A Doctor's Journey of Empathy and Global Kinship with Marc David Munk

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Welcome to Transacting Value, where we talk about practical applications for personal values when dealing with each other and even within ourselves.

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Where we foster a podcast listening experience that lets you hear the power of a value system for managing burnout, establishing boundaries and finding belonging.

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My name is Josh Porthouse, I'm your host and we are your people.

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This is why values still hold value.

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This is Transacting Value.

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I wasn't a particularly athletic kid, but I was always the kid with the first aid box on the sideline, who was like in the neighborhood and prepared to put bandages on the knees of kids who fell off the bikes and stuff.

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I was always very, very interested in being a helper and that's a value that stayed with me over the years.

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Today on Transacting Value.

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How do you find self-worth in the emergency medical field when you're surrounded by death, sickness, disease, burnout, overwhelm and stress regularly.

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Folks, I'm honored to introduce emergency medicine physician Dr Marc David Munk, whose new book Urgent Calls from Distant Places an emergency doctor's notes about life and death on the frontiers of East Africa showcases an on-the-ground account of his time as a flight surgeon serving 11 East African countries, the unimaginable challenges he and his team faced in providing medical care to patients suffering from severe trauma and disease, and also the immense gratification he found in healing under such challenging conditions.

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So join me in this conversation as we find out how to not only instigate self-worth for the patients and their families, but also the providers.

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So, without further ado, I'm Porter, I'm your host, and this is Transacting Value.

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Dr Munk.

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Marc David, how are you?

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Perfect Porter, Thanks for having me.

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All right, thank you very much for being on the show.

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Can I call you Marc?

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Is that okay with you?

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Of course, yeah, that's great, all right.

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So, Marc, there's a couple of things I think it's important to get out in the open.

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Now.

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In any particular relationship and this is my own perspective I'm sure you could align pretty closely.

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Though If we don't know who we're talking to and we don't know who our audience is, there's a very high probability all our points are going to fall flat.

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So let's just start out in the beginning here and establish a little bit of resonance.

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Take a couple of minutes, however.

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You want to answer this.

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But who are you?

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Where are you from?

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What sort of things have shaped your perspective?

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Yeah, great question.

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So you know, as you say, I'm a doctor, I'm an emergency physician.

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I've had a pretty interesting career.

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I've been at this for a while, but I didn't start my life thinking I was going to be a doctor.

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I actually was kind of a pretty introverted kid.

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I grew up in Canada, spent a lot of time by myself.

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I always had an interest in helping people, but I just wasn't quite sure how that was going to come to fruition and just kind of bumbled my way through my younger years till I got to college and I ended up becoming, strangely enough, a philosophy and religion major, which in retrospect maybe it was useful, but it's not exactly the path towards a lucrative career, I can tell you.

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But accidentally, what happened to me in college was that I ended up volunteering for the town's local ambulance service.

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It was a small town in upstate New York that had, like many small towns, a volunteer ambulance service and they were looking for people to help, and so I joined them as a volunteer EMT and after spending four years working there as a volunteer, seeing patients going to people's homes, I had a reckoning one day where I realized what I really wanted to do was to practice as a physician and it was going to be a big path ahead I mean a rough road ahead if I was going to pursue that course, because I hadn't done any science classes not a single one in college and so I had to go back and do all the sciences and that took me a couple of years and had to apply, and I finally got into medical school and became an emergency physician and I've worked I've been in medicine ever since, but really in various different areas of the profession.

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And so this is all in the States, right?

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You said you grew up in the States.

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Yep, I grew up in Canada and I moved to the States when I was 18.

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And after I finished my training, I worked abroad.

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Actually, I worked in the Middle East for about two years in the country of Qatar, and that was my first posting overseas.

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But I spent a lot of my career since then overseas as well.

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All right, so let me reel it back for a second.

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So you grew up in Canada, went to school in the US, worked abroad and now you're back stateside.

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Now I'm back stateside Yep.

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I spent over the course of my career about six or seven years working overseas.

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Oh, wow, okay.

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So your transition, I guess, from philosophy and religion to somehow making the leap into sciences I'm assuming one didn't discredit the other.

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You found some sort of resonance between the two.

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Not a lot of resonance between the two and I thought for me the hardest part of the sciences were just simply the technical skills.

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Actually, the hardest part of medicine were the technical skills.

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You know, I don't know if I intuitively was a great biochemist, you know, a great organic chemist.

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That stuff was hard for me but, like any other technical skill, I think it was balanced by the fact that I had strengths in different areas, which was a lot of interpersonal skills and ability to relate to people and communicate with people and, I think, in large part empathize with people who were coming from.

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And so, like a lot of doctors, you got to make up your weaknesses and I certainly made mine up by studying really hard in the sciences.

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I think in retrospect it was probably easier than my colleagues who came in as hardcore scientists and just couldn't talk to anybody.

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That was probably an easier skill set to fix.

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But it ended up in emergency medicine and did residency at University of Pittsburgh, which was really well known for its EMS programs and flight programs, did a fellowship in global health and then ended up starting my professional career as a young attending doctor in university hospitals, university emergency rooms.

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And so this is actual physical health, when you say global health.

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Yeah, I studied global health, which was a lot of public health, tropical medicine expertise and things like malaria and dengue fever and how to treat patients with those kinds of parasitic infections that you get in tropical climates, and so I spent a lot of time studying that stuff, a little bit outside the normal skill set of a US-based physician.

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Yeah, yeah, I'd say so.

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I'm originally from Florida and that's actually where I live now.

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But even despite our climate, it's not equatorial type disease saturation or especially a second or third world country type environment to facilitate a lot of that traffic as well.

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So when you get into that you mentioned something earlier for example, some of your colleagues a bit more socially setback than scientifically setback let's call it so for anybody new to the show.

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I guess let me start here too setback, let's call it so for anybody new to the show.

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I guess let me start here too.

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My background is in the Marine Corps infantry and I've been active duty for the last 14 years of my career to this point, and I went to college prior to that.

