and hit a 98% success metric to keep the contract. Right? [00:34:20] Yeah. And there are stories like this in business too. You work on what you can measure, what you measure. Is what moves. And so do you think, is that one piece of the [00:34:30] problem? I know there's a lot of problems here, right, with the system. Yeah. But that seems like one piece. What are some other pieces that you see that make the [00:34:40] system so broken for so many? **Speaker 6:** I mean, you can juke the stats, right? We see that across society. Yeah. We see that in quarterly corporate reporting where they're like, uh, totally. We'll figure out [00:34:50] how to make that number right. We see it in policing. That is overs stat heavy. The example you gave is incredible, terrifying and wrong. And I think a lot [00:35:00] of it stems from the question of what is the point, right? **Speaker 7:** Mm-hmm. **Speaker 6:** Why are we here? And I think that having the kind of leadership that helps us [00:35:10] remain centered on that helps because I've seen those same statistics being used to improve care, right? In the emergency department, we measure a lot of things and have to report a [00:35:20] lot of them wait times. For example, the number of people who leave before they're seen, the time it takes for somebody with a heart attack to have their artery opened. [00:35:30] The pace that we use, clot busting drugs for people with stroke, like these are things that they're not perfect, right? **Speaker 8:** Yeah. **Speaker 6:** Science will continue to [00:35:40] evolve. We'll make them better, but they're used to sort of say, here's our landmark for what we think quality is. The challenge then is how do you use that? Right? [00:35:50] Because once you take it to that next level where it's, okay, well are we able to do this with everybody? Right? Who are the populations that aren't [00:36:00] achieving those goals? Can we mm-hmm. Improve it with them? Is it the older people, the younger people who aren't getting it? The black people, the white people?

**Speaker 7:** Mm-hmm. **Speaker 6:** What about people who aren't insured? [00:36:10] Once you start really saying, if this is our bar, how do we get everybody there? As opposed to figuring out, well, how do we just maximize our profit around these [00:36:20] things? Or how do we juke the stats? These are managerial questions also. Mm-hmm. Mm-hmm. Like you reorganize an entire system that's been doing things one way to do something else. [00:36:30] That's not easy, but that's what's required. Yeah. And so I think the metrics can be used effectively if we have [00:36:40] this clarity about the moral purpose of our healthcare system is. Protect each other when we're vulnerable. **Speaker 5:** Yeah. I wanna touch on [00:36:50] this briefly, which is Tala, which is mm-hmm. This law that was signed in 1986 by the Reagan administration, and it [00:37:00] requires ERs to treat anyone who comes through the door, whether or not they can pay. And that sounds right. That sounds great. But you know, in the book you talk a [00:37:10] little bit about. Sort of the unintended consequences of that. Can you talk about what you think EMTALA got right [00:37:20] and what did it set in motion that we're still kind of grappling with today? **Speaker 6:** Okay. Let me try to do this briefly. The emergency medical treatment a lot. Active Labor [00:37:30] Act is designed to keep emergency departments from finding out somebody's insurance status and dumping uninsured people who might be an act of labor. Yeah. Into public [00:37:40] hospitals rather than caring for them where they are. Yeah. This then requires that you serve everybody regardless of their ability to pay and stabilize them to the extent capable.[00:37:50] **Speaker 7:** Mm-hmm. **Speaker 6:** It's an unfunded mandate to provide care for everybody. On the one hand, we ought to provide care for everybody. [00:38:00] This is obvious. Right? **Speaker 5:** Right. That seems right. Yeah. **Speaker 6:** On the other hand, we also ought to be paying for everybody, right? Yeah. I think the component that's missing is Mm, it [00:38:10] demands the next step, which is a universal payer, right? Yep. Yeah. Everybody who shows up ought to be able to be served. Yeah. And because institutions have to do that [00:38:20] because it's not only the law, but it's. The moral requirements. Somebody comes to you bleeding, you're like, eh, you can't pay. No. **Speaker 5:** You share in the book these horror stories. Right. Of [00:38:30] that as it used to happen. Seems unthinkable, but it did. Yeah, **Speaker 6:** it did. Yeah. So it means that hospitals then try to figure out if this is going to be a loss leader, how do [00:38:40] you balance out the house of medicine so that you maintain some profitability? And that means other hard choices as opposed to stepping back and saying, we need to think differently.