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Pharmacy Leaders Podcast: Inspiring Pharmacy Leadership Interviews

Jan 19, 2018

Interested in having great investments, control of your finances, a profitable business and a happy family? David Draghinas, an anesthesiologist, started the podcast Doctors Unbound to interview those experts that can help you get there.

It's a show that highlights doctors doing interesting things outside clinical medicine, and the experts that can help them. Starting a business, or blog, investing, writing, or entering politics, this show gives you a behind-the-scenes look at doctors doing amazing things.

Full Transcript: 


Welcome to the pharmacy leaders podcast with your host Tony Guerra the pharmacy leaders podcast is a member of the pharmacy podcast network with interviews and advice on building your professional network brand and a purposeful second income from students, residents and innovative professionals.

Welcome to the Pharmacy Leaders Podcast. Today I have a physician on, who is a fellow podcaster he is a physician podcaster at He's a consultant, an investor. He calls himself a perpetual student. He's an anesthesiologist by specialty, a graduate of the University of Southern California and currently practices in the Dallas Fort Worth area. Dr. David Draghinas, welcome to the Pharmacy Leaders Podcast.

Hey thank you so much for having me.

Great, well I wanted to start off with just a quick background. Everyone's leadership road is a little bit different. Tell us a little bit about where you've been and how you got to where you are today.

Sure, so I am currently a full-time practicing anesthesiologist and I've always been interested in how technology, the rise of the internet, social platforms can impact healthcare and its delivery at a greater scale. So about five years ago with a buddy of mine we created a website called anesthesia myths and the reason we did that is because we noticed that a certain subset of our patients came to the operating room just completely scared of anesthesia. And a lot of times, you know, they'd been scared for days or weeks getting on their googling information about anesthesia and when I googled myself I found out that there was a lot of terrible and misleading information about anesthesia and anesthesia related topics. So we created this website Anesthesia Myths to hopefully explain in simple language to people different topics about anesthesia and hopefully allay their fears a little bit. And building on that success a more recent project is Doctors Unbound which is a podcast where I get to talk to physicians doing amazing things out there, typically outside of clinical medicine. But my idea was to highlight physicians and really healthcare professionals. This can work for pharmacists, other healthcare professionals as well but I wanted to connect with them I wanted to learn from them and I wanted to highlight all the awesome things that these healthcare professionals were doing out there to hopefully uplift the profession.

Okay well in a recent political interview you actually spoke to a physician, I think this was actually your last episode on the.


On Doctors Unbound and we only have one pharmacist represent, we only have one pharmacist in Congress, all of Congress. Can you tell me a little bit about what he talked about in terms of being an outsider? How we, you know, this staying, you know, talking and doing this kinds of I guess, I'd say advocacy is actually, puts you as an outsider inside Washington.

Yeah, so that was Dr. Andy Harris and I believe he's our only anesthesiologist in Congress. He represents a district in Maryland and, you know, that's what Andy was saying and what I agree with is, we need more physicians, we need more pharmacist healthcare professionals out there. It's kind of crazy that we're considered outsiders among Congress but we actually need these people who understand how health care work to help, you know, shape this policy that affects all of us for patients and then obviously for the professionals as well. I think those interests are aligned.

Yeah and a lot of your advice in the interviews that you do kind of fall into three categories and what I wanted to do with this interview is kind of call attention to those categories and get some comments from you on the guests that you had.


As I saw it was kind of purpose and family. Why do you make the money in the first place and family always being first and then, you know, how do you make the money outside of maybe the traditional professional roles whether it's pharmacy or nursing or physician and then we have many high-income earners but then it's keeping it. You have a number of your guests have kind of talked about how sure you're  going to make X number of dollars and maybe the student thinks, oh well, it's  going to all be okay I've got four hundred five hundred thousand in loans. And it'll all be okay because I'm  going to make a quarter of a million dollars a year but then we find out quickly how little they keep and I think it's a little less than half to be honest. So maybe we could start with organizing your time in life. The very first episode you did was, why you are doing the podcast and it's always good to kind of reflect and say, okay why am I going to do this, why am I going to take time out. So tell me a little bit about the frustrations that you've personally encountered with physicians and health professionals that made you put this extra piece in your life.

