In today’s episode, Ryan talks with Dr. Regina Harrell, an Internal Medicine physician and an assistant professor in the College of Community Health Services at the University of Alabama. She plays a significant role in the geriatric rotation for family medicine residents at the Capstone Village, an awesome place to learn about geriatric care.
Links and Other Resources:
Full Episode Blog Post
NPR Article – Why A Patient’s Story Matters More Than A Computer Checklist
Regina Harrell, MD Bio
The Crimson White Article
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MappedCon presented by Blueprint Test Prep 2024 is this Friday, October 26, 925 Eastern. I'm starting the day in my track, the pre-med track, planting the seed of your personal statement. We have three tracks going all day long and a couple hours of amazing exhibitors where you can learn more about their programs. Again, MappedCon presented by Blueprint Test Prep, October 26, register for free. It's a virtual event and all the sessions will be up after. So even if you can't make it live, go register and get access to the sessions. Go to MappedCon.com right now, register. That's M-A-P-P-D-C-O-N.com. If you're applying to medical school in 2022 to start medical school in 2023, join me Wednesday or Thursday, Wednesday night at 9.30 p.m. Eastern or Thursday at 11 a.m. Eastern at premedworkshop.com. Go register today. I'm going to show you how to tell your story in your application. Again, that's premedworkshop.com. If you are applying to medical school in 2022, be there or be square. The medical school HQ podcast, session number 56. Hello and welcome back to the medical school HQ podcast. The place to learn how to excel as a premed student, learn what it takes to survive medical school, and turn your dreams of becoming a physician into reality. We're bringing you the most unbiased, honest and accurate information available online today. Hi, folks. As always, my name is Ryan Gray and I'm the host of the medical school HQ podcast. Thank you very much for joining us today and taking some of your time to listen to what we have to say. If this is the first time joining us, welcome. You have 55 episodes to catch up on, so you better hurry up. Good thing you have the winter break to catch up on those episodes. If you've listened to all 55, and this is your 56th, congratulations. I know there are a few of you out there that have listened to all of them because you've emailed me and told me that and I appreciate every one of you out there that listens to us. Today, I have a little bit of a different interview for you. Today, I am interviewing Dr. Regina Harrell. She's an internal medicine physician that works at the University of Alabama and she is involved with the Department of Family Medicine there and interacts with the residents. She plays a significant role in the geriatrics rotation for family medicine residents at a place called the Capstone Village, which if you go on Google Capstone Village, it looks like an awesome place for both the patients and for the residents and medical students to learn about geriatric care, which is kind of cool. But the weird thing or the interesting thing that brought me to Dr. Harrell was an article, a piece that she wrote, that originally was published in an article in a magazine called The Pulse and it was reproduced on NPR and I read it and it's an article about how Dr. Harrell is voicing her frustrations with electronic medical records or electronic health records, if you want to call him that as well, EHRs. And I was very interested in what she had to share because there was there was one key line on here and it said, "As a teaching doctor, my feedback to the residents now consists mainly of explaining how to document their visits so that we will all get paid instead of teaching them how to take care of elders in their homes." And when I read that, I had to reach out to her and talk to her and this isn't a pod. This isn't an episode that's going to teach you the tips and tricks on your application, but it's more an in-depth look at what practicing medicine is like in today's day and age of electronic medical records systems, the frustrations that we have as physicians using these systems that really aren't the best systems out there and some of the pros and cons. And what I hope you take out of this interview is the fact that at the end of the day, every day we go to work and we take care of patients. We deal with frustrations throughout the day, but every day we take care of patients. And at the end of the day, that is the ultimate goal and what matters. And I hope you can get that out of the conversation that I have with Dr. Harrell today. So one thing I want to mention before we get into the interview is that the Academy has reopened. And I want you to go to jointheacademy.net and check it out. We're in the process of uploading some awesome video testimonials. So if they're not there yet and if you're kind of unsure if you want to sign up, you can wait for the videos. But it's an awesome community. We're growing every week. We have a webinars, office hours, specialty series, interviews, and the community there is awesome, non-anonymous. Go check out jointheacademy.net and sign up. Come join us. You got nothing to lose, you get 30-day money back guarantee. So if you jump in there and you don't like it, no harm, no foul. But jointheacademy.net and we look forward to seeing you there. So why don't we jump in and listen all the way through. At the end, we'll give