[00:38:50] **Speaker 5:** That's incredibly helpful and it makes a lot of sense. I'm curious,

so. We met through our friend James, and I know you worked with James at a [00:39:00] studio called Redesign Health and **Speaker 7:** Yep. **Speaker 5:** I'm an investor in this company called mis Salud Health. Cool. In fact, the founder, Bismarck was on [00:39:10] the podcast last season and. Actually, I feel like I'm Juan, you two would really hit it off. I should introduce you. He's a very successful entrepreneur. Operator, has an incredible [00:39:20] story about coming to this country as an immigrant from Mexico. His parents picked fruit up and down the west coast, you know, until he was [00:39:30] seven. Nice. He ended up going to Stanford and starting all these companies, worked at Google, all the things. But what's really cool about Bismarck and where I see the parallel with you. Is he's now [00:39:40] created a company called Me Salute Health. Which then goes back and services these workers in the fields with telehealth, [00:39:50] telemedicine in their native language. It's free to them, right? Like he's really brought his whole experience full circle, right? And is now like on the ground [00:40:00] helping his community in the way that he really understands. And I see so many parallels to what you are doing as well, and particularly as we're gonna talk about next in your run for [00:40:10] Congress. From an entrepreneurial standpoint, in your work with Redesign Health as well, do you see creating new companies, entrepreneurship, [00:40:20] starting new systems from ground zero as a way to fix what's broken or how do you think about your involvement in these [00:40:30] entrepreneurial endeavors? **Speaker 6:** Yeah, look. It is not the solution, but it is part of the solution. Mm-hmm. In order to create a future that's never existed, we have to build new [00:40:40] things. Let's say that we wave a magic wand and tomorrow we have universal healthcare for everybody. We have an [00:40:50] entirely equal society where everybody has the resources they need to stay healthy in an equivalent fashion. Like we undo 400 years of injustice. Let's say we do all that tomorrow. [00:41:00] We'll still need to knit together our fragmented healthcare system. **Speaker 8:** Yeah, **Speaker 6:** we'll still need to translate languages in order to ensure we serve everybody. We'll [00:41:10] still need cures that don't exist. We'll need to figure out how to expand our services. Across geographies, how to extend the resources [00:41:20] of our existing services, how to train more doctors across technology, how to allow for teams to incorporate different services and [00:41:30] tools we'll need to incorporate families into the care process. All of that does not exist today. We'd have to build all of that. There's a role for startups to start doing [00:41:40] that now. We don't have to wait. Mm-hmm. We can do that. The company you're describing is doing that. Like many of the things we were building at redesign is starting to build the future. Now [00:41:50] it's just that can't be the end all. Like the role of public is required. The only way in which we can ensure that [00:42:00] everybody has a stake in everybody else's health is by doing that through public systems. That's the role of the state, right? Yeah. **Speaker 8:** Yeah. **Speaker 6:** And [00:42:10] so it's both, right? We need a state that is robust, that is reflecting of true democracy, and that we deploy in order to [00:42:20] serve everybody's humanity when we're most vulnerable. And we need to build new things to ensure that when we do that, we have the kind of care that actually serves and [00:42:30] creates a future that doesn't look like the past. **Speaker 5:** Well, I'm so excited that you are stepping in to the political arena because you've worked inside [00:42:40] the system as a physician, as a hospital exec, but you also were a White House fellow, right? Mm-hmm. Under the Obama administration. Yeah. And you saw how shaping [00:42:50] policy addressed some of these inequities. So let's talk a little bit about your step into the bid for Congress. What was your breaking [00:43:00] point when you said. I can't just treat patients anymore, like I need to do something that is upstream, that is gonna affect more people. **Speaker 6:** Yeah. [00:43:10] To be clear, taking care of people who are sick is deeply meaningful, right? Mm-hmm. It matters, but I can't stop people from coming into the emergency department shredded by [00:43:20] bullets. There's no medicine that keeps people from catching diabetes or hypertension, or puts them in the kinds of jobs that don't offer them insurance.