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Now I'm in the Marine Corps reserves here in the United States and so, as we're recording this conversation, Marc, you and I, there's a lot of experiences that despite, I think, professional endeavors we actually overlap quite a bit, namely your travel abroad with physical health and emergency medicine and then my travel abroad via deployments and humanitarian aid, disaster relief type mission sets, let's just say for right now excluding combat zones, but I think you cover a few similar aspects in your book to that and some of your takeoffs as well.

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But saying that, so we've got a lot of people that get out of the military and don't know how to translate their skills or don't know how to socialize because they've been removed essentially since high school for 20 years.

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I mean not to directly compare felons in the US prison system and the military, but you know, 20 years removed a lot changes for a lot of people, regardless of circumstance.

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And I think in those life situations I mean you had eight or nine to yourself just in education alone before you actually got out to work, right.

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So what were some ways before we get into your specific areas of expertise a little bit more thoroughly, what were some ways that you've seen maybe can help your colleagues or maybe can help people in that position where they're more apt to grasp some of the harder skills and sciences and maybe not so much the humanities and social aspects and social skills?

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What have you seen to work effectively in your experience so far?

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It's interesting, when you talk to most patients about their experiences in medicine, what they will normally say.

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It runs in sort of two veins.

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They'll say, yeah, the doctor was technically skilled and made the right diagnosis, but he was a real jerk.

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He didn't speak respectfully to me and my family.

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He didn't explain things in a way that my family could understand it.

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He seemed really rushed.

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They were coming in and out of the room.

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That's one common complaint and you kind of hear that a lot.

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The other complaint and I think we'll talk about this is just the dehumanization of the American healthcare system, where you know you're treated like a number, you're moved like a piece of industrial process through the system, you're getting these ridiculous bills that nobody understands or can afford.

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You just feel taken advantage of at every opportunity.

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And we'll talk about that a little bit later, because that's really what I've tried to focus my career on fixing for the past 10 or 15 years.

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But of that first part, it's a real shame that, as somebody once said to me, they don't really care how much you know till they know that you care right.

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And I think that's in an era of artificial intelligence where all of the technical aspects of my job and your job are threatening to be taken over by smart robots who can do a lot of that stuff better than we can Raw knowledge, raw synthesis, raw processing of data.

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That means the human skills are just going to be so much more valuable than they have been in the past, and to me, the human skills are something that a computer can't do.

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It's that building trust with people, serving as an interface between their understanding of the world and the way the world is, or your understanding of the world.

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But there's that critical human interface which is the most important aspect and paradoxically maybe we can talk about this before, but I found that when you start focusing on being that human interface and being that bridge for people, it's actually, paradoxically, the most rewarding thing for you.

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I mean, I've never found great satisfaction in being a repository of technical data and just regurgitating it right, or being a sort of a skilled craftsman.

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I mean, that's nice to be able to do things well, procedures well, but to me, the joy of it if you allow yourself to enjoy that experience is to serve as the human interface and to share people's stories and to sort of accompany them in their journey during difficult times.

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Alrighty, folks sit tight and we'll be right back on Transacting Value.

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To me, the joy of it if you allow yourself to enjoy that experience is to serve as the human interface and to share people's stories and to sort of accompany them in their journey during difficult times.

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I like that a lot accompanying them on their journey.

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I like how you put that.

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It is a lot the same Now in my I guess you could say professional career with the Marine Corps.

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I'm an instructor, so I teach Marines and sailors how to better communicate cross-culturally in a deployed environment or stateside and what that looks like to better work with people and build interpersonal relationships in a particular tactical setting or whatever environment applies.

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And I think, in trying to accompany people in those moments where maybe they're confused or overwhelmed or there's some shock factor involved, especially in war zones, trying to find ways to communicate with people when they're really not mentally there is difficult.

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And you've done this in places I can only assume have a pretty substantial language barrier and obviously a little bit further setback to whatever medical standards maybe you were educated to.

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So when you're communicating and working with people in that capacity, how do you convey that, the humanity, how do you bring it?

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So when you're communicating and working, with people in that capacity.

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How do you convey that the humanity?

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How do you bring it in when you don't speak the same words?

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There is a story in my book and, by the way, just 15 second synopsis for people who haven't read the book or don't want to read the book, interested in the story.

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These are stories of my time spent with the East African Flying Doctor Service, the AMREF Flying Doctor Service, which runs Medevac, really through East Africa, all through East Africa, mostly going out to the undeveloped parts of East Africa, bringing patients back to Nairobi pretty sick, pretty sick patients.

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The book is really a synopsis.

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It's 22 stories of flights to 11 countries and interesting patients, interesting tropical illnesses, interesting history of the organization.

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But there's one of the stories in there that I recount where we flew to northern Kenya to pick up a young boy who'd been hit by a car.

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And Kenya is really kind of a smattering of a bunch of different ethnicities and different tribes and different languages, and the area that we were flying to was northern Kenya where there were a bunch of regional dialects.

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People didn't speak Swahili, which was the dominant language in Kenya.

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They didn't speak English, but they spoke regional dialects.

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And so we got up to Northern Kenya.

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We landed on this strip.

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Eventually, a car came and met us on the tarmac and there was this little boy who had been hit by a car two or three days earlier, who was just sick as a dog, bleeding internally, and his parents were very, very simple people.

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I was told that they the first ride in an airplane was the ride that we were about to take for the little boy.

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It was his first ride in a car.

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They had flagged down a taxi or a passing car to bring him to the runway.

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There was no surgeon in Northern Kenya.

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He was, actually there was one surgeon, he was on a conference and so there was no surgeon in Northern Kenya.

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And so we had to take this little boy back to Nairobi.

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And I remember distinctly thinking just how different we were.

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There was clearly a woman wearing a headscarf there.

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They were Islamic.

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Her young husband was accompanying us.

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We didn't speak a language.

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We came from completely different areas, we had no similar socioeconomic backgrounds at all, but what I do recall was that this mother looked at me and she carried her little boy in her arms and she handed the boy over to me and I carried him and brought him to the ambulance and put him down and I thought this is like such a final and important experience that I've just had.

