Special: Crisis lessons from inside the ER, with Dr. Bon Ku
Hi Listeners it's read. We have lots of exciting news to share. I on May Twelfth. We return with season six and our first brand new episode features Angela Errands. It's a two part episode. You'll never forget second masters scale has been nominated for two. Webby awards and we'd be honored if you'd vote for us in their people's choice awards. The categories are for best business podcast and for best live podcast recording. You can vote at vote. Dot Webby awards DOT COM. That's vote dot. Webby awards dot com and I should add. This special episode is presented in partnership with the Hustle and their premium newsletter trends dot co a community in research publication helping businesses navigate this time visit trends dot co slash scale to get started and now onto the show. When this first started it was very dramatic. The emergency room literally changed overnight. A wish more people can see what is going on in hospitals. I don't think we're seeing the images that we really need to see those stories. I cannot trust enough to people that Dow's depths that we're seeing now are preventable. I've seen a lot of creativity and hustle going on in my hospital in hospitals across the country. We have this opportunity to fundamentally redesign our healthcare system and we are never going to go back to the old normal. That's Dr Bond Coo. An emergency room doctor in Philadelphia. He's been on the front lines in fighting covert nineteen trying to manage healthcare for a flood of patients. It's required constant integration from sourcing treatment options via twitter to Three D. Printing test. Swabs this is Bob. Sathian host of masters of scale Rapid Response Bond coups experiences emblematic of the resourcefulness risk and hope of medical first responders in the pandemic. He says he's pretty sure that he'll get cova. Nineteen at some point and he worries about infecting his family. He also worries about faulty incentives in the medical system and offers on the ground business lessons for all of us to take away from the crisis. Let's listen I'm Bob Sathian and I'm here with Dr Bond coup an emergency room physician working in the covert war at Jefferson University Hospital in Philadelphia. He's also an assistant dean at the medical school there. Director of the Health Design Lab and author of the Book Health Design Thinking. He's been doing regular shifts at the emergency room staying at a nearby hotel and then on off days returning to his family. He's coming to us from the hospital itself just across from the emergency room as I asked my questions from my home in New York Bond. Thanks for joining us. Thanks for having me you work directly in the covert ward. How did you get that assignment? Amon Emergency Room doctor. So all of us who work in the emergency room spend some shifts in what's called the hot zone of the emergency department so we see patients who have symptoms of Cova nineteen there and those patients go to the hot zone because we want to eliminate those patients who seek regular care in the emergency department from being infected with Cova nineteen. So I've just destroying of shifts over the past ten days in in that part of the emergency room. So what is the typical shift is a change from what Shift was like six weeks ago even four weeks ago like is it changing all the time. When this first started it was very dramatic. I had worked an overnight shift in the emergency room. The volumes have been down by almost fifty percent on some days. And it's been eerily quiet in the Emergency Room. It's been like an empty e. r. and then when a return this was in early. March than when a return to work in the emergency room all of a sudden. I saw my colleagues wearing full protective gear. They're wearing those scary looking has met suits with a pampers. These are those hoods and masks that you put on and I had come onto my shift and immediately I had to intubate a patient who was suspected of having cove in nineteen and that means putting that patient on a mechanical ventilator so the emergency room literally changed overnight. It's a Mike and has it then stayed at that same feeling that same pace since early. March we saw a rise in cases dramatically and it seems like right. Now it's plateauing the number of cove nineteen cases and what's also been encouraging. Is that people who have regular diseases. That are outside of cove in nineteen. I'm talking about heart attacks and strokes and people with appendicitis. Those patients are starting to come back to the emergency room and seeking care so our volumes have been picking up but the number of sick Cova cases. Seems like it's been plateauing but the situation changes from day to day. So it's it's really hard to provide a day by day analysis. I think what we are looking for is trends in that data watching and reading the news it can be hard to keep track for me of serve. What the medical and treatment information current for a doctor or like you on the front lines. How do you know what is most relevant? How do you keep up? It's hard to keep up with the news. There's so much misinformation and disinformation out there in terms of treating these patients. It is very complicated because it's a new disease that we've never seen before and we don't have the randomized control trials that normally guide our medical management of these patients. So what I've been doing. A lot is talking to my emergency from colleagues in New York City. Getting advice from them Lot of doctors like myself have gone on social media actually on twitter and on blogs and podcasts and learning from those doctors who that I trust who have managed many more of these