Yeah, so like I mentioned a little bit earlier I've always been fascinated with the technology side and, you know, if you survey physicians out there you see that there's, you know, there's growing frustration among the ranks and I think this is multi-factorial. Physicians are becoming more and more employees. We're losing a lot of our autonomy, you know, that's part of it the stress of the job, the long work hours of the job, you know, that's part of it as well. So there's a lot of that kind of building up and I wanted to connect with other physicians and highlight what they were doing, you know, like you said for all those different areas, you know, create this community that we could all learn from these physicians out there that we're doing pretty awesome things.

Okay, well you went right to, just kind of talking about mindset after I think you were talking about a book that you had read and that there's this kind of divide between the person who thinks, okay well I'm smart I get good grades but then the person who's the hard worker. And we're both parents and I think you have three kids, is that right?

That's correct, yup.

Okay, so when you when your child does well my understanding is that it's better to tell them, yes, your hard work led to that end point. Rather than wow you're really a good basketball player or you're really a good student. Can you talk a little bit about that kind of mindset?

Absolutely, so the book was called mindset I forget the subtitle but it's by Carol Dweck. I believe she's out of Stanford now and like you were saying she really breaks down the difference between a fixed mindset and a growth mindset. And the idea being that somebody with a fixed mindset believes that, you know, there's sort of inborn talent either you got it or you don't and there's not much you can do to change it versus somebody with a growth mindset that believes that sure there may be some talent there that, you know, we're blessed with but we can drastically improve either areas based on our efforts. So, I found myself very intentional like you were mentioning with my kids. Praising their effort, praising their creativity, praising hard work versus just saying, oh you're so smart. Because they've done some studies with this and they found that kids that believe, you know, who are more in the growth mindset when they encounter problems that they cannot immediately solve they are much more likely to stick with it and work towards a solution. So, you know, with something like entrepreneurship, right? Because what are entrepreneurs at their core really? They're problem solvers, right? So the ability to kind of stick with a problem, keep at it, be creative, come up with creative solutions that can work for everybody those are all growth mindset things. And that's what I'm trying to instill in my kids as well.

Well when we, you know, have our children we want them to have great lives and careers that are satisfying to them. We might find ourselves with them saying, oh hey, I got into medical school or hey, I got into pharmacy school. But then you had an episode where you have burnout and you talked to a physician who had kind of had enough of the bureaucracy, the administration and all those things. Can you maybe talk a little bit about how you're seeing both sides of it? Where, you know, you've got these great expectations and then some of those expectations maybe fall a little flat once you're in practice.

Right, so I think if somebody is experiencing some dissatisfaction in their career and they're, you know, considering something drastic like a career change or they're experiencing burnout something like that. I think the very first thing that's important is to drill down and really figure out what it is that's making them unhappy. Because sometimes it might be not that you're dissatisfied with your career choice maybe there's something specific maybe there's a specific part of your job that you don't like. Let's say you're an anesthesiologist. Maybe you really don't like to do cardiac cases but you really like obstetric anesthesia. Now you can tailor your practice hopefully to eliminate the parts you don't like keep the parts that you do like and be happy that way or maybe it's a particular person or a particular, you know, environment. It maybe it's a particular place that you work that is causing the unhappiness. So I think the very important thing to do is be honest with yourself, be able to do a little bit of searching and figure out exactly what it is that the problem is maybe it's something that you can adjust. And then by adjusting, you know, you can continue in your career for a very long time with a lot of satisfaction and happiness. And only consider a career change if after doing kind of that really deep introspection, you know, you find that, okay, this really isn't working for me.

Now on my understanding as a pharmacist I don't necessarily know how medicine works but in residency there are certain specialties that are preferred over others and to some extent the hours are quote unquote better. I don't want to say they're good but they're better and my understanding is e-emergency medicine and anesthesiology are two of the better ones in terms of those kinds of hours. But how much does that factor in and do I guess, where do medical students, how much choice do they really have and you know once you've taken the USMLE is it over like, it's like that's your score that's your residency, you know, or how much movement do they have I just don't know as a pharmacist.