[00:43:30] These are all upstream issues that, yeah, I kind of talked about, I had trouble with before, but I had faith that we were on the right path, we're working on it, we'll get there. [00:43:40] And then they passed this budget bill that strips 17 million people from health insurance in order to give wealthy folks tax deductions. And then we're [00:43:50] attacking science and my waiting room is terrible. Yeah. The challenge of serving people who are already on a razor's edge, [00:44:00] already struggling and injured, just trying to live, and now we're not taking steps to make it better. We're actively making it worse. I couldn't sleep. [00:44:10] **Speaker 8:** Yeah. **Speaker 6:** And it was then that I kind of remembered that I'm a part of this long struggle. And I think that in moments like this, you serve, right? This is [00:44:20] when I felt like, okay, I have the capacity to stand up. I've learned enough stuff, I've got enough gray hairs, I have enough tools to [00:44:30] understand how many of these systems work. And it's kind of one of these questions where you kind of don't get to choose the outcome. Like you don't get to choose how you die, you choose how you live. **Speaker 8:** Yeah, **Speaker 6:** and I [00:44:40] sort of have an opportunity to choose how I address this, and that's what

pushed me to public service. That's what I see this as. **Speaker 5:** And [00:44:50] you are running for Congress in the community that you have continued to serve. Is that right? Yeah. I mean, it's pretty amazing how it comes full [00:45:00] circle. How do you want voters to see you? Do you want them to see you as their doctor, as an activist, as a politician? What are your thoughts on that? **Speaker 6:** I wish I had earned the [00:45:10] monikers of activists or politicians. I'm a doctor, right? I have been by the bedside and cared for this community for 20 plus years. I've worked [00:45:20] upstream in healthcare and outside of healthcare for a very long time, and now what I see myself doing is entering public service. This is a very old notion where regular people [00:45:30] work in the public to try to create things, to try to improve things and go back, right? As a public servant, I intend to bring [00:45:40] all of the tools that I've experienced in the public sector, in the private sector, in the emergency department to try to solve meaningful problems for real people. And so that's [00:45:50] how I hope that my patients, my communities see this effort. **Speaker 5:** I have not run for office, but I have friends like you that have, [00:46:00] so I know that the whole money and machinery of politics is its own sort of broken system too. How are you navigating all [00:46:10] of that as a first time candidate? **Speaker 6:** It's a steep learning curve, right? Yeah. It is one of those sorts of stretch experiences that's always a little bit uncomfortable. You're [00:46:20] never like, mm-hmm. Oh, I know exactly how this works. And like all things that are difficult, having experience probably makes it easier no matter what it is. So I suspect that [00:46:30] others who are running for this seat and every seat in this area who have run for office before will have the reps and familiarity that I don't, but I have a passion for this. Right. I [00:46:40] feel called to it. Yeah. And so that makes it worth it, right? Particularly considering I'm not a savior here. Like there's no one person that's going to unravel all of what's [00:46:50] been built. I'm standing up to be counted as one of the people who is willing to fight for it, right? Mm-hmm. Because I can, I'm not the only doctor who's fed up and sleepless about [00:47:00] this. Or nurse or police officer, right? Or taxi driver, right? I'm not the only one, but I'm one who can stand up, right? I have the time and capacity at [00:47:10] this moment in my life. I'm healthy, my family's healthy, where I can say, you know what? I wanna be one of the people who fixes it. That means, okay, I'm willing to figure out the [00:47:20] fundraising things, make the calls, do the events, figure out how to get on the ballot, inspire people to work with me as volunteers to get signatures [00:47:30] in the community. I'm willing to talk to all the community leaders and the local political leaders who have been working on these things and earn their trust, support, and ultimately votes. [00:47:40] Again, you don't get to choose the outcome, but. I intend to pursue this with sort of clarity and integrity and decades of experience of [00:47:50] recognizing what really matters, that then leads to a moral clarity. **Speaker 7:** Mm-hmm. **Speaker 6:** There's a lot at stake, and so let's not forget that. Yeah. I don't at all see any of the other [00:48:00] candidates as like the enemy we're running together. **Speaker 7:** Mm-hmm. **Speaker 6:** The issue is poverty, segregation. Yeah. Yeah. Stillness. **Speaker 7:** Mm-hmm. **Speaker 6:** [00:48:10] Misinformation. That's the problem. Yeah. And so long as I'm focused on that, I feel like whatever happens will be the