patients and I have and getting the real time advice because our traditional method of learning through scientific journals. It's too slow right now. There's a whole community. It's called free open access in medicine. And there's some experts that I trust as authorities on one of them is Dr Rich Levitan. Who have been talking about. Best Practices in the management of patients with Cova Nineteen and so a lot of experts have been sharing their management of patients on on twitter and on blogs. I'm reading a lot always trying to educate myself the public health information. Seems like it's so so fragmented right and you're not necessarily able to rely on your own hospital your own hospital system. Oregon's your on hospital system may not have enough clear information. I think this has exposed some fractures that we have in our healthcare system and one of them is the ability to act on real time data because data and especially data from Chani health records are silo. It's very difficult for me. Dr In Philadelphia to learn about the management of these patients from doctors in your city who've seen just more cases that stuff so I've been relying on social media to get some of this knowledge and our our way of disseminating data is full of roadblocks the electronic medical records so those are not designed to be linked up in this kind of way for community health purposes correct electronic. Health records are amazing. The grades but they've been primarily designed for for billing and they have not been designed for doctors in real time to make a decision at the patient's bedside and I think what we can learn from from this crisis is how do we fundamentally change data systems. How do we redesign them? In order for us to make real time decisions based upon quality data. I know you're have long been interested in invested in the interaction between design and health and medicine and how to make that work better. I know a major role with your patients. You're contributing to and encouraging design solutions. There's two different projects that help design lab that we've been engaging with one you know it comes from this need for mechanical ventilators and back in early March. What's horrified me was that it was projected that we would not have a ventilators and that we'd be in a situation like our Italian colleagues where they were making decisions on these horrible decisions on who gets ventilator and who does it and I was fortunate to link up with a team from Mit WHO's working on a bridge ventilator as they call a as a temporary solution until hospital ventilator became available and so this team of MIT engineers work with several companies in in New York City. Actually new lab and Anteks Beta to design and manufacture a ventilator within a month which has been a amazing on our end. We've been working. On a project of how to safely manually ventilate patients that means training a volunteer corps of humans to patients if there were no ventilator so we just did this because we're were literally trying to build a plane while flying it. We don't ever want to be in the situation. Where as a doctor you have to decide who gets live and who gets to die and so it was important for us to act quickly and to come up with options. Fortunately the way depending is going. It looks like we're GonNa have enough ventilators for this phase in in the spring. Well that's reassuring certainly but I can see why you wanted to have other options you you also have a three D. lab at the hospital. What are you doing in the three D. lab so my colleagues have been working on a project to three D prints swabs for covert testing. What has happened as we've expanded our ability to test patients for Co vid. We've run out these little sticks that you put in a patient's nose in order to test for covert if we don't have those sticks swabs we can't test and there have been researchers working with three. D. Printing companies to open source. Had it three. You print the so what we've been doing for the past week is repurposing our lab in order to manufacture these covert swabs in house. It's like you have to be your own supplier as a last resort. It is what this pandemic expose. Is the vulnerability in our supply. Chains for hospitals hospitals are designed for maximum efficiency which is good but it leaves no room for hospitals to build this surplus of supplies and medications and equipment that's needed in order to meet surge capacity. We're running out of some of the most basic medications my New York City colleagues of told me when they intimate a patient and put them on mechanical ventilation. There's not enough of the proper meds to sedate a patient. It's a scary thing that within a matter of weeks of virus has totally up ended the supply chains of hospitals across the country. And get some of this is if you're running your hospital from a business point of view before this. Well you don't WanNa pay for equipment or medication or beds that you're not using so you try to keep things as full as efficient and despair as possible and then you get a surge like this and suddenly that whole approaches well the limitation show. Oh absolutely were. Hospitals have in the hardest. Hit areas have become overwhelmed because hospitals weren't designed to meet search capacity hospitals. Weren't designed to deal with these pandemics and hospitals make money from elective procedures and operations schedule. -Ties specialty care. Outpatient visits the lose money on primary care hospitals lose money on public health prevention hospitals. Don't get paid for preparedness and I believe that. Healthcare is fundamentally going to changes. There's GonNa be no going back to normal pre pandemic