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I mean, there is a universal understanding between us and this young family that I'm there to help and there was an understanding of what the doctor was there to do and there was an understanding that I wasn't there for any malevolent gain.

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I was there really to try to save this little boy's life and we were all united in that mission.

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So to me there was this like enormous hour of that bridging experience, that ability to relate to other people, to share a common humanity.

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That, to me, was one of the high points of my trip.

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Honestly, I remember we were in a village in Afghanistan I don't know about a decade ago now, I guess it would have had to have been we're not there, but anyways, about a decade ago and we were in the village and I was working with this kid.

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He wasn't too young, I guess maybe I don't remember 12, 13 years old, something like that, and his father owned a rug and apparel open air shop in the bazaar outside the base.

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We had to walk through the bazaar.

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I'd say the greater majority of our patrols leaving the base were dismounted, meaning not in vehicles, they were all on foot, and so we're carrying our equipment, our antennas and all of our gear and walking in and out of the bazaars.

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We had to go out to wherever we were going and then inevitably we would turn around and walk back through the bazaar.

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He and his father were there all day, every day.

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He didn't go to school, he couldn't.

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There wasn't a school, and his father spoke Dari and probably or doing a few other dialects, I'm assuming, but at least Dari and he spoke Dari and broken English because over the years, as people had come in and out the base, he picked it up because he was self-taught, not because he was academically educated, all right.

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So the words he knew, you can imagine, weren't very polished or, uh, street slang you might call it, as far as US military is concerned, and maybe some dark humor, jokes and whatever things that he felt would make him fit in a little bit more.

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I spoke conversational to Dari at the time and so after a few months of going in and out of the base, I saw him standing outside the shop just leaning on some rugs just watching us walk by and for context, he wasn't big, like for his age.

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He wasn't necessarily malnourished either.

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I'd say probably close to four feet tall, but chiseled, and I don't mean like thin, wiry muscle, I mean like actually built chiseled muscle, just really short.

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And so when I started talking to him about what he was doing and how he got through his lifestyle and whatever, long story short, we ended up becoming decent friends.

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When we were there, I would take him to the gym whenever we weren't out on patrols and he and his father would give me lunch whenever I had the opportunity to come out to their shop and we'd just sit and talk culture basically.

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And one night, maybe a month, two months before we left, there was a group of people, and this was a joint base, so there was all different nationalities Mongolians, canadians, australians, whoever was there Brits and we were sitting there, we were eating, we were talking, and by this point I had brought a few friends over there with me from my platoon and we were just laughing, having a good time, and I don't remember who it was and it's not important which country walked by.

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But some group of people walked by and they were complaining because it was raining and it was cold, sort of on the verge of snowing, and so everything was wet and slush slush.

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And he said I have no idea why any of you are complaining.

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I have to live here, in a manner of words.

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And it was an interesting point from my perspective, similar to what you had just brought up.

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It was a lot more primal, I think, than he had intended, because it was only at face value and he probably could have misinterpreted what he heard.

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But the way he said it and then that he said it just happened to convey that.

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You know what, maybe we're out of our depth here, maybe we're holding ourselves to a different standard, and it was eye-opening for me that maybe a little humility goes a long way too, not to mention who's listening to whatever comments we're making right?

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So when you were in Kenya, you said Nairobi, right, this is Nairobi yeah.

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Yeah, okay.

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So when you were there in Kenya, where else had you gone, where you think maybe you had similar sort of perspective shifts and experiences?

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Yeah, you know the whole book, what I realized in retrospect.

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Somebody asked me why did you write this book now?

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Because the stories I'm recounting really are from 2008 and 2012.

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It's been a while, and I said, one of the reasons I wrote the book now is that I realized in retrospect what a pivotal moment that was for me professionally and how it really changed the trajectory of my life.

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And the reason it was such a pivotal moment is because that time in Africa was an opportunity to get away from the insanity of American industrialized medicine and really take time, to spend time with myself, to really look inside myself and to really reassure myself that the path I was on professionally was the path that I ought to be living.

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I think that's kind of an introspection that you're forced to do over time, and what I came to realize, I think, is that the path forward involves two things.

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One is the humility that you describe, which I think is just so important, and the second is curiosity.

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One of the things I said to my children, who are still very young I dedicate the book to them, but one of the things I've told them in person is, if you guys can learn anything in life, it's that you should approach the world fearlessly.

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But you need to approach it with curiosity and humility and I think you'll find that when you end up in places that are completely unfamiliar, if you have those two attributes, you're going to find that the world tends to treat you pretty well in exchange.

00:20:24.842 --> 00:20:36.862
I think people recognize that you are sort of a soul trying to find his or her way through the world and recognize a kindred soul in some spirits and treat you with the respects that you hope you're going to earn.

00:20:36.862 --> 00:20:40.167
And that's just been so rewarding for me those two attributes.

00:20:40.949 --> 00:20:48.103
If you go in, you know people say God, I read your book, I'm really glad you didn't go in some know-it-all Western doctor hero trying to save the world.

00:20:48.143 --> 00:20:49.306
That's not what the book's about.

00:20:49.306 --> 00:21:07.115
The book's about really going in with a lot of questions about me and a lot of questions about the world and honestly not answering all of them, not answering most of them, but maybe picking up on the fact that the world's a pretty complicated place and people live complicated lives and just commenting on that fact and I think ultimately the goal.

00:21:07.115 --> 00:21:20.067
As I've gotten older, I'm sort of in the last, probably third, of my career at this point One thing I've learned really is, with this combination of both curiosity and humility, you start to get what Adam Grant in his book calls distilled wisdom.

00:21:20.067 --> 00:21:25.846
There's a different type of wisdom, I think, that starts to happen at an older age, that you don't necessarily possess in the younger years.

00:21:25.846 --> 00:21:37.221
I think the younger years are a lot about getting the technical skills and getting good at it and getting faster at it, and your later years are really about the distillation of wisdom and approaching problems in a much more sophisticated way.

00:21:39.135 --> 00:21:41.565
Alrighty, folks sit tight and we'll be right back on Transacting Value.

