How to Turn Conflict Into Opportunity and Get Back to Medicine! w/ Amanda Brisebois MD

Erik Sunset: [00:00:00] Hello

Amanda Brisebois: Point.

Erik Sunset: welcome back. I’m

Erik Sunset: Erik Sunset, your host of the

Erik Sunset: DocBuddy Journal. This is episode 44 with special guest Dr. Amanda Brisebois to try to do her justice here. She’s got a long list of accolades and certifications, but she is a dual certified physician in internal medicine and palliative medicine based in Edmonton, Alberta, Canada. Dr. B is also a Mayo Clinic certified wellness coach, and additionally, she’s a certified health care and executive coach through ICF, a certified mediator, and she has extensive training in leadership, equity, diversity, and inclusion through the University of British Columbia. has also served in high level leadership levels across Canada on medical boards, multiple medical directorships, and has served as an associate chief medical officer. for making a little time for the podcast today. You are a busy person, Dr. Brisebois.

Amanda Brisebois: I laugh because I always think, why did I do all that stuff? There are [00:01:00] reasons. I think we all feel inefficient sometimes, so you just have to go do more and more, but

Amanda Brisebois: it’s nice to have it done.

Erik Sunset: That’s the truth. Yeah. And obviously, Hard earned all the certifications. I think part of the reason, and I’m taking a stab in the dark here a little bit, part of the reason to go through all of that, uh, education and training and striving for so much is that one of your prime directives is coaching physicians and their teams in order to turn conflict to opportunity. and get back to medicine. Tell us a little bit more about what that means.

Amanda Brisebois: While doing all of those things, you’re absolutely right. There was a purpose to it because as physicians, we’re all often not really trained very well to do leadership and who’s trained to actually manage conflict. Very few people. And so I went back to do all that because during the pandemic, I was leading a big team and we weren’t getting to solutions.

Amanda Brisebois: I did a lot of listening. I thought, Oh, listening is what it’s all about. I will be able to solve a conflict by listening [00:02:00] to someone. And I realized very quickly, it’s not really the case. And this training really made me realize that there’s a process to how we actually support people. And you can work through things in a very processed way every time so that you can come to solutions.

Amanda Brisebois: And get follow up and this is where I’ve really found my impact is that I can sit in front of people rather than being at one of these high level leadership positions. I’ve kind of dropped myself into the middle of the pod to try to sit right in front of people. and listen to them and help coach them and talk to them about what processes they use to help them have better work lives.

Amanda Brisebois: And it really does make a huge difference. It takes time, which is difficult for people because we have very little of that these days, but applying process to things have really seen it helps. And that’s where I’m most passionate right now about supporting teams to do that.

Erik Sunset: And truly there’s a lot to be done there. I know speaking for our [00:03:00] stateside providers, both physicians and mid levels, there is physician burnout and provider burnout is rampant. I know it’s no different. It’s north of the border for you in Canada and even our friends across the pond in places like UK and Europe with the UK’s NHS system. Burnout is a hot topic and it’s unfortunate because it’s seems to be that no, nobody in Western medicine has been spared. So for you, as you say, dropping yourself into the pod. sure there’s no shortage of different types of conflict that you help your providers and fellow clinicians with, whether it’s just sort of your run of the mill workplace conflict, conflict, or even conflict with the technology that in some cases you’re forced to use. So what are, what would you say are some of the biggest keys to getting physicians and maybe even their organizations back to medicine?

Amanda Brisebois: Well, I love the Stanford Model of Professional Fulfillment. It’s got three big pie wedges in their circle. It’s the culture of [00:04:00] wellness, efficiencies of practice, and then of course, as we all know, resilience, which I think we’ve all done a pretty great job of. So I try to sort of negate that piece a little bit because we’re already doing it.

Amanda Brisebois: But the big things for me are how do we Change the culture and that piece to me is actually really talking to each other and knowing each other and being okay when we disagree with each other, because hallelujah, when we do, we will have better ideas and better outcomes if we have different people at the table and that culture.

Amanda Brisebois: I think that we can. Work on those simple things to know each other and create that atmosphere of it’s being okay to do something that might not have felt like it was in the right direction. And how do we correct that? And how do we learn from that? And not go talk to someone about. The other person in the back hall, because this is happening an awful lot, and it’s not helping individuals or teams in their workplace.

Amanda Brisebois: So that culture piece, and then the efficiencies piece [00:05:00] is so massive, and this is very hard for providers right now, because there’s a lot of resource issues. We don’t feel that we have enough resource. We don’t feel that we’re. Helped enough we think we’re working too hard and I think all of those things to be true I really do feel though that on the bigger system We can be much more efficient all the way from how we respond to things I always say the reaction is just as critical as the action when you’re sitting there doing something and how do we manage our day?