that there's going to be a new normal and that there has to be A federal mandate of how we re incentivize hospitals of changing our payment system so we incentivize public health right now because public health because primary care a money losers what we see now is some hospitals are closing down. Some hospitals are laying off healthcare workers in the worst public health crisis in a century. There's irony around that you mentioned earlier that there was a point where the flow of patients. Who you normally would see in the emergency room. Slow down what happened to those people. Where did they go? We don't know across the Board. Speak With my colleagues Minor earns mezin colleagues and some of the data. That we've gotten is that there's been a forty to fifty percent decline in volume of emergency room. Visits one explanation is that people are afraid to go to the hospital. A relative of mine shed call me last week and she was in severe pain and we facetime each other and I looked at her and you got to get to the emergency room and I thought she had a kidney stone which ended up. She did have but said it's safe to go to the hospital. We're going to protect you from getting sick so you should go to the hospital. But I think a lot of patients but we're seeing a delay diagnosis that they're staying at home when they're having symptoms of heart attack symptoms of stroke symptoms of severe infection when they should beginning care. Because when I think the public looks at what's going on in emergency rooms they think it's what's happening in New York City which is not the case for most hospitals across the country. Yes some hospitals are like that but a lot of hospitals can accommodate you. And it's safe for you to go and see care and as you described this sort of forty or fifty percent drop and this kind of delaying do you think. Then they'll be some sort of second order impact like another wave of different kinds of patients. We're going to see that. The collateral damage from Cova nineteen is probably worse than the corona virus itself that there are going to be a lot of patients who have not gotten the care for their chronic conditions that they have delayed diagnoses that they're going to have worse health outcomes. I have to ask you this question. How much do you worry about your own health? I don't think about my own health that much because I had already resigned myself to probably getting Cova nineteen from the beginning and that is a risk that I take. I feel very fortunate. My hospital that the leadership here has done an amazing job of preparedness so we have stockpiles of of P. P. That every time I go to the hospital I could wear in and ninety five mask. I have the papper the hood that I can wear so feel very actually protected at work. What concerns me more is potentially infecting my kids and my wife and that's caused me to sometimes stay in a hotel room sometimes not and I get very concerned of potentially having co vid of being a symptomatic knocked symptoms and in that latent period infecting my children was able to string a bunch of ships together and so during that time as well. I'm working a lot in the hospital this week. I'm going to go and check into a hotel and now this week. I'm not working that much. I've been sleeping at home by been away from my family. We have a spare bedroom that I've been sort of sheltering in place there but it's it's hard. It's hard on a lot of emergency room doctors along lot of frontline healthcare workers nurses. It's this mental stress. That's always in the back of reminds. I've spoke to some of my colleagues in the New York City area. Several of them had did learn that to my colleagues their moms just died of Cova did in the past week and another doctor. Slums currently in ICU. With Kovin so it's a lot of mental stress. On many of those who are in emergency rooms are working an ambulance of m. i. infected and am I gonNa Affect others of a whole protocol protocol. As soon as I'm done working a shift in the emergency room I go to my office which is right above the emergency room. I strip out on my scrubs. I leave my shoes in my office. I put my scrubs in a trash bag and I put on a new set of clothes and as soon as I get home. I usually have a bag scrubs. I immediately put into the laundry and then I go immediately to the shower at a routine that I a lot of healthcare workers have been doing. I've heard some of my colleagues actually stripped down at the front door before they even enter into the house so they're getting naked and probably their neighbors can see them but there is a. I don't really care because it's other me exposing myself for or me potentially infecting my family and when you come in how do they react to you when you come home or they like? Oh Daddy's home yet. They sometimes they go. Oh I thought you were sleeping the hotel and then a really affectionate with them. I and I wanted touched and hugged them. But I can't and so that's very difficult. I think it's hard. It's hard for them to understand the chaos that a lot of healthcare workers are seeing in hospitals. And how dangerous this disease and viruses? It's Kinda like when you get a weather alert on your phone and there's a storm coming or the storm here thunderstorm and what I usually do is I look out the window and I go what. It's actually kind of bright and sunny outside. That reality doesn't match the data that I'm getting from my phone but I wish more people can see what is going on in hospitals and what frontline healthcare workers seeing in some of these sick patients so they can understand this. This is a very serious disease. It's something that we have not seen before and we don't have good data out there