right outcome. **Speaker 5:** Yeah. Well, I think running for office is one of the [00:48:20] boldest things you can do. Certainly a bold precedent to break. I wanna talk about what you wanna build in Congress. What is the big idea that you wanna bring to the [00:48:30] table? **Speaker 6:** There are a few that I think are worth starting with. First of all, I am very interested in centering healthcare, making sure that we [00:48:40] create a vision for healthcare that extends beyond just simply undoing many of these cuts, but building the kind of healthcare of the future. Creating an economy that understands what's at [00:48:50] stake, that recognizes that the inputs to our health are all economic inputs, housing, food. Things like inflation and the cost of [00:49:00] utilities are all central to allowing for us to thrive, and you can measure that in the length and quality of our lives. And I'm deeply interested in public safety, [00:49:10] right? Mm-hmm. I really want to ensure that I see fewer of my neighbors and their kids coming in full of violence. There are a couple of really interesting solutions that I've [00:49:20] seen and would love to amplify. Okay. One of them is I have a colleague at the university named Dr. Douglas, who has put together something called the [00:49:30] Rifle Act that creates a license for gun dealers to sell their wares in the state. By first paying into a collective [00:49:40] fund so that victims of gun violence, who Oh wow, may need resources that aren't covered, have that pool, right? Mm-hmm. It creates more of a shared [00:49:50] responsibility. **Speaker 7:** Mm-hmm. **Speaker 6:** And may also help them to think carefully about, well, if we wanna shrink this pool, how do we restrict access to these guns to only [00:50:00] the most legally available and the most responsible? I'm also interested in looking at some of the work that's been done in California where they've done [00:50:10] some collective purchasing for generic insulin, pushing down prices of drugs. Okay. For the people who need the most. Yeah. Not only is that good for the [00:50:20] individuals who are sick, but we have so many excess costs in our

healthcare system that lead healthcare to be 17% of our GDP and Rising. We're making choices between [00:50:30] healthcare and roads, healthcare and education. Mm-hmm. And so ideas like that that can be legislated at the federal level so that everybody can benefit from fewer guns on the street. Cheaper [00:50:40] drugs are very high on my list of priorities to start with. **Speaker 5:** Awesome. If Tala was the landmark law of the eighties, what do you think [00:50:50] is the equivalent today? What kind of policy shift could finally move us from emergency care as a safety net and have it [00:51:00] be true equity, **Speaker 6:** universal coverage? That's the answer. Yeah. I mean the easiest way to do that is Medicare for all. Yeah, and we've heard that called [00:51:10] for by a lot of people. Right? Right. That is the easiest way. We already have Medicare. We can extend it to everybody, but there are other ways to do it too. That's why I don't just simply say Medicare for all. There are other [00:51:20] ways to cover everybody. You can talk to a bunch of wonks at many of our universities who will spin those out. Like you could extend the coverage of Medicare, increase the [00:51:30] coverage parameters of Medicaid. Offer public options for people on the exchanges. Mm-hmm. Subsidize employer based care and you get everybody covered that way too. [00:51:40] Mm-hmm. But we need everybody, like everybody. Yeah. Right. Everybody. That includes people who are not currently documented. Right. Because they still come to our emergency [00:51:50] departments and we still serve them and they are still people. Yes, **Speaker 8:** yes. Figuring **Speaker 6:** out what is the right way to do that. **Speaker 8:** Hmm. **Speaker 6:** Is something we need to talk about. And I [00:52:00] think that is the next revolution of how we get everybody covered. And so that is one of the ways we can create the sort of state that both honors our humanity, take [00:52:10] seriously what's at stake and we will have implications that reverberate. And I think it's better than simply saying, look, we're gonna go back to where we were. **Speaker 5:** Mm-hmm. **Speaker 6:** We [00:52:20] still had a lot of people uninsured and underinsured. **Speaker 5:** Right. There's absolutely more to do. What precedent do you wanna most break in [00:52:30] Congress? Is it how laws are written, how leaders connect with their communities, something else as you look ahead? **Speaker 6:** It's a tough question. I think it's [00:52:40] probably the tone of Congress, which then probably translates into how it's legislated. Like I'm not fortunate enough to have been a legislator. I have not worked there, but I see it [00:52:50] on television **Speaker 8:** yet. **Speaker 6:** Not yet, and I've seen examples of this. Yeah. But I want to persist in speaking with [00:53:00] courage and truth. Look, we get to spend a fair amount of time talking. What you see on television