Sure, so there's a couple of things going on. Traditionally, the special, sort of the specialists or the sub specialists, if you will that the pay is better versus primary care. That's probably one big reason why you know everybody talks about the primary care shortage. The way reimbursement happens, if you're a specialist your pay is typically better. So that's one aspect of it. Yeah, so that makes the special, you know, and again these are all generalizations.


So that makes some specialties especially surgical subspecialties maybe a little bit more competitive a little bit tougher to get into. So I think that's part of what you're, you know, you might be hinting at. Once, you know, so of course board scores becomes a part of it then you get on the interview, you know, interview trail and that's a part of it. And once you get into a residency program then it becomes it's not impossible but then it becomes, you know, quite a bit more difficult to switch residency's or to switch specialties. It does happen but it's a little bit more difficult.

Okay, well you talk a lot about finances where you interview a number of people who are specialists in finances and in personal finance in a lot of cases. In episode 10 you talked about making a living or making a life and this kind of also encompasses some of your other episodes. But I guess what I really want to know is, how much are student loans impacting decisions that students are making. I feel like if I had four hundred thousand in debt and the quick math is to just double the amount of loan to know how much you're going to actually pay back. So I'll pay back about three quarters of a million dollars. How much does that impact a physician's choice of specialty and do they maybe pick something they might not want it much or because of this debt because it seems we had our average debt in pharmacy as 160. When I started hearing physician debt I started appreciating that that wasn't that bad.


Quotation figures.

So I think it definitely impacts people's choices of specialty unfortunately. I think that's definitely the case and as you just hinted people getting into their medical training with that large amount of debt and then getting into a specialty maybe they've chosen for the wrong reason and it's a competitive specialty and there's a lot of stress and you don't enjoy it. You can see how this can impact burnout in people feeling like they're stuck. Even though they're in a high-paying field because they've chosen maybe for the wrong reasons that are not enjoying it and just to add my personal story I went into medical school not knowing what specialty I would like. And I went to an expensive medical school. I went to a private school, I went to USC, fantastic school fantastic clinical training but it is a private school and so I was  going to have, you know, quite the loans coming out. And even back then I knew that I did not want money to impact my choice of specialty. So what I did is I chose to do a military scholarship. So I was in the U.S. Navy, paid back three years, three and a half years for in exchange for them paying for three years of my school. But one of the big reasons why I chose to go the military route was because I thought to myself, hey, what if I love Pediatrics and Pediatrics just isn't reimbursed as well. I want to be able to choose Pediatrics and not worry about having this, you know, these huge loans over my head that I won't be able to get out from under them.

Okay, and that kind of led me to episode 15, which is who wants to be more happy. But it sounds like, really getting this financial piece in order, is it more that what you're buying with that with being kind of mindful of the finances is some kind of flexibility or more autonomy in a health care system that really is kind of taking a lot of the autonomy from us.

Yeah I think the money part is a big part of it because of that and what I like to tell people is that, you know, wealth or money does not give you happiness but a lack of money can certainly cost a lot of stress and unhappiness unfortunately. So that's kind of how I look at it so, you know, money is a tool, money is a tool that obviously buys us nice things to take care of ourselves, to take care of our loved ones and just like you hinted at it also can buy us freedom so that we can work on our terms, right? Maybe you want to dial back to part time, maybe you want to be able to have that confidence to go in and negotiate better so, you know, what I'm going to be working, you know, this type of work but not that other kind of work. So money I think, you know, if we are good stewards of our money it allows us more freedom in all those senses.

Okay, well let's go on to some of the businesses and the side businesses that may be turned into full-time jobs that you had on some of the interviews. Episode two you brought in a physician who I think she spent five years putting her book together or finally getting it out but, you know, having heard her story what would your recommendation be to somebody who wanted to be an author? Would you go the self-published route or would you recommend going through a traditional publisher?

So, I think it depends on the purpose or it depends on the person. You know, I think many of us have writing a book on our bucket list. It's probably on my bucket list too even though right now is not quite the right time for that. But I think basically what you got to do, just got to do a little bit of research out there and really understand, you know, how much help you need and what's important to you. But what I really love is that, in the environment that we are now, you know, the major publishers for the longest time were the gatekeepers, right? So if you couldn't get.


