Melina Davis 

Hello, I'm Melina Davis, and I'm your host for the JoyMed Podcast. Welcome, everybody. Today, I'm very happy to have with me Dr. Alan Dow. He is the division chief of hospital medicine and tenured professor of internal medicine at the Virginia Commonwealth University. 

He seeks to translate the challenges he experiences in clinical care into practical solutions that help his patients, his colleagues, and learners. I love this word, learners, by the way. He works with leaders in the healthcare industry, government, and nonprofits to augment their executive performance and ensure they thrive as leaders and as people. He is a proud husband and father of two teenagers and a couple of adorable cats. I love your bio. It's very fun. It's very personable. 

Alan Dow, MD 

Well, thank you for being here and happy to turn this into a cat show if you want to talk about cats. 

Melina Davis 

Only if you'd brought one with you. 

Alan Dow, MD 

Oh my goodness. Didn't know that was allowed. 

Melina Davis 

I know. Doesn't everybody like a good cat video? 

Alan Dow, MD 

Yeah, it's great. 

Melina Davis 

Thank you for making time to be with us here today. 

Alan Dow, MD 

My pleasure. 

Melina Davis 

You and I have spent a little time getting to know one another, but you're working on some interesting and exciting things right now. I could delve into a lot of questions, but I thought I might just let you share what you're most excited about that is happening. 

Alan Dow, MD 

Wow, I'm most excited about. So, During the pandemic, I was asked to come back and lead the hospital medicine division, sort of right at the beginning of the pandemic. And first I said no, and they asked me again. I said no again. They asked me again, I said, okay, fine, I'll do this. So, I said yes. And I've been doing that for five years. And I think there are two things about that have gotten me excited. 

So, the first was I've done a lot of work earlier in my career with students and residents, but this was really a job where I was responsible for faculty, often young faculty on the front line caring for people and helping to sort of nurture support and build what they're doing. And so that as a leader just felt like the place I was supposed to be as we faced the pandemic and now as we're sort of moving beyond. 

Melina Davis 

I'm sure they needed that support more than ever, really. 

Alan Dow, MD 

Yeah, I think it was a tough time, but honestly, I think healthcare has always been hard. And so that was a particularly tough time, but I think it's not that the challenges have gone away. 

But the second part of that is it got me thinking a lot about the challenges of that moment and how everyone was so tired because of the challenges we were facing. And when I talked to people that were not on the front lines, that were other people that were around the healthcare environment, administrators and support people and whatnot, and then also people that are outside of healthcare, they were also really tired. And I think it's sort of the challenge of our time is that a lot of us feel fatigued and worn down so much. And so, I think a lot about how do we bring joy back into what we're doing and how do we thrive. And I think we're just in a moment in our society where we're really struggling with those challenges. And I'm glad that I get to work on that because I do think there are ways through that. 

Melina Davis 

It's so relevant. I want to talk about the antidote eventually here, but what's the difference in your mind between tired and fatigued? 

Alan Dow, MD 

So, I think about 6 lenses of fatigue, and I'll be happy to go into each of them, but I'll sort of go through them quickly. And I think tired to me is that idea of sort of feeling physically worn down, those physical manifestations, and it can come from any of the fatigues and often several of them acting at the same time, but tired is sort of that physical manifestation where you sort of feel that weight and you just you feel like you can't go on. 

Melina Davis 

Rest and sleep can help with the tide. 

Alan Dow, MD 

They can, they can, yeah. And that's the first fatigue is physical fatigue. But also, I think there are other fatigues that are important. So I'll mention inactivity fatigue, sort of with physical fatigue, which is that fatigue from not moving around. I think we're meant to be people that move around. And I'm a big fan of exercise. And I think it has all sorts of wonderful things that it does for us and for our patients. And there's even more and more data every day that sort of shows that. 

There's a group of fatigues that are emotional fatigue, mental fatigue, and social fatigue that have to do with those sort of relational things, I think, that make us tired. And so emotion is our attention and how it's pulled in all these directions and how we often have things that are pulling on our emotions that are not the relationships in our lives, but maybe our interactions with our phone and with media and just the craziness of the world right now. 

There's intellectual fatigue, which is how work is sort of non-ending for us and boundaryless now. And I think that that's a problem, that's a modern, uniquely from a modern problem. 