00:21:43.654 --> 00:21:49.888
Alrighty folks, if you're looking for more perspective and more podcast, you can check out Transacting Value on Wreaths Across America Radio.

00:21:49.888 --> 00:21:53.545
Listen in on iHeartRadio Odyssey and TuneIn.

00:22:06.762 --> 00:22:10.605
Your later years are really about the distillation of wisdom and approaching problems in a much more sophisticated way.

00:22:11.926 --> 00:22:17.191
There's a sophistication and a wisdom that they've learned over the years, and I think you can see that in medicine as well.

00:22:17.191 --> 00:22:19.332
There's a certain calmness that descends upon you.

00:22:19.332 --> 00:22:21.159
You've seen it before, you're comfortable.

00:22:21.159 --> 00:22:24.838
It's just a different approach to the world, and I think that's what I was hoping to emulate.

00:22:24.838 --> 00:22:29.999
Was that the sense of ease with who I am, the sense of ease with the world, ongoing curiosity and humility?

00:22:31.842 --> 00:22:36.268
I think that's a perfect segue into this segment of the show called developing character.

00:22:38.148 --> 00:22:41.311
Now for anybody new to the show and obviously, Marc, for your own edification.

00:22:41.311 --> 00:22:43.073
This segment is two questions.

00:22:43.073 --> 00:22:44.520
It's as vulnerable as you want to be.

00:22:44.520 --> 00:22:46.201
Answers are entirely up to you.

00:22:46.201 --> 00:23:02.478
But when it comes to identifying self-worth or even just self-awareness, for that matter sort of like the journey that you've been on here more recently over the last what 15, 20 years is identifying?

00:23:02.478 --> 00:23:03.221
What is it that's important to you?

00:23:03.221 --> 00:23:04.946
What is it that stands out to you, right and specific to at least transacting value?

00:23:04.946 --> 00:23:07.557
I ascribe that a little bit more heavily towards a value system.

00:23:07.557 --> 00:23:17.708
So my first question, Marc, if we rewind back, let's just call it a couple of years, right, as you were growing up, what were some values that you were exposed to or that maybe you were even raised on?

00:23:18.609 --> 00:23:19.893
I always knew that I wanted to help.

00:23:19.893 --> 00:23:23.007
Somebody commented on this in an interview recently.

00:23:23.007 --> 00:23:35.627
You know, tell me about experiences when you were young and I distinctly recall I wasn't a particularly athletic kid, but I was always the kid with the first aid box on the sideline who was like in the neighborhood and prepared to put bandages on these kids who fell off the bikes and stuff.

00:23:35.627 --> 00:23:41.299
I was, I was always very, very interested in being a helper and that's a value that stayed with me over the years.

00:23:42.201 --> 00:23:57.481
I'll say there's something that happened to me as I, as I got towards middle age, was that I became very, very possessed with achievement, wanting to achieve titles, wanting to achieve status, wanting to take big roles, wanting to do big things.

00:23:57.481 --> 00:24:03.621
You know, that was very, very important to me and I don't knock it now because I think a lot of us find ourselves in that same boat and in fact it's a bit of a balance, right.

00:24:03.621 --> 00:24:04.881
I mean, you don't want to be a bump on a log.

00:24:04.881 --> 00:24:06.661
There's got to be some drive, I think.

00:24:06.661 --> 00:24:17.145
But like all things, I think it can get taken.

00:24:17.145 --> 00:24:18.007
Helper part stayed.

00:24:18.007 --> 00:24:21.991
I think that kind of ambition was polished a little bit.

00:24:24.036 --> 00:24:43.329
Yeah, being able to take opportunities, I think, at face value, with a little bit more of an open mind, right, and just accept that it's okay to change, and maybe that's what it comes down to just being able to stop whenever we get into that moment of a reality check and just this is OK, you know, and just be able to process it, I think makes a huge difference.

00:24:43.329 --> 00:24:52.277
And so, in saying that, you had mentioned your trips to Africa, but I'm curious, and this is my second question how have your values changed Then?

00:24:52.277 --> 00:24:53.362
What are some of your values now?

00:24:54.295 --> 00:24:59.440
I have to tell you what's happened over the years is I've become a lot less tolerant of greed and people taking advantage of others.

00:24:59.440 --> 00:25:05.003
I think when you're a bit younger it's easy to turn a blind eye to people who are opportunistically taking advantage of the system.

00:25:05.003 --> 00:25:10.042
What happened to me sort of mid-career after I finished my training was that I was raised on all of these ideals.

00:25:10.042 --> 00:25:18.425
Right Medicine, I think very much like military service, is like military service is inculcated with a set of values and oaths that we take to one another and there's a code by which we live as doctors.

00:25:18.425 --> 00:25:27.077
And when you go to school and you're in training, the code reigns large.

00:25:27.077 --> 00:25:28.483
It's something that we take very seriously as doctors.

00:25:28.483 --> 00:25:51.584
And when you find yourself or when I found myself, having finished training, out in the world seeing patients, I realized that I was part of a almost like an industrial medical industrial complex that was there to just churn through as many patients as possible and there were so many profiteers at the table making money from the American healthcare system, whether they were selling overpriced pharmaceuticals, whether they were selling overpriced devices, whether they were doing too many procedures that were unnecessary.

00:25:51.584 --> 00:26:01.685
It just felt to me like you see these average American family coming in to get treatment for their children or for themselves, and they didn't have the money to pay for health care and they had the world's crappiest insurance.

00:26:01.685 --> 00:26:08.929
And they were being taken to the cleaners by people who the insurance companies and by others who were just taking advantage of the fact that they were desperate and sick.

00:26:08.929 --> 00:26:31.897
And I wasn't an angry guy when I was younger, but I've developed an anger and a passion about trying to fix this in the years since, because to me it feels like such a great injustice that really the past 10 years of my career have been trying to build different systems of care in the United States that compete with the incumbents, to try to disrupt them, to create better models that are more affordable and deliver higher qualities of care.

00:26:31.897 --> 00:26:33.721
I'm a bit of an instigator.