you some information on how to stay in touch with us. To start the interview with Dr. Harrell, I asked her how she started on her journey to becoming a physician. So I grew up in a nursing home. My father was a nursing home administrator. So I always had 100 extra grandmothers and I thought that was really cool. I thought I might want to go into medicine in high school. So when I got home from my first year of college, my dad said, if you think you want to be a doctor, you need some experience. I signed you up for the nursing assistant class at the nursing home. And as an 18-year-old who had only ever been kind of a nerd diving into books, learning how to give somebody a bath was really eye-opening experience for me. But it was fun. And I figured out that holding hands with people and helping them put their clothes on in the morning and helping them eat lunch every day and even helping them go to the bathroom was really an honor and a privilege and it was lots of fun. So that's when I really fell in love with hanging out with people. And I thought, since my mom had breast cancer while I was in college, that I was going to become an oncologist and I was going to save the world from all cancer. And I followed around an oncologist in Birmingham where I was in medical school and she was, she had three children and she was always exhausted and always frazzled and always sure one of her kids was not going to survive to be 18. She just felt spread tooth in all the time. And I thought, you know, I don't think I want that job. So then I followed around Jerry attrition who was semi-retired from family practice. And he said, you know, when the weather is really pretty, maybe I'll go play golf today. And tomorrow I'll go check on my cute little old people at the nursing home. And I thought, now that might be the kind of job I'm interested in. So when I really enjoyed geriatrics, I enjoyed internal medicine residency and then even more geriatrics. And when I got out into practice, started out full time. And when we had a little person, then I would, if he was sick and we didn't have family in town, I would stay at home with him during the day, then I'd go around in the nursing home from 5 p.m. to midnight while my husband was at home. And I'd stay up with a sick baby all night, and then I'd get up the next morning and do it again. And that was a little nuts. So when we moved here to Alabama, where we are now, I decided part time was more my speed. So I didn't lose my sanity. So that's where I am, living happily ever after in Alabama, trying to make it work, being a mommy and a doctor and a wife of a doctor. Wow. So you've come full circle growing up in a nursing home. And now you work in nursing homes and are working with the same people that you grow up with. Yes. Did you ever think that was going to happen? Growing up, no. But once I got into medical training, I realized that there was a reason I had all that experience and all that enjoyment and all those positive memories. And it really came together then. Yeah. And so your, your dad working in the nursing home wasn't a physician, he was an administrator. He's an administrator, so business background. Okay. So on your pre-med path, how did you find the journey? Was it, was it hard for you? Was it easy? What, what kind of struggles did you have, if any? Well, when I was an undergraduate, I always picked the hardest of everything. I, I thought I was more or less invincible. And then I took some upper level molecular biology classes at Vanderbilt and found out I wasn't invincible. And medical school, the year I applied was actually pretty challenging. There were more applicants than I think had ever been. They set a new record. So I applied to maybe 12 or 15 schools and got into one of them, which was a very humbling experience after being handed scholarships to more than one place as an undergraduate. But it ended up being the right place. It happens to be where I met my husband and it all worked out great. Yeah. And I think that's a, a common scenario. And we, we talk about it a lot. The fact that it, very similar to athletics, you might be the, the best baseball player in your hometown. And then you're, you move up into college and maybe you're the best player on the team. And then you move into the pros and you're a nobody in the pros. Exactly. And so the, the more you move up the ladder, the, the more the competition gets and, and the more you realize that there are a lot of smart people out there. There is always going to be somebody smarter than you out there. Just accept it. Yes. That's right. And just with it, it's okay. You don't have to be the smartest at everything. Nope. Nope. Just got to try your best. Yes. So right now you are still working part time. Yes. As a geriatrician. Right. Okay. And you're interacting with residents currently. I am. I'm a faculty member at the University of Alabama. And so I have undergraduates. I have medical students, nursing students, nurse practitioner students, and medical students, and family medicine residents rotate with me at times. So you get the whole spectrum. I get lots of students, which is very fun. So here's a question. When you're interacting with med students, what is something that you've noticed that, that you think to yourself, man, I wish these med students would have learned this earlier? Good question. I think here in Tuscaloosa, we do a better than average job of pointing out the shortage of primary care doctors in the United States. And we're very