Social fatigue, which has to do with relationships, and there's relationships that enrich us, and there are relationships that may not enrich us, but also are part of our lives. And so sometimes the relationships that we are involved in can, you know, they're important, but they may also be ones that don't make us feel better about ourselves and better about our lives.  

And then the last fatigue, which I think is set unto itself, is purpose fatigue. And that's the idea of not feeling something meaningful and worthwhile in the way that we're going through life. And maybe it's our work, but maybe it's also sort of our life in general. And so I think that's the landscape that I look at things through those six lenses as I try to think about fatigue and the feeling of being tired and how we think about what the cause might be or causes and what the antidotes might be. 

Melina Davis 

That's so interesting. And I think I've experienced almost all of those in my… in my life. It's interesting how core to being human all of those elements are. And we don't tend to pay much attention to them as almost what comes to mind is garden. And we don't take care of our garden and all of those elements in our garden. And it's interesting we take it for granted, all of those things you mentioned regularly. 

Alan Dow, MD 

Yeah, I think it is important to step back and sort of take an inventory of where we are and understand, Sos I think all work in some way. There's an element of sort of autobiography and self-help in it. And certainly for me, I felt all six of those fatigues and some of them I feel right now. 

And so you're trying to sort of figure out, okay, how do I navigate through this life? Through things? And for me, I'm fortunate to be in a position where I get to help people in what I do, whether it's the people that I take care of as patients or the learners. And I use that term broadly to include students, residents and junior faculty that I'm trying to help, you know, move better in their careers. And so, in moving through that aspect of helping people, that gives me a lot of purpose. And so, I actually find that work doesn't make me tired often if I'm doing something where I feel like I'm reaching that purpose of helping other people. And so it's kind of interesting how fatigue is not necessarily… do less. Sometimes it may be doing more. 

Melina Davis 

Well, and doing the things that fill you up versus drain you. And some of those things we can't help. Sometimes in life you have to do what you have to do, but. 

Alan Dow, MD 

Yeah, oh yeah, for sure. 

Melina Davis 

Right, but we need to be mindful of those things that can counteract the fatigue. What are some of those things? What are the antidotes to some of these? 

Alan Dow, MD 

Yeah, wow. Well, I think it really depends on the different lens of fatigue. So, we've kind of touched on purpose a little bit. I think it's important to understand those things that are meaningful and valuable to you and to make sure that you are creating opportunities to engage in those things. 

So, when you ask people what's important, a lot of people say family and friends. And I completely agree that that's at the top of the list for many people. And how do we create venues to spend time with family and friends that is something to look forward to? We know that, for example, when you go on vacation, about half the enjoyment from the vacation is the planning of the vacation and the looking forward to it. And about half is the actual vacation. 

And so that idea of saying, okay, let me plan this thing where I get to spend time with family or friends is actually a really important skill for us to feel good and engaged about ourselves. And so maybe that's the vacation, maybe it's the weekend planned, maybe it's the anniversary, Valentine's Day is coming up. 

So there's lots of different kinds of things that you can sort of say that are important and being able to sort of create those moments or those life experiences that we actually we enjoy what we're doing and we look back on them fondly in terms of the things we've done. 

Melina Davis 

It sounds like some of this is just sort of taking a moment and being very aware and recognizing the joy of that moment and drinking that in a little bit. Is that what I hear you saying? 

Alan Dow, MD 

Yeah, I think you're right in that I think they're…not given an operations manual for life in the way that we might like. And I actually wish there were things that we may be taught in school. And I don't even think this is medical school. I think this is, you know, life school. Yeah, life school, exactly. That help us think about how to sort of navigate things. Because if you're making a choice to do something and not something else, there are ramifications of this. 

So, one of the other fatigues is emotional fatigue. And that is the idea that there are things that we are bringing into our lives that are tapping into our well of emotional strength and ability that we have that is not endless. And so if you are spending time getting mad at social media, it's siphoning that stuff away. 

Melina Davis 

It's taking something out. 

Alan Dow, MD 

Yeah, and it's designed to make us have reactions and want to keep watching and sort of keep sort of, you know, scrolling and scrolling and scrolling. And so, if you're putting emotional energy into that, you're not putting it into thinking about different sort of joyful other experiences that you may be having. 