or on TikTok is like soundbites, [00:53:10] 15 seconds. These are very big, complicated, difficult issues that are very hard to sum up into those really brief snippets, but I want to [00:53:20] try. And I wanna do it in ways that in no way obscure our humanity or the facts of the situation. Like what is the truth, not what's poll tested and what do people wanna hear? [00:53:30] What's the truth here? And then have that reflected in our policies. Mm-hmm. That's what I want to do and I want to do that for long enough that we can see change and then I want to hand it [00:53:40] off to the next person. Yeah. There are people with generation behind me that are smarter than me about a lot of things that I'll never get smart on. They need their shot too. **Speaker 5:** Well, they have AI [00:53:50] to rely on. So no, it's a whole generation behind us that's gonna be smarter in so many ways. I wanna close with just a story that really [00:54:00] touched me at the end of the book, and you mentioned the beginning of this interview that your grandfather was a lawyer and that was really precedent breaking for that time. And [00:54:10] I remember reading at the end of the book, you're graduating from medical school. And your uncle comes to celebrate with you. Can you talk about the story where he brings [00:54:20] the wine and the grapes from the vineyard and that toast that you all make in recognition of your ancestors? **Speaker 6:** [00:54:30] Wow, I haven't thought about that story in a while. Oh, **Speaker 5:** so beautiful. **Speaker 6:** So this is my father and his brother. My grandfather, the one in Kansas who was a [00:54:40] genius but didn't finish school. Mm-hmm. He had on his land, fruits, vegetables, and grapes. One of the grapes he made into a [00:54:50] wine and sort of kept in the basement and my uncle salvaged some of it and he brought it to my medical school graduation in like a [00:55:00] Welch's grape jar. He poured us each a little bit and it was kind of. More like a spirit than a wine. By then, it was kind of burned and [00:55:10] was silky in the mouth, but he toasted to the ancestors and mm. In that way, my grandfather was there with me. **Speaker 7:** Mm. **Speaker 6:** And he said [00:55:20] how proud he'd be that I was a part of this lineage, that although he didn't go to school, my uncle and my dad did, and now I've [00:55:30] achieved. A level of being a physician and I still carry this responsibility. I'm a part of something bigger. **Speaker 7:** Mm-hmm. **Speaker 6:** Right. And in fact, we all are, whether we [00:55:40] acknowledge it or not, I'm a part of this family. I'm a part of this cultural tree of being a black American that struggled and often [00:55:50] didn't get the benefits of that struggle. I'm an American, right. I live in this moment. And I'm a healer, right? And in some ways, in that moment [00:56:00] I'm reminded that we must never forget to care for each other, right? We're a part of something bigger, and as long as we remember that it like helps to keep me going in the right direction. [00:56:10] **Speaker 5:** Yeah, it's really incredible. I just think that you know what you're doing today and stepping into public service and pushing [00:56:20] precedents, breaking precedents. I think it's just another moment that your ancestors, your lineage would be so proud of. So thank you so much for this amazing [00:56:30] conversation. Thank you for being here today. It's truly inspiring to hear. Awesome what you've done. Can you share with us a little bit more about where people can find out about your [00:56:40] bid for Congress? **Speaker 6:** Absolutely. You can come to my campaign website to get more information or even to sign up to get updates. It is Thomas Fisher [00:56:50] for congress.com Easy. Thomas Fisher for congress.com. **Speaker 5:** Amazing. And we'll put it all in the show notes too, so people can click right through. Awesome. Thank you so much for being here. **Speaker 6:** It's [00:57:00] been fun. Thank you. **Speaker 5:** That was Dr. Thomas Fisher, an ER doctor who refuses to accept inequity as abstract for him. It's not [00:57:10] policy, it's in the waiting room, and now he's taking that fight upstream into Congress. What hit me today is his conviction that health is the truest measure of [00:57:20] justice. And his willingness to run, not just practice, to make it real. And if you know someone who is rewriting the rules, like Dr. Fisher, breaking precedents in [00:57:30] healthcare, politics, or anywhere else, I wanna hear their story, you can drop me a note on my website@breakingprecedent.com. Until next time, I'm [00:57:40] Leah Sullivan. ​