much geared towards encouraging people to go into primary care because there is such a shortage. And there are several folks who come rotate with me and go, gosh, you know, house calls aren't as bad as I thought they were going to be. I don't know what bad they thought they were going to get into, but they enjoy working in nursing homes and assisted living and doing house calls more than they thought. And they realized that, and there's some not very favorable stereotypes about older patients, especially if you see just the really, really sick ones in the hospital. And so it really broadens their view of what geriatrics is. Okay. So I think a large majority of people listening to what you just said heard you say house calls and said, doctors still do house calls? That's what my patients say. Is it the stereotypical walking in with the big black bag and plop it down next to the patient? What is it? What does a typical house call look like? So my bag is brown instead of black, but it has it has my stethoscope and my otoscope and it has I just got an app for my phone so I can even do an EKG at your house. I can do a pulse oximetry. I have my reflex hammer and I got all that stuff, all those old fashioned doctor toys and some new fangled ones go with me. And we sit down on the couch and we chat about Christmas and we chat about the weather or football or whatever. And then we get down to business and have in theory what's a normal primary care doctor patient interaction, but in a deeper, I think more meaningful way because it's at their house and it's more personal. That's that sounds awesome. It's way fun. You should come hang out with me sometime. Well, I actually did kind of a pseudo house call recently. It wasn't with a patient, but it was it was in a doctor patient type relationship, but it wasn't it. It was for something totally different, but the I was acting as a physician in the role speaking with a a widow of somebody that had just died and on base. And so I went and I was talking to her and getting some information about her husband and just sitting in the house and interacting with her was totally different than being in an in an exam room because now you're on their playing field and you're not you're more vulnerable than they are vulnerable. It's switched. It's very interesting. Yes, I always make sure to thank my patients for the privilege of allowing me into their house at every visit because it really is. And do you think they open up more to you in their home versus in an office setting? Most of the time, some people I see at their house because they have dementia and they think someone outside is trying to hurt them. So they're afraid of everything. And so to try to even just chip into what that is, you have to see them in their own environment. So some people are not at all interested, but they're not interested in anybody. But most of the time, people are completely thrilled and much quicker to open up because they feel like you're taking them seriously because you bothered to show up at their house. That sounds great. So I have another question about med students before we move on to some other stuff that I wanted to talk about. What is some of the biggest struggles that med students have nowadays that you see on their rotations with you? They've had a hard time, I think, balancing all the demands that are put on them. There are now work hour restrictions where they didn't used to be. So they're watching the clock to make sure they're not breaking any rules, but also trying to be a sponge and absorb as much as they can. And technology has been both helpful and hurtful for that. You can look things up faster, but every place that you go has a different electronic health record, and you spend a lot of time trying to wade through which button you push to just try to record something that means you learned something. And so there are a lot of challenges in a lot of directions, a lot of things pulling for your attention. Yeah. And all the wild trying to learn how to interact with patients and interact with the attendings because they're the ones that are grading you and the residents. Yes. It's a lot. It is. So I reached out to you because of an article that I read that you had written initially for an online magazine called The Pulse, but NPR published it and reprinted it, reprinted in air quotes on their website. And you wrote about the struggles that practicing physicians have nowadays with electronic medical record systems and the whole health information and IT area. And you just mentioned a little bit of it that everywhere you go, there's a different electronic medical record system that you have to get used to. And it's a totally different system and different buttons to click. And I'll tell you from my experience, as an intern, there was one hospital that I worked at that had four different EMR systems in one hospital. Yikes. Yeah. It was a physician-owned hospital. And so it seemed like you would get one electronic medical record system and some physicians liked it and some didn't. So they would go out and buy another one, but they would keep the old one for the physicians that liked it. And it was just a massive one. It was hilarious. But and so students listening, premed students and medical students listening might want to know why the heck am I talking about electronic medical medical record systems and why we're going to talk about some of the struggles that you think are out there and and teaching residents the future of this. But