Or in the case of healthcare practitioners, the emotional empathy, that emotional labor that you have to bring to work because our patients, they do require emotional labor sometimes, often in what I do in the inpatient setting. 

Melina Davis 

Well, and most caregivers, no matter whether you're in healthcare or you're caring for a loved one in some capacity, you are giving of yourself to fuel and help in service that other person, you by nature are giving and by act, you're giving away something in that you may also be getting from that service. But if it's constant, you mentioned the pandemic, that was part of the problem during the pandemic. It was constant, never ending. 

Alan Dow, MD 

Yeah, And I love that you mentioned caregivers and used that term broadly. I think one thing that we can do in healthcare that helps our patients is actually to compliment the people that are giving care to them, because if you've been a caregiver, you know how hard that is. 

Melina Davis 

So hard. 

Alan Dow, MD 

Yeah, so hard. And just a little nod from the doctor saying, you're doing a great job. Because I have patients that don't have anybody sometimes, and they're in the hospital, and we're it. We're their safety net, and it's so great when people are trying to help someone who has some sort of ability in some way to try to live a fuller life. 

Melina Davis 

It's interesting because I do think as a doctor, a nurse, and other sort of professional role in healthcare, you don't necessarily see yourselves as the leader in the moment. Sometimes you do, but you don't recognize that other people are turning to you often, even with that emotional leadership, which I think is interesting. You're there for the medicine or the nursing, I noticed this as a layperson that you don't assume a leadership position and that sometimes that word from a leader, what that can do for somebody else is huge. 

Alan Dow, MD 

Yeah, that's a great point. I think we're so focused in medical training on becoming expert on our aspect of what we do. And one of the good things about it, I consider myself a generalist, so I'm not an expert. I know a lot about many things, but I also know what I don't know and get help from my friends that are more specialized. And one of the things that comes from that is recognizing that I have to coordinate and collaborate and lead in all these different ways. And that way in which you lead and collaborate and coordinate with patients and their families is so important in terms of helping people navigate through their current illness, in the case of what I do as a hospitalist, but then also think about, okay, where are the next steps? Where is this going to go? And how do we sort of think about, okay, where's the trajectory of this person's life and the things that are meaningful to them? 

Melina Davis 

And I love that you connect very clearly the idea of leadership and collaboration, because I think sometimes it's easy to think that those are separate elements, but in a healthcare setting, collaboration is key to getting things done well. How does that fit in the idea of thriving? Do you notice collaboration is important in this space? 

Alan Dow, MD 

I think it's tremendously important. So I think the more I think about thriving, the more I think it's all about relationships. And we spend, 8, 10, 12 hours of our day at work, during the week particularly, and on weekends lots of times, as physicians. And so your relationships with the people around you on the healthcare team are just so essential. And I try to make sure that I have good relationships and that we enjoy working together. 

A lot of this isn't rocket science, but for example, I just finished two weeks on the inpatient wards with the residents and on a specific unit. And I try to make sure that when I walk on the unit, as those elevator doors open up and I'm like getting off, I'm like, okay, Now I need to think about myself as trying to inject some energy and some passion into this work as a physician and as a teacher, but as a collaborator with the other people on the unit. 

So, I walked in and the first thing I do is I walk past the unit secretary. I say, good morning, how are you? How's your day going? And just try to elevate the energy. And they seem excited to have people talk to them. And I have great relationships with the nurses and we chit chat about things and whatnot. And it's a way of just trying to build that team and those little small social things that really don't take a lot of effort for me, but I know that when we're in a situation that's dire, or if they need my help, that we're going to have a good working relationship that's going to help us also help our patients. 

Melina Davis 

One of the things about doctors, I notice, I spend a lot of time with doctors, as you know, that there's a sense that you have to be very objective and that you have to really make sure that you're emotionally available but not emotionally involved. And that must get to be a very difficult line with the idea of collaboration and then can help lead to burnout versus thriving if you don't understand how to navigate those fine lines. 

