This podcast features an interview with Dr. Danielle Ofri, MD.
I’ve been working on networking with other authors and experts who can speak to the issues that physicians face every day.
For example, what can we do to make primary care more attractive? How can we lower the debt load that many medical students face?
That’s why I thought I’d bring a special guest to the podcast, Dr. Danielle Ofri, MD, PhD.
Dr. Ofri is a physician at Bellevue Hospital, the oldest public hospital in country. She writes about medicine and the doctor-patient connection for the New York Times, and other publications. Her lectures to medical and general audiences are renowned for her use of dramatic stories (and avoidance of PowerPoint).
This interview reveals the following:
– Learn about the amazing path of a combined PhD & MD program (& why Dr. Ofri decided to focus on one of these paths)
– Check out her views on the waste within the healthcare system & the one idea that could save our healthcare system billions of dollars!
– Her secrets of engaging articles & blogs & what kind of opportunities to look for
– Her key advice on how to become an awesome writer and what she did before she ever wrote a book
Dave: My name is Dave Denniston. Welcome to my latest episode on The Freedom Formula for Physicians Podcast.
I’ve been working on networking with other authors and experts who can speak to the issues that physicians face every day.
For example, what can we do to make primary care more attractive? How can we lower the debt load that many medical students face?
That’s why I thought I’d bring a special guest to the podcast, Dr. Danielle Ofri, MD, PhD.
Dr. Ofri is a physician at Bellevue Hospital, the oldest public hospital in country. She writes about medicine and the doctor-patient connection for the New York Times, and other publications. Her lectures to medical and general audiences are renowned for her use of dramatic stories (and avoidance of PowerPoint).
Her writings have appeared in the New York Times, the Los Angeles Times, the Washington Post, the New England Journal of Medicine, the Lancet, and on CNN.com and National Public Radio.
In addition to all of that… Danielle is the author of four books about the world of medicine:
*What Doctors Feel: How Emotions Affect the Practice of Medicine
*Medicine in Translation: Journeys with my Patient
*Incidental Findings: Lessons from my Patients in the Art of Medicine
*Singular Intimacies: Becoming a Doctor at Bellevue
Her essays have been selected by Stephen Jay Gould, Oliver Sacks, and Susan Orlean for Best American Essays (twice) and Best American Science Writing. She is the recipient of the John P. McGovern Award from the American Medical Writers Association for “preeminent contributions to medical communication.”
Danielle is currently working on a book about doctor-patient communication, while several unfinished novels in various states of disrepair gather prime New-York-City dust under her bed. Ofri lives with her husband, three children, loyal lab-mutt, and the forever challenges of the cello in a singularly intimate Manhattan-sized apartment.
Welcome Dr. Ofri!
Dr. Ofri: Thank you it’s a pleasure to be here.
Dave: First, tell us a bit about yourself. What inspired you to be a doctor? What’s been your journey like?
Dr. Ofri: Well I come from a family of one hundred percent teachers, educators, social workers. Nobody in medicine or science and I’m not quite sure how I got the medicine bug in my head. I think I originally wanted to be a vet because I had a dog and that was my goal and somewhere along the line it seemed to have lost and I think it’s because in my local high school if you like science you’re going to be a doctor. I had no idea what doctors did, I didn’t know you can be a scientist so I just went along that route. I ended up at McGill University in Montreal. It had a very late application deadline, I was a little behind in applying and I found myself in meshed in a complete science program. It’s a British style school and so I suddenly learned about the world of science and that real intellectual stones of science and only technicians go into medicines and so I said “Oh my gosh I have to go into bench science” and now I found the right to do MBPHD Program which seemed to solve the problem of both and I figured it out along the line. And so I did that, I had a wonderful time here in NYU and I thought I was going to Neurology since I was doing neuroscience research. But I had still one year internship which I did at Bellevue and I just fell in love with general medicine and stayed, so that was kind of a test to clinical medicine. I didn’t know what actors did but I love doing it once I got there.
Dave: Is this path going, getting a combination MD and PHD, is that additional, usually there’s three, four years of medical school, is there additional schooling you have to do for that? Or was it a longer residency or what is that?