I think it's a valid point to talk about because we're trying to show premed students medical students what life is like on the other side, how it's it's not all roses sometimes and there are struggles and there are frustrations. But in the end, the story that you tell about going in and taking care of the patients is obviously the ultimate goal and why we continue to wade through the frustrations. So but I just want to show that there are frustrations out there. So why don't we talk about a little bit about your story that you wrote? Sure. First, it's important to notice that there is no perfect way to keep a record. Paper charts had their flaws too. When I first started doing house calls, I went with a bunch of paper charts in my trunk. But then if the billing office needed to look up something, I had the chart with me 10 miles away. So even the paper system while it was less complicated had its flaws too. So we have a particular electronic health record at our office because we're an academic medical center and we have a psychiatry group and we have student health and we have trainees and they have to be able to submit their notes to someone else to sign. There were fewer choices than you would have say at a private practice where you didn't have quite as many restrictions and things that had to be in the record. The reason we got an electronic health record was to try to improve communication so that when somebody was in the hospital, you could pull up on your computer their office records hopefully to provide some seamless continuity of care. Then the federal government mandated that electronic health records become a part of your record or you'll get paid less and the way our office did the negotiations between both the federal government and the state government they're considering telling me I may not get paid at all or at least a large chunk of my salary just won't get paid if I don't do this. But they've had a little bit of a challenge trying to figure out how I'm supposed to document something when I'm 10 miles from nowhere and there are no bars on my cell phone or my laptop and I'm supposed to enter an electronic record. We had a meeting with our financial planner and he had read the article and made a comment about it and I said just imagine you having an annual review with your clients about their finances from memory because you don't have internet access. That's what I'm doing every time I go on a house call is I'm trying to remember what's in their chart because I can't look at it because the computer doesn't work. So it is a challenge but thankfully because I'm part-time and because you don't see as many patients on house calls as you do in an office my brain most of the time works well enough to remember most of the things that I need to remember. Yeah and it sounds like it can be a struggle but when you look at paper charts back in the day and they had their negatives and you look at the electronic medical record systems now what do you see as far as what their role is in in health care and I'm asking a specific question do you think they're there to make your job easier? They should be but that's not why they're there. They're there because the government said they had to be so there are companies out there designing things that meet the government requirements to so that you get paid none of the programs were written to make doctor-patient relationships better. Yeah and I think that's the biggest problem that the majority of physicians are having and yes they're it seems like it's become a barrier to patient care instead of helping patient care. Yes. As you work with other physicians and residents during the day and and interacting with them and watching them kind of grow up with electronic medical records do you see a difference in in them because they grew up with this whereas you transitioned transition to it from paper. That's a good question I just turned 40 so I'm kind of in the middle I didn't grow up with a cell phone I started out with a pager as an intern and didn't get a cell phone until I was an upper level resident but I had electronic records in our VA system through my entire training career so I really am kind of in the hybrid generation where I've kind of done it both ways. I have seen plenty of 60 and 70 year old physicians jump right in full force and be completely fine with it and I've seen some 25 and 30 year old physicians be just as frazzled as the quote typical near retirement physician who didn't grow up with it so I don't know that it's as much a function of age as it is maybe sort of techie interest or personal interest in electronics and things that flash and have keys. So more of a comfort level with computers in general is the same divide for normal computer stuff. Yes. Okay. Moving forward. Do you see this getting better? That's a good question. Hopefully enough physicians will revolt to the fact that we're being asked to use something that's not helpful for patients. I mean it's tricky. The physicians aren't the buyers they're just the end users so we got to make all the teams cooperate and Americans are pretty stubbornly independent folks so working as team players is not something we're culturally known for being really good at. Yeah. And I think that's part of it we live in the capitalist society and everybody wants to have the best of the best so there's not one great program out there. There's a bunch of little ones and it's all divided and the same thing that I ran into during my internship