Alan Dow, MD 

Yeah, I think equanimity was the word that I think Osley used a long time ago and wrote a whole book about it. It's a very hard skill. So, one of the things that I just marvel at with healthcare when I sort of step back sometimes and think about what we do is that you're seeing a patient in a room. You have this awful, horrible, life-changing conversation with them. You may feel sad for them. And on a personal view, you may feel sad because you have a relationship with them or it strikes a chord and whatnot. And then you have to walk out of the room, you just shut the door and you move to the next room and there's the next patient. And they also have some needs. And hopefully they're not also similarly dire, awful needs, but you have to then bring something else into that room. 

Melina Davis 

Fresh energy. 

Alan Dow, MD 

Exactly. Yeah. I do think that you can learn and sort of build that skill, but It really has to rest on a foundation of other strong relationships in your life, and that includes outside of work with your family and your friends, but also your peers at work and the people that you can turn to support. sometimes just vents about, I have this really challenging thing or I made a mistake or, all the different things that can happen in healthcare because it's such an emotionally high valence area and such a high risk area and it's, you know, it's important what we do. And that's great and wonderful, but that means that there's this downside to it too, potentially. 

Melina Davis 

No, at the Medical Society of Virginia, we have really spent some time thinking about how we show care for the individual in health care, how we help support where they are and teach them how to care for themselves better. And it's not a very popular stance to take, interestingly, because we all are trying to root out systematic root cause and change the system that we all know is broken.  

But I'm convinced that we also have to keep putting the oxygen mask on the individual and making sure they're ready to continue to care for the other humans while we're working on the system change. I mentioned that only because I'm so struck by so much of what you're talking about. Sounds a lot like an intentionalness, a mindfulness to care for yourself and make sure you're connected to others in a way that we tend to in medicine think is not as important as systems change. 

Alan Dow, MD 

Yeah. Thank you for all your work and leadership in this area, because I mean, it's really important, and I will say, so I've I'm twenty-five plus years now into doing this, and it has changed and evolved A lot. And MSV is part of a movement that I see going on and how things have changed. It is. And I see it in our younger people. I think about just my hospitals group.  

So, I started our hospitals group in 2004 and it was six of us and we kind of, we're going to go do it. We're going to be hospitalists. We didn't even know what that was. I think the word is been around for under 10 years at that point. And we had a certain way of thinking about this is the way that things are going to work. Now, fast forward 20 plus years later, there's 115 people in my group. So, we're a huge group. And we're the biggest division at my institution and bigger than almost all of the departments. There's a few that are bigger than us. But most of the other departments are actually smaller than our division. So a lot of people.  

One of the nice things that I've seen that has happened over time is that we have a lot of people in our group who are not full-time. And the typical story is that they start full-time and then they have a family and they're like, I want to spend more time with my family. And they decide to go to part-time. And this is both men and women. And so it's not, it's probably more women than men that generally make that decision, but also men are doing. 

Melina Davis 

Yeah, I love it. 

Alan Dow, MD 

Yeah. And I just say that to say that, you know, 20 years ago, it wasn't even an option. It was not something that you really could do. And now we're very flexible of people being able to think about, okay, how does life fit in with work? So it's wonderful to see that.  

Similarly, I see in the residency program, they now have someone who's on what it's called Wellness Reserve. I'm not sure I love the name, but it's Wellness Reserve. It is, yeah. And basically, it's a resident that will come in and help if someone needs some support in some sort of way. I just worry because the residents on Wellness Reserve is always the one that's getting pulled in to like, you know, cover the ICU at night or, you know, can you step into this really tricky situation? So I always feel bad for the residents, but I love that they have that. And I love that there's this idea of like, okay, let's think about how we navigate the challenging tasks of becoming a doctor and then, you know, moving on through our careers. I think where we actually have a lot of opportunity is that when people graduate residency, I don't think they're really done with becoming a complete physician. 

Melina Davis 

Right. 

Alan Dow, MD 

I think you learn a lot in the past few couple years of the first couple years of practice. And I think you are still trying to figure out, okay, what are the next 30 years going to look like? And often we don't have the same kind of mileposts that we have as we do in residency or medical school or college or this, what's really very sort of step-by-step kind of way of doing things. 

Melina Davis 

It's already set in stone. 

Alan Dow, MD 

Yeah, and I think MSV has actually been really great about sort of saying, okay, now that you're out in practice, let's think about how you can sort of navigate this. Because I think our organized medicine groups, whether it's state societies or the Richmond Academy of Medicine or our professional societies or more national are just really key to helping people understand how to navigate that. 