and a lot of times. We can't tell who's going to get better and WHO's not you're on the Faculty of the Medical School there. What impact is this likely to have on medical school situation? We have not had medical students rotating in the hospital. One is because we don't have enough a enough P P to protect all our learners older medical students and they are missing it. They want to be in the thick of it. There's a group of medical students here who started a an organization to help provide P to two local hospitals. They have the sense of that they want to help. They want to support and they want to help out their fellow. Americans is telemedicine useful right now. Is it filling in some of the gaps of people coming into hospitals or what is the role of telemedicine likely? Look like as we move out of this. Telemedicine is here to stay and I think unfortunately it took a pandemic to convince both patients and doctors that it's going to be really part of the backbone of our healthcare delivery system so as we think about the future and we think about how we're going to redesign the healthcare delivery system. Tell health is GONNA play a pivotal role in that. What is encouraging is a lot more patients. Doctors are getting more comfortable on this platform and I think that is going to continue post pandemic. I think it's going to eliminate some of the traditional barriers that we've seen to accessing healthcare. But I also want to stress to we still gotta think about our vulnerable populations and going forward. How are we GONNA do a better job protecting them? This virus has disproportionately impacted communities of color. It has impacted and really killed a lot of people with unstable housing a lot of people in our prison system. Those who work in factory jobs like meat packing facilities. We got to think about how we as a society how we as a country or going to protect the most vulnerable in our society. Because how are we going to protect those populations over society? Who are disproportionately impacted. Telehealth may role but we gotta make sure. Those patients have broadband access and they can access telehealth patients. Can it sounds pretty stressful. How do you manage your own stress in this environment? What's been helpful? This past week is connecting with my emergency medicine colleagues. A lot of colleagues that I've trained with WHO are in different areas of the country. It was a very traumatic week for us because one of our colleagues in New York City died by suicide. I she was a emergency room. Doctor someone who was our friend a friend of mine I trained with. It's a very stressful time. And what helped me would help us? Getting through is reconnecting with those who knew her reconnecting with those who are going through the same thing that we are Go into different areas of the country and it is extremely stressful time. For many of us we had online zoom memorial service for her yesterday that her department of Emergency Medicine Dead and three hundred yard. Docs on that memorial service expressing our grief and mourning and that was very helpful or all of us to process and gives me hope is that there are some really good people who are who are on the front lines and who are trying to do their best to take care of. Patients in hospitals across the country gives me hope you said to me at one point. That working in the hospital is the most normal part of my day. You explain what you mean by that. It's surprising that for me. Going into shift in the emergency room we're going into my lab is actually the most normal part of my day. It's because we are doing what we did before the pandemic were trying to just take care of patients who We work in team so I work a lot of overnight shifts and it's great to work with the same team that I've worked with before the pandemic and I'm not at home working alone and sometimes when I'm at home just writing emails and reading on this pandemic. It's actually more stressful. At least I feel in the hospital. I've been trained to take care of patients and it feels a lot better being able to practically do something I've had so many great people reach out to me and go. What can we do to help and fortunate enough to have a job or go and actually make a difference during this time? So it gives me a purpose in this pandemic. Do your kids understand and appreciate the risk that you're putting yourself under that you coming home puts them under like do they understand it? I think they do this past week when it was a very difficult week for me. I been very upset by what had happened. And they've seen that in me. You know. Usually I'm pretty optimistic. Guy Who doesn't like to cry and the they've see me crying this week and so it's been so I think they say that it's Just a extremely stressful time. Certainly what's happened in the last week? Underscores that the burdens. That folks like you are under your own. Mental State can become more fractured. You mentioned that you have seasonal allergies. Sometimes you get sniffles and that you start to worry like that. I have something. Yeah my allergies. Have been kicking in that. I'm thinking Am I my stuffy? Nose is that related to covert or. Is that just my allergies? And I'm trying to attest like did you. Every morning is a mixture. Be able to smell the coffee that I make in like relieve when I when I have that sense of smell and I'm relieved when after taking my allergy medications. My nasal congestion has gotten better. What really gives me hope but really helps me to get through. Each day is seeing my colleagues. The nurses the doctors the paramedics the environmental services who cleaned the rooms in the hospital. They're showing up and doing their