A major publisher to just sign on and publish your book you're kind of done. That was the end of the story and now having a self-publishing option is fantastic and what you can do is, you know, you can search online and find an editor you can search online and find an agent. So you can you basically can go and seek out all of these pieces yourself and figure out some kind of option that is best for you. Maybe that's self-publishing, maybe that's some kind of hybrid model, maybe that's a traditional publisher. Some people still want to have the prestige of a traditional publisher but I think what's great is that those gatekeepers have been removed and if you think about it you and I are sitting here on a podcast and if you, what is a podcast really? It's, you know, a radio station without the gatekeepers, right?


So I love podcasting as a medium, you know, that's why I got into it myself because those traditional radio station gatekeepers have been removed and we can talk about a podcast, we can talk on a podcast here that is specific to pharmacists and those healthcare professionals and we can have a great show about it and I can do one for physicians and I think that's just so awesome about the times that we live in.

Well, let's transition to another episode. Episode 5 where you interviewed someone with six-figure medical writing and my initial thought was going to be, oh, this is somebody who works night and day writing. But if I remember right she had about 40 writers and she kind of created a company and specialists, kind of share the wealth and I guess going back to my own life where, you know, my wife asks me to do something my initial thought is I have to do it but what she really wants to see just wants it done. So when somebody asked for medical writing they just want it done. So can you talk a little bit about what it's like to or what you know kind of tips she gave in terms of kind of starting that business and growing that business from. She was doing the writing to kind of getting other people on board.

Right, so that was Emma Nichols and she was a PhD and she found out that she really didn't like academia she really didn't like the bench research but she really love writing. And so her career of course transitioned. She started off first by, you know, cutting her teeth figuring out how to do the medical writing online and growing that way and eventually it, like you said, it turned into a business where she coaches others how to get into medical writing and then she actually has a writing business where she can actually get the writing gigs if you will and pass them on to people within company and her network. So if that's something that interests you, what I would do is because I think a pharmacist like physicians other people that are, you know, higher income professionals by the time we've gotten to where we are at we tend to have a little bit more money and a little bit less time. And I am the type of person where I'm willing to trade some money in order to get somebody to coach me up or mentor me up for whatever it is that I'm trying to learn. So I think with something like this it's definitely worth going through, you know, a coaching program or something where, you know, you're not going to spend the hours, you know, doing it wrong and trying to figure out how to do it. You know, you're going to find somebody who knows the ropes, learn from them and then you're going to be able to take off that career a lot quicker.

Well, tell me a little bit about startups, episode eight and nineteen. I don't want to put medical marijuana and healthcare startups together but starting a business when you're already a busy professional. What recommendations do you have for maybe first steps? How do you start a start-up when you have just a couple hours a day if that?

Sure, so that episode with healthcare startups. What I really liked about that episode is that we were able to kind of deglamourize, you know, some of the romance and mystique, you know, in start-ups.

Yeah, yeah.

Because, you know, start-ups are kind of like the cool thing, you know, they're the cool kid, right? Everybody is, startup this startup that, people are throwing millions and billions of dollars at startups. And the truth of the matter is start-ups are just a lot of work. There's high failure rate, right? Because if you think about it business is so cutthroat the market doesn't care who you are it's either going to like your product or it's not. So I loved that it was able to kind of deglamourize, you know, some of the aspects of startups. But like you said, I think as physicians if you're not going to completely do a career transition I think the ways that physicians, pharmacists, other healthcare professionals can get involved is either by trading some knowledge some, either some sort of knowledge, what's the word I'm looking for? Advantage that they have, you know. Let's say you're a pharmacist and you really know about some specific, you know, drug product or, you know, particular drugs that are coming out. Now, you know, you might be able to take that and leverage that into maybe some consulting work with a particular company. You know, they'll say a drug startup or leverage that into a piece of equity or something like that. So I think that's where healthcare professionals can really do well is leverage their personal experience, leverage their expertise into providing maybe either some kind of consulting and maybe even a piece of equity. So that they have a piece of that company but they're not the ones who are running it full-time. Because, you know, like we talked about earlier if you're going to be the one running the startup then that's a full-time gig and a half.