Melina Davis 

Well, and this collaboration, using your word, across experienced physicians and young physicians, I see both ends getting a lot out of that interaction. Docs have been around for a long time, want to share and really get fed, particularly around students and residents. You can see it. I love to put these groups together. It's fun to be in a room. We've actually done speed mentoring before. And you cannot imagine, we had more mentors than we had students and residents because people were so excited to be able to connect. It's really a fun moment. And you can see that energy, that energy of saying hello and connecting just start to spread radically. It's fun. 

Alan Dow, MD 

Yeah, and I think how we create venues for that to happen. I mean, I'm lucky I work with young people all the time, so I've sort of chosen that path. But I think you're right, and it can be within healthcare, but also I think, you know, can you coach the YMCA basketball team or the Little League or, you know, volunteer with the high school kids? I've got a high school son right now, and he loves hanging out with me. I don't know if he'd admit this, but he loves hanging out with me just because I think he feels like he's sort of part of this grown-up kind of thing. And I know he's watching me and I'm molding him. And I hope it's in a positive way. 

Melina Davis 

It sounds like it is. 

Alan Dow, MD 

Well, you know, you do things you're like, maybe I should. 

Melina Davis 

I know. You know, we've talked about burnout in health care and fatigue in health care, but we know that this is happening in other genres and other industries. Do you see a lot of correlations? Is it the same across industries? 

Alan Dow, MD 

That's a great question. So, I think there are certain high burnout industries. So healthcare is one of them. Law is actually another one of them. And I think it has to do with how we structure the work. What I actually find, and this is an area we can work on, and I think we are working on it, is non-healthcare industries are actually more receptive to thinking about how we really move to decrease burnout than healthcare has been. 

Melina Davis 

That's interesting. 

Alan Dow, MD 

Yeah, and I think we're, again, we're, I think, starting to have the conversation. So that's important. And we've made progress for sure. But I think we're behind that. Now, you don't go into being a doctor because you don't want a challenging career. I mean, it's going to be challenging. 

Melina Davis 

And you expect a lot of yourself, and you expect it to be difficult. 

Alan Dow, MD 

Yeah, and so there may be a sorting factor to the people that go into healthcare is that they're like, well, I'm not going to get burned out. I'm not going to get burned out. And they are, but they're not admitting it to themselves in some ways. But I actually got other industries are still ahead of us in healthcare. And so, I think we have some work to do, and it may be because of the particular demands of what we do. But it's interesting law, a demanding career, but I don't find law necessarily has the emotional, mental demands are probably the same, but the emotional demands that they have in healthcare. 

Melina Davis 

Yeah, the drain. 

Alan Dow, MD 

Exactly. 

Melina Davis 

Yeah. 

Alan Dow, MD 

Not necessarily an expert on law, so maybe I shouldn't say that. 

Melina Davis 

So it could be the sorting hat. It could be training, and it can be the nature of what the job is. What else could it be? 

Alan Dow, MD 

I do think the structure of health care and how we pay for it are probably some factors that are there. 

Melina Davis 

I think people believe this. 

Alan Dow, MD 

Yeah. 

Melina Davis 

And yet it's the hardest part to change because it's almost not the people in health care that do it. It's the people who run health care. 

Alan Dow, MD 

Yeah. 

Melina Davis 

And that's interesting that they're not one in the same. 

Alan Dow, MD 

Yeah, I think the stats as well as I do, but the number of physicians in this country have grown by a few percent in the past 25 years, whereas the number of administrators I think are up fourfold over the same time. 

Melina Davis 

And all the money is there. 

Alan Dow, MD 

Yeah, and there's this sort of battle between the administrators of, you know, the hospital or the practice plan or the physician group versus the payers, whether it's insurers or government, whatever, to try to sort of like, figure out the money thing. And then they ask the, in my case, the doc to say, oh, can you document this in a different way so that we can get paid? We know you did the work, but you got to sort of write this in a different kind of way. 