job and keeping the doors open so we could take care of people in our society and that that really gives me a lot of hope. Is there anything that we haven't talked about that folks listening in should know about a point that WanNa highlight is that we have this opportunity to fundamentally redesign our health care system and we are never going to go back to the old normal? And what are we going to do? Moving forward are we can do everything from redesign emergency rooms to make it safer for patients getting care that they're not exposed to Kovin or other viruses how we need to just change the financial incentives for hospitals so that we pay for public health that we pay for preparedness. Because there's going to be most likely a second wave happening in the fall in wintertime. And what are we going to do to prepare for that? I cannot stress enough to people that thousands of deaths that. We're seeing now are preventable. If we look at other healthcare systems across the world like Korea and Taiwan and New Zealand. Who did a much better job at being prepared and containing the virus that they have had far fewer deaths in our country. We really need to ask ourselves. What are we? GonNa do to promote our country. However you're not going to repeat the same mistakes that we've made and what are the changes that we're going to ask health systems in order to prevent thousands of dots. It upsets me. Every time I see a patient die every time I hear of a another colleague who has been infected with co vid colleagues mom who has died of Cova when I think of these debts when I think of these people getting affected. That many of these were preventable. This was an inevitable. We could have prevented a lot of the tragedy that we're currently seeing. And how do we move forward to not let this ever happen again? But right now you don't necessarily see if there's a next wave the comes in the winter that we haven't put things in place at least the you've seen yet that would make it different. I've seen a lot of creativity and hustle going on in my hospital in hospitals across the country. It impresses me but in order to deal with a pandemic of this size we need to have a federal national unified strategy. It can't be a piecemeal approach. We could have been better prepared. And that just looking at data from other health systems in other countries that they were able to test early they're able to contain they're able to socially distance. Their hospitals were better equipped with P P to protect health care workers but I have hope because this virus has not wiped out our country and that we are going to learn from our mistakes and that we are going to change our system in order to better protect our country and I think the way that why we have failed is is a direct result of how the financial incentives of our healthcare system healthcare was already broken. They're already fracture. Lines and the healthcare system the Cova crisis just exposed them what we've incentivize healthcare to operate on profitable procedures and operations and specialty outpatient visits and. I think it's crazy. That hospitals are shutting down in healthcare workers getting laid off and this public health crisis that does not make sense of. That's why a for profit system that exists with these financial incentives that cannot exist anymore it absolutely cannot so needs to be a redesign of how hospitals get paid. That narrative is coming through which is sad. I don't think we're seeing the images that we really need to see and those stories and because of that I think people the public on whole. I think they need that. They need that sort of emotional anchor to help them understand how serious this is how this ravaging so many people less question. How was your stamina? This has been going on a long time with a lot of stress for going on two months. I feel that the long hours of residency training have prepared me for enduring some of the sleep deprivation and exhaustion physical exertion the remedy for that. Is I try to sleep and I try to. Exercise that physical exertion. I've learned in my career how to handle and deal with I think many doctors nurses have what has been more difficult as the mental and emotional exhaustion. And that's something I I in. A lot of my colleagues are still trying to deal with. Normally we don't have that sort of mental and emotional stress so it's day by day Situation we I've been trying to reach out to colleagues checking on them. People have been checking in on me which has been great and I hope this is over soon and it just take it day by day. Well our our thoughts and our prayers are with you here in New York every day. At seven o'clock people go to their windows and they clap for essential workers and healthcare workers like you and I hope some of that Applause and appreciation is felt and has some impact. But we really appreciate all that you and your colleagues are doing and thanks for your time great. Thank you master. Scale rapid response is a wait. What original the show is recorded? Remotely using sanitized audio gear. It's hosted by me. Bob Sapp Masters Scales editor at large and Masters scale host. Reid Hoffman our executive producer. June Cohen and Darin trip are supervising producer is J. job. Our producer is Jordan McLeod scripts by Cristina Gonzales original music and sound design by Ryan Holiday and Daniel Lisa bomb audio editing by Keith j Nelson Mixing and mastering by Brian Puke special. Thanks Emily McManus. Sarah Sanmen Kelsey Capitana. Tim Cronin Charlie Manassas and say this. Fbi DATA VISIT MASTERS SCALE DOT com slash rapid response to on the transcript for this episode. And be sure to subscribe to our email newsletter.