00:26:33.721 --> 00:26:42.317
I don't want to call myself a rebel, but I'm a bit of an instigator trying to push back on the system because I'm not comfortable with the way the system is performing today.

00:26:42.317 --> 00:26:43.701
I think we can do a whole lot better.

00:26:43.701 --> 00:26:45.957
That's probably how my values have changed.

00:26:45.957 --> 00:26:48.765
I've become a lot more of an activist, I think, than I was before.

00:26:48.765 --> 00:26:50.861
How, what do you mean?

00:26:50.861 --> 00:26:52.836
So I think there's two ways.

00:26:52.916 --> 00:26:56.784
When you take a look at the American healthcare system today, you know clearly we deliver.

00:26:56.784 --> 00:27:00.029
If you're super sick and you've got whatever, it's a great place to be, right.

00:27:00.029 --> 00:27:02.681
All this no doubt about it best place in the world.

00:27:02.681 --> 00:27:05.407
If you've got an advanced cancer or something weird going on, sure.

00:27:05.407 --> 00:27:21.071
But no matter how you measure medicine, the way we do it in medicine typically is called the quadruple A and we measure healthcare based on four things it's the quality of healthcare, access to healthcare, it's the patient's happiness with the healthcare system and it's the doctor and provider's happiness with the healthcare system.

00:27:21.071 --> 00:27:27.421
If you can kind of measure all of those four different things, it gives you a high-level snapshot of how well the system is performing.

00:27:28.002 --> 00:27:30.859
And the American healthcare system is really not performing well in most measures.

00:27:30.859 --> 00:27:38.106
I mean we spend by far the most money of any Western healthcare system, like by far multiples more than anybody else.

00:27:38.106 --> 00:27:41.565
Our life expectancy is shorter than most other Western countries.

00:27:41.565 --> 00:27:44.823
Medical costs are the number one cause of bankruptcy in America.

00:27:44.823 --> 00:27:45.826
They're wiping out families.

00:27:45.826 --> 00:27:47.779
Patients hate the healthcare system.

00:27:47.779 --> 00:27:57.943
For the most part, they hate their insurance company and they hate their healthcare experience often not always and the doctors and nurses are at this point getting so burned out that they're leaving the profession as fast as they're entering it.

00:27:57.943 --> 00:28:01.424
So we are in a state of crisis in US healthcare today.

00:28:01.424 --> 00:28:02.579
There's no doubt about that.

00:28:03.757 --> 00:28:08.275
The question is, I mean, how do you go about fixing something as big as you know, multi trillion dollar industry?

00:28:08.275 --> 00:28:15.184
It's, you know, perhaps the largest industry in America and I've always thought that there's two ways to go about trying to do this.

00:28:15.184 --> 00:28:19.270
The first is that you embed yourself in the system and you incrementally try to fix it from within.

00:28:19.270 --> 00:28:25.234
That's some people's approach and I've got great respect for people who go to work every day and grind it out right.

00:28:25.234 --> 00:28:34.528
They show up and they just incrementally try to make the system better and, on a person by person basis and patient by patient basis, try to deliver great care and make it incrementally better.

00:28:34.528 --> 00:28:35.037
That's fine.

00:28:35.980 --> 00:28:48.464
The other approach is to try to do it from outside the system, and really where I've been working for the past 10 or 15 years of my career are companies that are new entrants, trying to deliver better quality healthcare, competing with the larger systems.

00:28:49.227 --> 00:28:58.507
So, as an example, I worked for a primary care company terrific primary care company that was based in neighborhoods throughout the United States I think we were in 12 or 14 markets or something for seniors.

00:28:58.507 --> 00:29:20.523
So these were really nice clinics that were located in strip malls, typically next to Walmarts, because that was the demographic that we were trying to serve Nothing fancy, just average Americans on Medicare, and we were able to deliver just a terrific primary care service to these seniors and made them healthier and got their chronic diseases much better managed and it was a big success.

00:29:20.523 --> 00:29:22.096
But it was a new entrance.

00:29:22.096 --> 00:29:27.637
We came from outside the system, built clinics outside of the large healthcare systems delivered a better product.

00:29:27.637 --> 00:29:36.067
Ultimately it was acquired, it was sold and it was acquired by large companies, but it was a great proof of concept and so that's how I've approached it.

00:29:36.067 --> 00:29:40.046
It's through working for small disruptive companies trying to build a better mousetrap.

00:29:41.515 --> 00:29:49.385
Some of my good friends that have gotten out over the years and some that are still in that eventually will get out of the DOD, the Department of Defense.

00:29:50.346 --> 00:29:52.871
Outside of the infantry are Navy corpsmen.

00:29:52.871 --> 00:30:04.582
Now, this is nothing against Air Force or Coasties or anybody else that has medical staff, but in my experience in the infantry, Navy corpsmen have played a huge role for me and a lot of other people.

00:30:04.582 --> 00:30:23.960
Now, when they choose to get out, a lot of them go their separate ways right and do whatever it is their hobbies or interests or economies of scale allow for, but a lot of them still intend to stay in medicine and they go become, you know, physician's, assistants or nurses, or I've even had a few that have gone on to try to become doctors in various fields.

00:30:23.960 --> 00:30:25.644
What about them?

00:30:25.644 --> 00:30:40.303
Because they've got a lot of a little more recently, I guess not so much, but they've got a lot of combat, trauma care and casualty care, which doesn't necessarily translate, I guess, depending on your neighborhood here in the United States.

00:30:40.303 --> 00:30:41.586
What can they do?

00:30:41.586 --> 00:30:43.902
How can they help with some of this?

00:30:44.734 --> 00:30:50.605
Listen, there's such a shortage of healthcare workers today and it's really the number one growing industry today.

00:30:50.605 --> 00:31:04.204
So, frankly, anybody who has the slightest inclination to go to nursing school, to go to PA school, to go to PA school, to go to nurse practitioner school, to convert whatever skills you have into the healthcare professions A you're guaranteed a job for the rest of your life that pays pretty well.

00:31:04.204 --> 00:31:06.178
B it's incredibly well needed.