And I think what's pretty clear, and this is across fields, is that burnout is driven more by those organizational small little cuts than these big traumatic events. And there was a recent study looking at, I think it was police officers in Australia that they said that it's the organizational bureaucracy is the hard part of their job. It's the paperwork, not the actual fighting crime or how you think about police officers. And the same thing is true in health care for sure. 

And so, I have some hope that AI may fix this and make it better in some way, particularly as people are thinking about how do we have fewer people in these jobs that may not add necessarily value to what we're trying to do. But I'm not optimistic that it's going to happen, if that makes sense. 

Melina Davis 

Yes, hopeful. 

Alan Dow, MD 

Hopeful, yeah. 

Melina Davis 

But not optimistic. Well, part of it is we need to understand the course that would change it all. It's big. It's not any one little thing, right? They're all big things. I think that is, it's so complex to change and so many of us are not in control of all the levers, right? So where there's the will, we haven't quite figured out the way. 

Alan Dow, MD 

Yeah. 

Melina Davis 

Though I do think a lot of people want to, that's huge. 

Alan Dow, MD 

Yeah, And I think the fact that we are starting to have the conversations over the past 10 years and that we are thinking about how do we make our lives better as healthcare providers, that lets us have this groundswell that we can work with our professional organizations to try to say, okay, let's think about what we can do from a legislative point of view and from a policy point of view and from how we oversee medicine in general. 

Melina Davis 

And I'll just say, organized medicine does work at creating change. And what's interesting is we've really sharpened the sword, if you will, of these institutions, these organizations that can help make a change. But what I find is the doctor has such an independent spirit that if they think they can do it alone, they don't have enough personal bandwidth or voice loud enough by themselves to create the change. And organized medicine collectively does. 

Alan Dow, MD 

Yeah, I've always worked in big organizations, so I don't have that perspective of the independent physician. But even some of the independent physicians that I'm close with, they're very active in organized medicine because they recognize that this is the pathway for them to have real influence on the way that the system works. 

Melina Davis 

What's interesting, we have a lot of active employed docs that are members. Interestingly, they want independent docs to speak for them because they don't feel like they are allowed to say and that they're in more jeopardy. So it's another moment where I see these groups who you easily could think that they're bifurcated and they're different and they don't represent one another actually they have much more in common and the employed physician very much would like the independent to even be louder on their behalf. There's a lot of synergy there. 

Alan Dow, MD 

Yeah, so that's interesting to me because there's been a lot of talk over the years that physicians need to learn more about advocacy in medical training. And it's sort of, it's come and gone, come and gone a little bit in terms of the level of focus on it. And I think the answer is yes, we do. 

The question is, where do you put that in someone's training? Because there are some med school sort of elective courses that have done that. And then residencies, you're just learning so many other things about how to be a doctor. So it probably belongs in the continuing education sphere and MSV in other ways have been great about developing these programs to help people learn to be advocates and leaders. But I don't know how we think about that in terms of should there be some sort of see requirements that you're a certain way out of practice now and let's think about how we help you be that person that can then lead for the next generation or lead for those patients that are going to come behind you that you may never care for. 

Melina Davis 

And it is a skill that easily can be learned and especially from a passionate, intelligent group like we represent. What I would say is what I wish is that medical schools and residency programs and practices really cared about building culture together and community together as they're all coming up. Because I do think this social relational thing is something you all miss out on that the rest of industries get more access to because you're so individually focused as you're going through your training. What do you think? 

Alan Dow, MD 

Yeah, no, I agree with you. Actually reminds me of a conversation I had with a student last week who was trying to think about what he was going to do with his life. And I have a bias towards generalism because that's, like I said, I'm a generalist. And so I said to myself, okay, I'm not trying to convince you to be a generalist, but I want you to know that most of us, we see something in medical school or residency and are like, okay, that's how I want to be. And then our practice often will follow from that. 

And it turns out there's all these ways that you can be a doctor that you're not getting exposed to. And so, I am in this certain mold of being an academic hospital medicine doctor and leader, and I do these kinds of things. But there are all sorts of people that are hospitalists, that their days, their job, their work, their hours, their kind of patients they are for, very different than what I am. And that's just within, hospital medicine, which is a segment of a segment of a segment in terms of what we're doing. 