Dr. Ofri: Well the medical school program instead of four years becomes seven to eight years. Usually you do the first two years of medical school and then go hibernate in a lab for three or four years, get your PHD and then go back to the clinical rotation. And now all your classmates are your residents, in some cases your attendings.
Dave: Your program going into residency after that or?
Dr. Ofri: You go through residency like anyone else, you’re equally unqualified once you finish the MDPHD program to practice medicine but you are now in your residency. So for me it was a long haul.
Dave: Wow.
Dr. Ofri: It’s about time I got into actual practice. I’ve been in school for a long time, I was sort of ready for it. I have expected I will be the typical MDPHD route is that you become a scientist who just wanted to work once a week in a clinic and mainly do clinical files and basically search. But I found that I really love primary care and also when I saw the world of research and the grand writing and the fierce cycle of trying to find yourself it didn’t appeal to me so much, although I love being in a lab and I love the science behind it, I just been seeing myself enjoying the rat race and grant writing.
Dave: Yes because you’re competitive, isn’t it? You’re having to compete and get money from large corporations in order to fund the grants throughout the time.
Dr. Ofri: Yes and it’s not only NIH grants but its seriously competitive and for most people they spend more time writing grants than actually doing research and I think that seems to be the challenge where if the research itself was wonderful but most people find it up there time, energy sassed by the grant writing of forever treadmill. And I was thrilled to be doing medicine.
Dave: Good you get to interact with the patients and got to do some other things, still do some of your research I mean obviously you’ve been able to have other outlets and one of the ways I connect it with you was by finding your blog and I thought you had a great post on there that talks about the ethics of money in medicine. I thought it was such a good post. You said, “The duty to take care of patients is the foundation of medicine, and all other concerns emanate from this primary mandate. This is distinct from other industries in which the primary aim is to earn money.” Tell us more about this and why you feel this way.
Dr. Ofri: As you mentioned I worked in a city clinic at Bellevue Hospital. It’s a big city hospital in New York and in a safety of a hospital, one of the reasons I love working there is that the patients are all wonderful and you do feel you’re doing something important and you can start to see how money can get in the way. A patient I sited in this article who was going to the pharmacy to get her medication and suddenly here Albuterol inhaler was a hundred and sixty eight dollars. She hadn’t had a, whatever she was, it was shocking. Albuterol has been around for fifty years and most countries it’s over the counter for seven dollars but she couldn’t do with that, she had not taken a blood pressure pills in that month because she really didn’t have the money. Ana that kind of thing, as a doctor its terrifying that in this course it’s incredibly cost ineffective because if she didn’t get her inhaler she will end up in the emergency room, generate ten thousand dollars’ worth of bills on behalf of medication that probably cost five bucks to make. And we hear about cost cutting and then feedings, which of course I support and we should be, extreme lining up cost but this types of thing puts on the backs of the patients and the backs of their direct health seemed absurd and also just seems immoral.
Dave: I think it’s a good point that if were trying to save cost that having someone run to the emergency room because they can’t get the medicine that they want seems kind of counter-intuitive.
Dr. Ofri: Yes I mean people remember until they’re supposed to stay, its common then. If you want to get medical care just go to the emergency room. Of course it’s a terrible way to do it and terrible medically and if you just continue thinking about cost it’s absolutely terrible financially.
Dave: I think one of the things that can be so interesting is the tension between hospital administrators and physicians. There seems to be more of a profit motive going on for those running the hospitals. What do you think? How does this compare to pharma or devices or other health care related industries?