Okay, all right. What about this medical marijuana practice the opioid crisis medical marijuana coming together at the same time? It seems like kind of a strange dichotomy but tell me a little bit about this physician who has a medical marijuana practice.

So that, you know, so that episode was actually very interesting for me because, you know, my background is that I'm pretty conservative I grew up very conservative. So honestly before I even decided to do the podcast I was thinking about actually publishing it. I, you know, I had a little, I had some reservations but I said, you know, what let me get out there, let me listen to this physician and keep an open mind about things. So for me, you know that episode really kind of challenged, you know, some of the things that, you know, maybe we're biases of mind towards marijuana and specifically to, you know, with regard to medical marijuana. You know, I think if used appropriately under proper physician guidance, you know, I see it as potentially another tool in the toolbox to help physicians care for patients. Because, you know, like you were alluding to the opioid crisis is, you know, is a very real and devastating thing. You know, I learned a ton about medical marijuana in just a different ways that, you know, it can be consumed. So I learned a ton from that episode. But I think again it's something that, you know, we have to proceed with caution.

Okay, well we've talked a little bit about family, a little bit about building businesses and some side businesses. Let's talk about keeping that money. Episode four was probably actually one of my favorites because he talked about the difference between financial independence and financial freedom. And I was really surprised at his two numbers. He said 25 X was his financial independence number but then I think his cost was only like 60,000 a year. So there's a couple pieces here. Can we start with what's the difference when financial freedom and independence.

Yeah, so I went back and I looked at I believe that it was the episode with physician on fire. And I went back and looked at some of his definitions and financial independence I think is the idea that you can replace your expenses or you can cover, I should say you can cover your expenses with, you know, other sources of income without having to work so whether that's investment income coming in whether that's, you know, what, you know, the interest that's coming off of your 401 K and your investment accounts, etc. And I believe the way he defined financial freedom was covering his course spending plus two times his discretionary spending. So it's a little bit more there but that gives you, you know, a little bit more wiggle room. Let's say, you know, as you grow older, you know, you're expensive you're things that you may want to spend on can potentially go up. But when I did that when I did the preparation and did that podcast the thing that struck me is, you know, as high income earners we all we're always thinking about how much money we make and how do we replace the money that we make. But really to be, you know, financially independent you have to replace the money that you're spending. So, you know, if we can live in, you know, I don't want to say necessarily frugal but in a, you know, in a way where we're just not spending willy-nilly. You know, you can get to that number a lot quicker and I'll add this final piece. They've done some research on happiness and I understand that happiness can be kind of a vague term but apparently after about seventy five thousand a year of spending.

I've heard that number too, yeah.

Yeah, your happiness doesn't really go up so, you know, a good number to shoot for I guess.

Yeah, yeah, okay. Well many of us use real estate. Some of us were lucky enough to buy an 08 or 07 and some of us, you know, bought way before that and I've made well through real estate. You had somebody on about multifamily real estate. So I have my house and then one investment property. But can you tell us a little bit about what it is to have more than one property?

So I've got a couple pieces of real estate and, you know, I'm, you know, I'm not an expert on real estate and you'll always hear the debate between multifamily and single-family. And I think most people who are making the argument for multifamily are going to make the argument of scale, right? Because, you know.


We have more doors under one roof, you know, so you can achieve a lot of economies of sake of scale in that method, thus the catch-22 if you will is that in order to buy, you know, any significantly sized multifamily you're  going to need a lot of startup cash. So unless you're independently wealthy which, you know, certainly most doctors and probably most pharmacists are not. Then you're probably going to be looking at some kind of a syndication deal where you're going to come in as an investor into a multifamily investment.

Okay. Well tell me a little bit about financial education. So you've done a couple episodes, episode 11, episode 14 and I had heard of the white code investor I'd read his book before. And, you know, I'd say, wow that was, you know, the famous guy you had on your podcast but then you brought in a congressman. So I'm like, all right well I don't know which Trumps which. No pun intended with the president but what can we take away from the white coat investor or his kind of thoughts because my understanding or when I was listening to the episode was that he was kind of a little bit sick of the way that maybe some financial and I'm not making a broad generalization here but some of the financial professionals that he ran into were giving some what he called very bad advice terrible advice. And that maybe some physicians are being taken advantage of because they may not keep a good track of, you know, their spending and things like that. Can you talk a little bit about some of the best takeaways we can take from the white coat investor?