And I think, organized medicine is actually a way to be able to sort of see that diversity of things that are going on in the community and in the world around us, because I love talking to doctors and through professional organizations and finding out, what does your practice look like? What do you do? How do you take care of things? How do you handle this challenge? And there's some really… exciting, creative, inspiring stuff that goes on out there. 

Melina Davis 

It really is. It's fun to watch you all connect. When you connect, it's almost like watching kids find friends. It's fun to see because you're always so surprised what the other one's willing to share and that you get that chance to have a conversation. I think you all are isolated way too much for what I choose for you. 

Alan Dow, MD 

Yeah, no, I think that's true. And I think there actually are some studies around emotional labor in healthcare that show that this was worked on in the ICU, that if you have a patient who's not doing well, the doctor feels solely responsible for the patient not doing well, and so doesn't feel like they can talk with the rest of the team about what's going on.  

Meanwhile, the nurses feel like the patient isn't doing well, and they're talking with each other, but they don't want to talk to the doctor about it because they don't want to offend the doctor. They feel like the doctor doesn't want to, they don't want to make them feel bad. Even though they don't think it's the doctor's fault, they see the doctor blaming themselves. They don't, well, we don't want to make them feel bad. And so, both groups in that are hurting and could really benefit from talking with each other and collaborating around that. 

And that's a dramatic example, but I think that's actually true with a lot of things and that we decide not to talk about some of the things that are hard because we're just not sure how the other person's going to take it. 

Melina Davis 

I think that could be an interesting thing for institutions to really encourage. It's not just communication around the patient and their care, but communication about how the patient is doing or how the people are doing around that care system. What other things can institutions do, you think? 

Alan Dow, MD 

Well, I think to build on that, so you're not going to want to be vulnerable with other people unless you feel like you can trust them. And you don't trust people unless you have this preceding relationship that is built of these smaller, less, less important… So, it all links back to together that you have to have these small, little things that sort of build a relationship, so then you can sort of take that risk. And we've all been through this because it's like dating, right? I mean, it's like, you're like, okay, trust building. Exactly. 

Melina Davis 

What can I count on you for? 

Alan Dow, MD 

Yeah, and again, you know, this stuff isn't necessarily rocket science, and we have learned this stuff. Maybe we've not learned to apply it, you know, from what we learned in preschool and kindergarten to, you know, working in a complex healthcare environment. 

Melina Davis 

Yeah. it goes back to your bio and something you said early on. It's about being people and learning about life, right? And that instruction manual, it's pretty, but kindergarten teachers did give it to us, but I think we forget some of these basic, but really important lessons about being a human. 

Alan Dow, MD 

So now you're making me wonder if we need more continuing education delivered by kindergarten. 

Melina Davis 

Yes, we might. It might be a fun idea, actually. Well, what gives you hope about the future for health care and for people thriving? We're in such a difficult moment in human history in our country. 

Alan Dow, MD 

Yeah, I think you just have to talk to a young person and really get them talking, too. I just, the people that I work with, these junior faculty and these residents, these students, they're just so impressive. And a lot of us who have been doing this, we'll say to each other like, wow, I don't think I could have gotten into medical school these days. Yes, I hear this a lot.  

And you just, you see their energy and their enthusiasm and their passion and their optimism. And that just, it's so exciting because it really is about people that are going to change things and set us on the better course for where we're going to be.  

And that means that our job as people that may be sort of big career is to think about, okay, how do you help try to open up that path for them a little bit? Not that you're going to lead the way, but you can open up to the path so that they can sort of like forge ahead and try to get some of the stuff done that we don't, because we got a lot to do, but I think we can do it. 

Melina Davis 

And I really think this next generation, they are so hopeful themselves and so talented with mentorship and guidance and partnership. 

Alan Dow, MD 

Yeah. 

Melina Davis 

They can do it. 

Alan Dow, MD 

Yeah. 

Melina Davis 

Well, it's been just a grand pleasure spending time with you. 

Alan Dow, MD 

Yeah, it's been fun. 

Melina Davis 

Thank you for your work. I think you're making such a big difference, and I think we've got more to learn from you. 

Alan Dow, MD 

Yeah, well, thank you for all you guys have done it at MSV. It's always been wonderful to partner with some things and see some things that you guys have done. It's inspiring to me. 

Melina Davis 

You're so kind. Thanks for being here