Dr. Ofri: Having not been in this industry I can’t speak absolutely with conviction but medical device companies are there to make money. There’s no bonus about it, the pharmaceutical industries are not there for our good wishes, it’s there to make money and their secondary aim is to provide the medicines that we need but not as a charitable service, it’s there to make money. So that is the first fall, you don’t have to, it’s a little bit different technically non-profit money of course non-profit hostels make quite a bit of money. so at the very least our goals are different, I think it does, administrators a bit I think that those who choose the hospital administrators still has a primary motivation for health care and not too much for money. Nevertheless you can come in conflicts with physicians and sometimes good example is somebody’s quality measures that hospitals are immeasurably very high tech about. So a couple of years ago when the guidelines for mammograms were relaxed because every year, every one to two years, changing of the guidelines cannot be as strict because the data for benefits can be debatable. Nevertheless the quality measures indicator is annual mammogram, so now we got email saying: although we got emails saying you have all these new guidelines have come out, you still have to remember to order the annual mammogram so in essence our numbers will conclude. So they’re seeing it differently than we are and of course we will be penalized and we look like we’re giving less quality care if we don’t order mammogram annually. So it can be that conflict between administrators and physicians in that type of thing. In my residency I did a summer spent in the family practice and we were sitting down at the desk and there were just stack of insurance forms for all of the different insurance companies that patients had on my desk, the patient when they need an eye exam so I have to pull out their insurance and how does that insurance company reimburse an eye exam every paper work and its different from different companies. We had three administrators per one physician just to deal with the different insurance companies. So that’s one way we’re incredibly grateful financially but also time wise I mean is there any reason we count have standardized forms for each of this different health insurance company? Why is it have to be reinventing the wheels for each company? It’s not that different, I was just doing a chiro authorization. Every company has a different form, it could be standard, it’s not that hard. Its diagnosis, medications, reason and make it online and they could have a standard form. We have a standardized size of knots and bolts for plumbing, I think we can do that for paper work in medicine.
Dave: Streamlining would be awesome. One of the things I think about too for many docs, I mean like in your case it’s a great example of here you spent all these time in education and so in most cases you’re ten years behind most of your peers before you start making money, so the way the system is currently set up with residency it seems like it could really be palpable to change that unless residency and fellowship change. I just saw a pediatrician in my office the other day. She has over $300,000 in student debt and is just completing her first year of residency. I gave her a copy of my book, the Freedom Formula for Physicians since there’s a lot of great info in there about debt reduction programs for docs. Anyhow, we talked about how for a primary care doctor like herself, that going into fellowship is a losing proposition. She’ll only be making marginally more and delaying that big income jump. It really struck me that we have to change the system. We’re going to have to do some out-of-the-box thinking.
I was noodling around the idea, can’t we attract more residents and more fellows to primary care if we increased the salaries in the 3rd year of residency? Could we cut a year or even half a year of residency? Could a year of their medical school debt be covered by a commitment to primary care for the first 10 years of their career? What are some more of your thoughts on ways we could change the system?
Dr. Ofri: It’s interesting when medical students attend medical school, in residency they pay the same tuition and call the same debt. Some physicians who will go into some specialties will make two or three times than people who go to primary care. Somehow that seems intrinsically unfair and I think we necessarily can decide how to, well there’s one thought of should we regulate how many specialty physicians are available. Here in Manhattan you just go down the block and there’s dozens of dermatologist and cardiologist but it’s always harder to find primary care doctors. And so one thought that people have folded around is regulating the number of residency slots based on what society needs and not what anyone wants to do. Now you can see that it will be met with such great feedbacks from doctors, I think people want to do what they want to do but we could make certain fields more attractive and clearly the shortage in primary care areas and we have no shortage of those specialists. And so forgiving a year or two of debt or some percentage of debt for the medical school I think makes perfect sense and that’s how the communist always adjust the things in the society. We give tax breaks or deductions to things of what people want to do, for example mortgages and tax the things they want to do less. I think that would be a wonderful idea, I think it would also be awesomely be cost effective if we had more primary care doctors especially in underserved areas. Again besides being morally the right thing to do I think it would be our money saver for the health care system overall.
Dave: Yes absolutely. Well I’d like to bring it full circle and talk again about your books. You’ve written quite a few! I think it’s really cool that you are doing all of this. What advice would you give to other doctors who are considering writing their own books or looking to get on the speaking circuit? What tools would you tell them to use?