Yeah, so just like you said and unfortunately probably among pharmacist just like among physicians there's very little if any financial education in our medical training. And our medical training is so rigorous, right? And you end up not having any time for it and just like white coat investor the same thing happened to me. As I was finishing my residency training I realized that hey, you know, my pay is going to go up and I don't know too much about money and I need to start learning now. So, you know, a financial advisor versus not their pluses and minuses to each one but what I think is imperative is, you know, nobody's ever  going to have your best interest like you do, unfortunately. And it really is time well spent even if you don't become an expert is to really start your financial education. In sites like white coat investor among the physician community there's a couple more there's physician on fire, passive income MD. A lot of these have come about because physicians really haven't had a lot of financial education and these physicians have seen the need and are providing some of that education there. Now I'll say one more thing about white coat. He is starting a course I think it's going to be starting soon and one thing that I like and I don't know if you've taken any courses but one thing that I like about courses is that it gives you kind of an A to Z in one complete package. So, you know, there are a lot of great blogs and websites out there where you can read a lot of free information on financial topics and that's probably a good place to get started. But what I like about courses is that you know you're going to get something kind of like soup to nuts in one, you know, like if you just follow the course from beginning to end. So I know white coat is starting something like that and I am looking at potentially being an affiliate of that and what I may do I, it's not a hundred percent yet but what I may do is do the course myself and I might create a little group and see if anybody wants to do it with me and maybe we'll go through, you know, lesson by lesson. Because I know I've got, you know, I still have stuff to learn too so I think that'll be awesome.

No that is awesome. And I guess that the fear we have. Well, I don't want to say fear but maybe technology is kind of coming in and we're I don't know we were given the promise that we'll always need pharmacists, we'll always need physicians. But my own experience with human-computer interaction and hearing about radiologists is that if you have two radiologists look at the same film you're much more likely to make a correct diagnosis. But then now they have I think some AI or some kind of technology that can replace the second radiologists but now there's the concern that are they going to also replace the first radiologists. And you've had someone on, you title the episode Future-Proof MD but let's try to make it may be Future Proof Health Professional. How can we make sure that technology doesn't nudge us out?

Sure, absolutely and Future Proof MD himself was a radiologist.


So that was interesting that's why I hit him up with that question but I think regardless of whether you're radiologists, a physician, a pharmacist, right? I think we all have to have the mindset of embracing technology. Embrace it, understand it, understand its limitations and figure out how it can improve patient care. Because that's how we're going to be the consultants and the experts, right? I think if we fear it if we try to keep it away, number one that's not going to work in number two that's going to do a disservice to our patients. So, I think what we have to do is just embrace it, become the experts at it and then by doing that yeah, maybe the way we practice our field is  going to change but that's okay. You know, that's I think just the best way to handle it.

I'm  going to go back to a prior episode just because this visual was so stuck in my head but my understanding was there was like a 400 pound patient that was upside down or something like that and some of the new technology and I didn't really understand that. Can you talk a little bit about how sometimes once a system gets a new technology and spends all this money on it that now they kind of put a little pressure on the healthcare professionals to use it? I didn't know the technology and I hadn't had a chance to look it up but are there instances where maybe, you know, the technology comes in and it really isn't a good fit but the establishment kind of says, well we're  going to use it we bought it?

Sure, so the story you're alluding to was in the burnout episode where.

Okay, yeah.

The doctor put medicine and what happened was he was talking about a time when he was practicing when the, I'm sure everybody's heard of the Da Vinci robot by now hopefully.

Okay, yeah, yeah.

So back when he was talking about the Da Vinci robot surgery was very new and when those surgeries are done typically now we use them a lot for gynecologic surgeries or for prostate surgeries. The patients have to be placed in what's called steep trendelenburg position meaning steep head-down position. So you can imagine a patient that has to be in a steep head-down position, the physiology of that when you have a 400-pound patient. Now sometimes you just can't do the surgery when the patient is that large because it affects the respiratory physiology too much. So what was really tough in Dr. Krista's situation was because the robot technology was so new the surgeon was still learning how to use the robot. So a surgery that might take two hours was taking eight hours.