00:31:06.178 --> 00:31:24.488
So my recommendation is you need to figure out, you need to get back to the basics and try to remember why you're in that business in the first place, which is to take of people and I think oftentimes it's very, very easy to get a little bit um, to throw your arms up in disgust and to sort of say the system's broken, I'm not going to deal with it.

00:31:24.488 --> 00:31:25.192
That's me.

00:31:25.192 --> 00:31:26.698
Walking away from it is the wrong approach.

00:31:26.698 --> 00:31:31.136
Uh, what you try to do is engage with the system and build a better system and you're so.

00:31:31.136 --> 00:31:32.601
You're just so enormously needed.

00:31:32.601 --> 00:31:34.867
Right, there's such a shortage of good healthcare workers.

00:31:36.393 --> 00:31:38.901
All right, folks, sit tight and we'll be right back on Transacting Value.

00:31:40.550 --> 00:31:43.441
This message is from the US Department of Veterans Affairs.

00:31:43.441 --> 00:31:55.029
Va disability compensation is a monthly tax-free payment to veterans who got sick or injured in the military and to veterans whose service worsened an existing condition.

00:31:55.029 --> 00:32:03.984
You may qualify for VA disability compensation for physical and mental health conditions that developed or worsened due to service.

00:32:03.984 --> 00:32:06.193
Learn more at va.

00:32:06.193 --> 00:32:08.361
gov/ disability.

00:32:10.592 --> 00:32:15.858
What you try to do is engage with the system and build a better system, and you're just so enormously needed.

00:32:15.858 --> 00:32:18.137
Right, there's such a shortage of good health care workers.

00:32:19.771 --> 00:32:20.635
Yeah, that is difficult.

00:32:20.635 --> 00:32:30.132
Obviously there's a certain degree of futility and burnout you're going to experience, no matter what you do in any industry, right, it just happens, I think, and happens to come with that overwhelm as well.

00:32:30.132 --> 00:32:39.336
But you know you had mentioned this sort of industrial machination behind American medicine and a lot of that profits over people.

00:32:39.336 --> 00:32:58.752
I mean, that's the point of capitalism, right, it just is for corporations to make a profit, and so if they don't, and they don't appease shareholders, you know there's got to be a middle ground, and I'm sure over the years and decades you've sort of stumbled into it or founded or created a new middle ground, right, where does that actually lie?

00:32:58.752 --> 00:32:59.454
How do you?

00:32:59.575 --> 00:33:01.461
increase humanity and maintain profits.

00:33:02.202 --> 00:33:03.727
Well, there has to be a middle ground.

00:33:03.727 --> 00:33:07.459
I will tell you the companies that I've worked for, these new entrants, we were backed by venture capital money.

00:33:07.459 --> 00:33:10.175
I mean, you need, you need capital to build a business, right?

00:33:10.175 --> 00:33:17.837
The question is when you, when you get to a certain point, medicine is not a pure play, capitalistic initiative, right you?

00:33:17.837 --> 00:33:18.337
You don't.

00:33:18.598 --> 00:33:20.101
It's a little bit unclear who the customer is.

00:33:20.101 --> 00:33:21.363
It's a little bit unclear who the payer is.

00:33:21.363 --> 00:33:23.904
It's a little unclear who makes the decisions oftentimes the doctor.

00:33:23.904 --> 00:33:28.807
So it's not like buying a car, right, where you've got one seller and one buyer and you can kind of negotiate terms.

00:33:28.807 --> 00:33:41.321
It's just such an opaque system and you've got so many people right now making a lot of money and the people I'm referencing, for example, are the large insurance companies who are just making money hand over fist for delivering not a whole lot of value, quite frankly.

00:33:42.143 --> 00:33:47.058
And when you take a look around the American healthcare system, you start to ask yourselves why is it?

00:33:47.058 --> 00:34:01.419
People are going to Canada, to buy medications in Canada and bring them back to treat their high blood pressure in the US, and the answer is the Canadians actually negotiate with the insurance companies or with the pharmaceutical manufacturers in Canada, united States we don't negotiate with the pharmaceutical companies at the federal level.

00:34:01.419 --> 00:34:09.476
We pay whatever they ask, and so the prices that we pay those folks could be 5X or 10X, but the Canadians are paying the same companies for making the same medications.

00:34:09.476 --> 00:34:11.635
I'm a big fan of capitalism.

00:34:11.635 --> 00:34:13.215
I mean, that's what makes America work.

00:34:13.215 --> 00:34:16.378
Right, it's not going to work any other way.

00:34:16.378 --> 00:34:23.315
But the question is, where do you start to place limits on people's ability to profiteer from sick people?

00:34:23.315 --> 00:34:36.931
There has to be some sort of policy that limits that, or, at a minimum, you have to encourage people to be able to negotiate with suppliers like pharmaceutical companies in order to like any other negotiation right when you figure out well, it's a fair price.

00:34:37.733 --> 00:34:40.601
Well, a lot of that too, like now my day job.

00:34:40.601 --> 00:34:43.074
Like I said, I'm a reservist and so my day job.

00:34:43.074 --> 00:34:59.134
I'm a licensed Florida realtor and right now, like other markets around the States, but specifically in Florida, in my opinion at least, where I'm located everything is pretty highly inflated in terms of market value for a cost comparison point of view.

00:34:59.134 --> 00:35:03.222
Now, on one hand, right commission is better.

00:35:03.222 --> 00:35:06.179
Obviously you get a percentage of a larger number, it's going to be better.

00:35:06.179 --> 00:35:21.097
But at some point, if those numbers keep going up, well, people can't sell because nobody's buying at those price points, which means they try to rent, which means rent goes up, which means people can't afford rent, and so they start picking and choosing what bills they're going to pay.

00:35:21.880 --> 00:35:33.159
However, if you say, okay, well, let's knock down price points a little bit in terms of purchase price or in terms of rental value, whatever applies, why would any landlords do that?

00:35:33.159 --> 00:35:35.228
Because people are obviously willing to pay more.

00:35:35.228 --> 00:35:39.382
They've proven it's a relatively inelastic service, so why would they?