Dr. Ofri: Well I think it all depend on what your passion is. I didn’t planned to become a writer or a public speaker, as I’ve said I planned to go into research and it only came about as I became interested in these topics and began writing about them and I will highly recommend getting some writing training. You wouldn’t do any medical procedure without being trained how to do it, I think the same thing can we said for writing. No one wakes up and becomes James Joyce overnight, there’s a lot of craft to learn, so I for example took a number of writing classes in the very beginning. I was in groups and then one on one with writing teachers and these were extremely valuable. I didn’t makes me the Nobel Prize writer but it improved my craft greatly and it took what ability I had and refined it to the point where my writing became much better. So I really recommend that anyone who wants to write work with a writing teacher or a writing class to hone their skills. There’s much that can be learned. Then it takes on a lesson of its own, for me I began, it took off a year and a half after residency and to travel and it’s a welcome tenants for doctors which was really a lot of fun and that’s why I began writing. I wasn’t writing or aiming on writing a book, I just want to write down some of the experiences that were so intense during residency. I trained during the height of HIV epidemic and it was a very intense time that there was no much time to think about the ramifications of what we were experiencing. So for me those eighteen months were time to write and think and then I began taking writing classes and at some point my teacher said I should write and I began submitting the essays to literary journals, it’s a great place to start and some medical journals. My first piece was in Jama and it’s a good way to start. Then you get invited to some speech and it’s all great around and the more you write the more people invite you to come speak and the more you’re invited to write for other publications. The thing is be open to meeting people wherever you go, when people have questions engage in conversation. You never know who you meet. You speak to a group of thirty people, one person may work for a journal or work for a publication and then ivies you, so I answer every email that people send, even the ones that are negative, I always respond and engage people and each connection opens up another door. So be open to that, be sociable and then be also be true to who you are, I mean when I first got an agent she said: oh well make you enough money so you will quit your day job. I said: No I don’t want to quit my day job, I am a doctor and that first I want to write about what I do but I don’t want to see writing as a way to earn salary so I can quit medicine. I am a doctor and a number of doctor commentators no longer see patients and I don’t want to be that, I want to be someone who’s first and foremost a practicing physician. My observation test some credibility but that’s also who I am, I want to stay true to my ideals and so I will turn that for example, I was invited a couple of times to give interviews for commercial ventures and I won’t do it because for me when I publish a paper or being able to say as no conflicts to dispose is very important. It will cart or preserve my independence and then I’ll never, I don’t want anything I do tainted by any commercial connections.
Dave: Very good. Well what can we collect to see from you in the future? You mentioned to me earlier you had a new book that you’ve been working on as well as several others that are in various states of disrepair, what do we expect to see from yourself in the future?
Dr. Ofri: The novels are under the bed and theoretically a whole bunch of them out, when I go on vacation and then I tend to go back under there but you know I might work on that again. So the book I’m working on now is loosely titled: What Patients Say What Doctors Hear and that came about in researching what doctors hear, I ended up interviewing the doctor, between him and a patient for whom he had a bit of a friendship outside of the office, that’s a topic I was interested in and I later interview the patients who give a completely different story and those kind of patients where thoughtful, intelligent people, very, very ethical but they saw the events that transpired between them in completely different way. And had I not known it could be two different stories and I was so fascinated by how that could be and I think that’s a very common scenario even with wall meaning doctors and patients that doctors hear the story very differently than patient tell a story. And that this could beside just not being good medicine you can imagine how many errors could take place besides no sees and I think a lot of patient’s frustration is around the area of not being able to convey to the doctor what they really mean and what they need and I think doctors even well-meaning doctors often missed the boat because they’re not getting it. And so I’ve been curious about this area of a doctor-patient communication and that’s what I’m working on and I’m looking to other doctors-patient-peers interview, so with a nurse or a doctor or a patient, and think they’re accounted for a part, doctor or patient who will be interested on talking to me please email me, contact me at my website danielleofri.com and anyone is anonymous as they wish to be and my goal is not to expose only one or people’s terrible errors but to see how communications can go array and how they can be improved upon.
Dave: Thanks again for joining us Dr. Ofri! I’ll look forward to reading your next post and your next book.
If you are a physician wanting to tell your story, grapple with these tough issues, and get on the soapbox for a few minutes, I’d love to share it too in the next Freedom Formula for Physicians Podcast. Make sure to contact me at dave@daviddenniston.com or on my website daviddenniston.com/physicians.
For the Freedom Formula for Physicians podcast, this is Dave Denniston. Thanks so much for joining us and make sure to subscribe and check in again soon! Have a good one.