with four different EMR systems in one hospital. Yes it is and there I mean this it's an endless cycle of very interesting debates in the VA system where I trained it was really easy you could look up the records from anybody in the entire country if they had come to your VA and you needed to look something up it coordinated well it was pretty seamless it wasn't very hard to use. But there were some inefficiencies in the one system so do you have a bunch of little systems that don't talk to each other that are maybe more efficient or one great big system which is less efficient and that goes for healthcare and for who's paying for it and which electronic record you have and lots of parts of it. So I think we've done a good job painting a negative picture with electronic medical record systems and and all the struggles that we have day in and day out and the electronic medical record system that I use on a day-to-day basis is horrendous but that's a that's a different story. What as a pre-med student listening to this what can you tell them to say it'll be okay life goes on you'll still practice medicine and enjoy patient interaction and and all that what do you what do you tell the pre-med student out there is freaking out. Well in the nuts and bolts parts some parts of it work really well like being able to look up someone's lab and x-ray results online is really helpful it's much better than calling the lab and trying to find somebody to read something to you and I I'm not gonna plan to carry a fax machine on house calls anytime soon so having somebody fax me results just isn't happening but more importantly than the nuts and bolts of it for any career that you are called to do you have to find the inside part of it that really is the calling part and for me it's holding a patient's hand and knowing that I will be their doctor at their house when they need me when they get sick when they are well when their spouse dies when their children are driving them crazy when they're driving their children crazy whatever the circumstances they know that they have us an established doctor patient relationship that is trustworthy and that relationship building is really the best part of medicine yeah that's that's the best part of the day is is interacting with the patient yes and building that that trust level and that rapport with the patient okay so there there is hope out there there is because I have one young lady who will do the charleston for me on house calls when I hold my iPhone up to her ear and pay big band swing music and I have patients who will share recipes and they'll show off cute pictures of their great grandchildren and they'll tell stories from world war one and two I've got just it's lots and lots of fun yeah that's awesome well do you have any other parting advice for a pre-med student out there or medical student as they wander through their journey I if I had it all to do again I was telling somebody the other day that my degree was a molecular biology major and a music minor and I have to say on the day-to-day basis I haven't thought about a cell wall very often in molecular biology and I might would have gotten more out of taking a few business or classes because there's a lot of business administration and medicine that we're not taught and it would be helpful to know yeah I think I think that's huge business running a business nowadays marketing yourself yes having an online presence nowadays all that stuff is hugely important and overlooked yes but with so much more in medical school to learn how do they how do they cram it in maybe be a a business minor with their science major all right or be a business major and just get in your pre-reqs or there you go like any way you can cut it as long as you get those pre-reqs in and and do well that's right all right folks that was dr. Harrell again I hope you were able to to get more of an in-depth look at what it's like to practice medicine with electronic medical records systems she shares some awesome information about being a doctor kind of more in a rural area making home visits which is cool and her life as a geriatrician but the the ultimate take home again is practicing medicine today can be frustrating but as you heard dr. Harrell say it was just as frustrating with paper notes because they had their own complications electronic medical records are just different complications and at the end of the day you're satisfied and you're encouraged by the interactions that you have with patients so let us know what you thought about this interview if you're excited about the technology involved with health care if you think it's only going to get better and you're excited where it takes us or or you're okay with some of the challenges as long as that as long as you're taking care of patients let us know if you think that go do the show notes medical school hq.net/56 as an episode 56 and leave a comment there and let us know what you think you can also say hello to us on twitter we're at medical school hq or we would greatly appreciate if you leave us some voicemail feedback that we can play on the podcast if you have a question or just some general feedback for us go to medical school hq.net slash feedback where there will be a nice big blue button you can push and leave us a voicemail so as always I hope the information provided will help better guide you on your path to becoming a physician and just as importantly I hope you join us next time here at the medical school headquarters [Music]