00:35:39.382 --> 00:36:01.038
There's no benefit or incentive for them to drop it, and I think a lot of the same middle ground that you're describing in medicine at least indirectly parallels to what's happening in real estate, where there could be a lot of movement and negotiation to that and in fact, national Association of Realtors is shifting that right now with buyer's agency compensation and a few other aspects.

00:36:01.038 --> 00:36:06.934
But the point I'm getting at is when we're trying to focus on working with clients in the real estate industry.

00:36:06.934 --> 00:36:20.338
It is a holistic representation of working with people not working on behalf of home sales and I think it's a difficult connotation to try to combat because that is what has been established Now.

00:36:20.378 --> 00:36:29.358
You had mentioned, yeah, and I think it's pretty similar all things considered, the main difference between like real estate and medicine, though, is, of course, the transparency of pricing.

00:36:29.358 --> 00:36:33.496
So, like you know, imagine if you got bad insurance and no insurance.

00:36:33.496 --> 00:36:34.099
You go to the hospital.

00:36:34.099 --> 00:36:38.036
You've got no idea what you're going to pay Like nobody tells you what the price is to get the bill after the fact.

00:36:38.036 --> 00:36:38.737
So it's intelligent.

00:36:38.737 --> 00:36:42.344
It's hard to make any intelligent decisions in healthcare, at least with houses.

00:36:42.344 --> 00:36:43.936
You kind of know what the price is, I guess.

00:36:44.510 --> 00:36:46.597
Well, to a certain relative degree?

00:36:46.597 --> 00:36:56.681
Sure Right, because one house is only priced to the extent that it is compared to other homes, you know, either of like kind or of replacement value, based on what an insurance company says these materials account for.

00:36:56.681 --> 00:37:02.518
And then what's the cost in terms of logistics to get new materials moved around?

00:37:02.518 --> 00:37:05.431
Well, based on whatever the supplier price it at, not necessarily what it's actually costing.

00:37:05.431 --> 00:37:20.155
But you had mentioned something working in the Medicare, emergency medicine field, that I think, for the sake of time, this is probably going to be my last question and this may be a loaded answer, so prioritize it how you like, but I can't help but wonder.

00:37:20.994 --> 00:37:33.869
Working in emergency medicine, you are not always as successful as you hoped you could be in terms of saving people or managing people's concerns through a process, making it as smooth of a process, whatever it is, as you could.

00:37:33.869 --> 00:38:06.621
Whatever aspect applies in emergency medicine and you had mentioned burnout because of doctors and maybe even the futility of the system, but in a more isolated sense, I have to wonder that, as far as doctors, nurses, pas and anybody else are concerned, in the medical industry there's an awful lot of downsides and depression and anxiety and burnout and death and suicidal ideations among patients and staff and all sorts of other things you've got to contend with from probably a mental health perspective as well.

00:38:06.621 --> 00:38:22.115
How do you recommend or how do you actually instigate self-worth in that environment for those individuals, for the, you know, the frontline workers, maybe the families, their spheres of influence, not just the patients?

00:38:22.115 --> 00:38:23.501
What options do you see?

00:38:23.650 --> 00:38:28.007
Yeah, you know the system, the healthcare system in emergency medicine.

00:38:28.007 --> 00:38:50.253
It's really where all of the dysfunction in the US healthcare system comes to lie, because no matter where something is broken in the system whether there's not enough skilled nursing beds, or whether the hospital is too full or whether whatever it is, the only place in the system that doesn't have a door is the emergency departments, and so, of course, the crowding always ends up there, and what you feel like you're practicing is really kind of triage medicine nonstop.

00:38:50.253 --> 00:38:55.594
It didn't used to be like that when I first got started, but today it really feels like a mass casualty every day.

00:38:55.594 --> 00:39:00.742
In most ERs where the patients are flooding in, you're having to cut corners and treat the sickest only.

00:39:00.742 --> 00:39:15.500
To give you an anecdote, my nephew was just in a football accident two, three weeks ago oh no and ended up in the local emergency department and was told by the nurse it would be a 13-hour wait to have his x-ray taken, which I guess was okay.

00:39:15.500 --> 00:39:20.213
I mean it turned out to have a broken collarbone and he would have been fine waiting for 13 hours.

00:39:20.213 --> 00:39:22.936
I mean it wasn't turned out to have a broken collarbone and you know he would have been fine waiting for 13 hours.

00:39:22.936 --> 00:39:24.476
But boy, I mean, that's not the kind of care you'd hope to get.

00:39:24.516 --> 00:39:26.840
And you realize the system is under such strain right now.

00:39:26.840 --> 00:39:33.166
It's just inundated with patients and the emergency medicine has always historically been underfunded, right?

00:39:33.166 --> 00:39:39.277
People, hospitals and health care systems like to fund the stuff that's very lucrative cancer therapies and surgeries and those sorts of things.

00:39:39.277 --> 00:39:47.780
Emergency medicine has always been a loss leader for many places, and so you're always operating under the sort of environment of scarcity and cutting corners and doing the best you can.

00:39:47.780 --> 00:39:49.291
It gets to you, right?

00:39:49.291 --> 00:39:53.202
There's a certain type of person, I think, who does well in that field, thank goodness.

00:39:53.202 --> 00:40:02.739
I mean, I've got colleagues who've been doing it for 20, 30 years and they show up for their shifts day in and day out and just grind it out, and they've been doing that for 30 years and I don't know whether I have that in me.

00:40:02.739 --> 00:40:05.280
I'm not sure I'd be able to do that for 30 years.

00:40:05.280 --> 00:40:11.266
They have a certain different perspective, but some things I've seen that sort of encourage those kinds of long careers.

00:40:25.610 --> 00:40:27.213
Number one is reminding yourself why you're doing it.

00:40:27.213 --> 00:40:27.547
As I say the opening quotation to my book.

00:40:27.547 --> 00:40:28.824
I quote a guy called Paul Thoreau who's a travel writer and the quote is I saw trains and I found people, which I love.