Oh my gosh.

So as the anesthesiologist, you know, we hang on every pulse ox beat, every heart rate, every blood pressure, you know, is, you know, it's like, so we hang on every one of those. So I think that's what made it so difficult for him is because he was in an environment where apparently the surgeon and the hospital staff and everybody else was not aligned with, you know, him trying to protect the patient and the patient interest. Now fortunately for me, I can say that, you know, the vast majority if not all of the places where I work not only is my anesthesia group supported of me as, you know, as the patient advocate but I would say, you know, the surgeons that we work with understand our expertise and that we are, you know, we're there for the patient's best interest. And I'll have that conversation with my surgeon and we might put that patient in that steep head down position and we'll do a little test and I can tell them, you know, this is going to work or this is not going to work. And I've actually had a case where I had to tell the surgeon, you know what, this patient is not tolerating this. And we had to convert in and adjust the surgery. So it's all about the practice environment, you know, aligning everybody's interest because come on let's be honest if that patient has a bad outcome, you know, that's not good for the surgeon, that's not good for the hospital and obviously, you know, number one is we got to take care of the patient.

No, absolutely. A number of pharmacists are trying to work with physicians but physicians are busy, pharmacists are busy. How have you guys in your practice or how have you kind of gone inter-professional with maybe other practitioners or kind of gone across lines from just the physician and so forth? Do you have any examples of that that could maybe inform or help the pharmacists listening?

Yeah, so I think that's one of the tough things about medicine because, you know, medicine even among physicians is so siloed, you know, you have this specialty, that specialty and we don't see ourselves very much. And then, you know, like you were saying inter-professionally with pharmacists that's, you know, that's even tougher. You know, pharmacist for us, you know, we interact with them not on a daily basis but it's important for us to act with them because, you know, I use medicines all day every day when I'm taking care of patients. So I think one thing that's helpful for us that work in the operative environment are working on systems that help with let's say, you know, drug shortages for whatever reason. There's probably multiple of them. You know, drug shortages in hospitals.

IV bag shortages right now.

Yes even IV bag shortages.

Yeah, yeah.

So figuring out methods of communication, you know, early advanced email systems or things like that where hey, we as anesthesiologist get early fair warning, you know, from our, you know, pharmacists colleagues. Hey, you know, this is the stuff that is kind of not completely short yet but, you know, it's kind of, you know, green light yellow light blue, you know, green, you know, red light sort of thing. So for coming up with systems of communication to, you know, to keep track of these shortages I think that's huge. I actually crowd-sourced this question in some of the physician groups and a lot of physicians were very thankful for pharmacists because pharmacists, you know, have a very specific knowledge base, can really help us, you know. That one person who is especially was working as a hospitalist in pediatrics was very thankful about the, you know, the expertise that pharmacist bring. But communication is a big one. One where people, how do I say this? Where I think maybe our communication can be better. As far as interacting with patients and giving patients advice on taking or not taking medicine versus keeping the physician in the loop or perhaps talking to the physician first. And I don't know enough about, you know, pharmacists and how, you know, their typical practice works. But that was one thing that came up was, you know, if you think a medicine that a physician has put a patient on is not good or needs to be adjusted or what have you. It would really help that physician if that's communicated to them, you know, early on I guess would be one way to put it.

No, that makes a lot of sense. Well, is there anything that we haven't covered that you'd like to talk about?

I think we covered a lot you know and I want to thank you because I don't know if anybody's done such a thorough job of going through the podcast that we have up so far. So I want to thank you for the opportunity to speak. I want to thank everybody who's listening out there, you know, pharmacists are an integral part of the delivery of our health care. So, you know, I've worked with pharmacists and I continue, you know, in my day to day practice as an anesthesiologist. So I want to thank them out there for all the hard work that they do and if they're interested in checking out a podcast about, you know, what doctors are doing out there, totally relevant I think to pharmacist too. They can check out Doctors Unbound and if they want to reach me they can certainly reach me through the podcast and it's just I'm always happy to connect with listeners. I love doing that.

Awesome, well thanks so much for being on the Pharmacy Leaders Podcast.

Thank you so much for having me

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