00:40:28.824 --> 00:40:42.443
That quote and what Thoreau is basically trying to say is if you go into emergency medicine and all you do is obsess about the system all day and how it's not functioning or it is functioning and how the system should all piece together, you lose track of the fact that there are actually humans in front of you who need something and that really the joy in our business is taking care of those people and making them feel better.

00:40:42.523 --> 00:40:44.932
And that's how you accumulate points.

00:40:44.932 --> 00:40:48.021
As they say, these are sort of eulogy points.

00:40:48.021 --> 00:40:53.791
Right, you should be over the course of your life accumulating things that people can say during your eulogy when you die, and taking care of patients.

00:40:53.791 --> 00:41:09.336
Fortunately, medicine is a pretty easy way to connect eulogy points, and so I say to people just remind yourself constantly of we're fortunate that this is a profession, that that kind of reminder is pretty easy to do, that you're doing good stuff in the world and you're helping people, one at a time, and don't lose your courage.

00:41:09.336 --> 00:41:18.474
Don't lose the sight of the fact that you're taking care of people, because the system is broken, and I bet the dysfunction of the US military probably could lay on you as well, if you don't remind yourself.

00:41:18.474 --> 00:41:19.998
I mean, it's bureaucratic right.

00:41:19.998 --> 00:41:21.742
If you don't remind yourself while you're there.

00:41:22.170 --> 00:41:33.811
Yeah, it's easy to get lost in the process and, like you said, oftentimes and I think maybe even initially the trend as you're, I guess, educated and groomed and grown within any industry is to see the trains.

00:41:34.552 --> 00:41:47.231
You may not know that they're trains, you may not know the extent of the problems or the issues, right, but you only know what you're explained to and how it's explained, and then you imitate for a while and if you stay around long enough, you can conceptualize and critically deal with whatever you've been imitating.

00:41:47.231 --> 00:41:57.117
And I think that's the point where either you start to find people or you quit and you get out and you go to a different industry, find new trains and do it again.

00:41:57.117 --> 00:42:03.619
So yeah, in the DOD and specifically in my case, in the Marine Corps, I think that's exactly where I've come to.

00:42:03.619 --> 00:42:10.782
I've started to see more people than trains and now I just enjoy the ride and it's made all the difference in my career and from my perspective.

00:42:10.782 --> 00:42:17.670
But while we wrap this up, are you got any more travel left in you or are you grounded stateside from here forward?

00:42:18.371 --> 00:42:19.594
I'm a little bit grounded stateside.

00:42:19.594 --> 00:42:20.034
I'm back.

00:42:20.034 --> 00:42:26.565
I've just spent the past four and a half years mostly based in the Middle East, actually going back and forth for work a lot.

00:42:26.565 --> 00:42:33.460
I was helping to set up some health care systems there in the Middle East and that was fascinating, fascinating work.

00:42:33.460 --> 00:42:42.023
But my kids are younger and I'm really happy now to be spending a little bit more time at home doing you know the basics of being at home and it's nice to be here.

00:42:42.550 --> 00:42:45.597
Yeah, yeah, I'm sure it is Now that you have the opportunity to do it.

00:42:45.597 --> 00:42:46.916
What about another book in the works?

00:42:47.630 --> 00:42:49.155
Well, I'm thinking about it, but I'm a little.

00:42:49.155 --> 00:42:51.601
I catch my breath after the last one.

00:42:51.601 --> 00:42:52.994
It took a long time to write it.

00:42:52.994 --> 00:42:58.382
I'm glad it's done and I got to keep an eye out for what's next, but I loved writing it honestly.

00:42:58.882 --> 00:42:59.762
Yeah, well, I'm glad.

00:42:59.762 --> 00:43:03.824
I'm glad and I hope it's as cathartic of a process for you next time as it was the first time.

00:43:03.824 --> 00:43:14.438
But saying that, Marc, if anybody wants to get in touch with you, find out about your book, follow along with what you're doing in your career or gain advice in the medical industry, anything all the above, where do they go and how do they do it?

00:43:14.739 --> 00:43:16.362
Sure, so I've got a website, mdmunk.

00:43:16.362 --> 00:43:17.864
com.

00:43:17.864 --> 00:43:20.347
You can find my email address and information about me on there.

00:43:20.347 --> 00:43:21.269
I'm on LinkedIn.

00:43:21.269 --> 00:43:24.601
If you want to reach out on LinkedIn, don't use other social media really.

00:43:24.601 --> 00:43:31.844
And the book is called Urgent Calls from Distant Places and you can get it on Kindle or all your local bookstore, amazon or what have you.

00:43:32.505 --> 00:43:35.378
Yeah, and I think I saw all those links directly on your website as well, right?

00:43:35.378 --> 00:43:36.862
Yep, that's right.

00:43:36.862 --> 00:43:39.164
Okay, all right, perfect Now for anybody listening.

00:43:39.164 --> 00:43:44.152
Obviously, if you're new to the show depending on the player that you're listening to this conversation you can click see more.

00:43:44.152 --> 00:43:53.659
You can click show more and then in the show description you'll see links to Marc's website and social and for the book as well, so be able to reach him there if that's an easier option for you as well.

00:43:53.659 --> 00:44:11.981
But, Marc, for the sake of time, I really appreciate the opportunity You're taking some time out of your evening to be able to come onto the show, talk a little bit and just broaden our perspectives on what it's like ultimately building and generating and maintaining self-worth in the emergency medicine field, which is totally brand new and foreign to me.

00:44:11.981 --> 00:44:18.036
So, on behalf of everybody who you can't hear right now, thanks for your time, man, I appreciate your perspective.

00:44:18.782 --> 00:44:19.264
My pleasure.

00:44:19.264 --> 00:44:20.070
Thanks for having me, Porter.

00:44:20.070 --> 00:44:21.315
This has been a good conversation.

00:44:21.570 --> 00:44:22.112
Yeah, of course.

00:44:22.112 --> 00:44:27.559
And you know, when in the future you find yourself with some free time and you want to come back on get in touch, I'm more than happy to have you.

00:44:27.559 --> 00:44:30.295
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00:44:30.295 --> 00:44:35.052
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