Amanda Brisebois: How do we get support from those around us? You know all this training I did I always say you don’t have to do that training. There are people around you that have that knowledge So go find them rather than feeling you have to do, you know, a master’s program and this and that, go find the people around you that can help you, because people really do want to help on your team.

Amanda Brisebois: And how do we become more efficient? We’re all deeply rooted into this health information technology and technology in our workplaces. How can we make [00:06:00] that work for us instead of against us? And I talked to a lot of people about this and they’re like, well, why is this on me? You know, everyone’s putting this on me and why do I have to do this?

Amanda Brisebois: I’m already doing a lot, but I do believe that we each have the power and responsibility to make our own workplaces better as well. And it’s not as much. Work as you would think I think stress um, feeling unhappy in your those things is a ton of work. And so, you know, you even put a fraction of that into some of these more progressive changes and I think that we will have better workplaces, but it’s it does take work.

Erik Sunset: Well, and you’re, you’re hitting on something really interesting in an organizational psychology sense, and that’s, that’s agency, right? Like, do do I make things happen or do things happen to me? And I think for most people, their reality isn’t on one end of the spectrum, but somewhere kind of in the middle. For the folks who feel very low agency or who happen to be very low [00:07:00] agency, how do you get them to see the light that you’re maybe a little bit more in control than you think you are?

Amanda Brisebois: Well, I lived that life for a lot of years and I think it helps me when I started medicine. I didn’t want to do leadership. I wanted to just go take care of my patients and teach. And that was it. And I felt that was enough. I would be in the emergency room complaining that I didn’t get what I needed. And why aren’t they paying attention to me?

Amanda Brisebois: And they should be. And I mean, really, I wish I had a video camera to look back at myself. I didn’t have time to get involved. I had three little kids. I had a busy spouse. And I thought that was Fine. It’s very interesting looking back on it because I feel my career was a bit eroded because of that. I really didn’t see the big picture.

Amanda Brisebois: It caused me a lot of internal strife. Because I kept thinking, I’m not being treated properly. Instead of flipping it to, you know, where are the gaps? And I love quality improvement because [00:08:00] that, I think it gives you some, it empowers you. So when you’re living in that pod that you don’t feel empowered, I can’t do anything, I really feel that we need to see how powerful we are.

Amanda Brisebois: Like even one individual who, You may not have any named leadership role, you have huge power and those who do have leadership roles, which I did during the pandemic and I sat back many a day saying, there’s nothing I can do, you know, I mean, commanded from the top to do things and I don’t have power and you do like one on one and how do you impact people and how do we help people see what, where do they want to make a difference and we’re different.

Amanda Brisebois: So, I would never say to you, oh, You have to do this and this happens a lot in the workplace is a leader will say you need to help step up. Go help here. Well, who wants to do that? I want to help in a way that where I feel that I can help [00:09:00] and I’m passionate about and I will actually expend my energy and something that improves my life.

Amanda Brisebois: So I think people need to sit down with each other and say, where actually. Do you want to make a difference and think for yourself, what do you like to do? And I always say that to people, you don’t have to change where someone tells you to do it, find out where you like it. And then all of a sudden you’ll want to do it.

Amanda Brisebois: I always say you have to make it cool. Like you have to make the meeting cool or you have to make it so that people feel that they’re missing out. You can’t tell them to come. But if all of a sudden everyone leaves the meeting goes, Oh yeah, that was a really interesting meeting. And we made this decision and that decision.

Amanda Brisebois: They’re like, Ooh, I should have gone so that you have to flip the narrative. I think to make it positive,

Erik Sunset: Oh, yeah. And well, to to make the meeting cool, what are some of your guidelines there? To be sure that when you’re. planning and hosting a meeting that it’s something people feel is valuable and that they want to attend. How do you make it cool?

Amanda Brisebois: I have a whole thing on meetings. Cause it is one of the biggest pains from a lot of people. You have to have some input into what’s [00:10:00] happening there. It really shouldn’t be about just providing information. Look how connected we are. I can read an awful lot or look at PowerPoint. So it takes me like 5 seconds to go through their hour PowerPoint.

Amanda Brisebois: I’m just like, okay, got the point. Uh, you know, meetings should be made for for knowing each other. Where are we at? making decisions and actually having agendas that people know how to get things on there and how things get taken off of there. And what happens when something doesn’t get done in your meeting, actually having a process, which it comes right back down to process.

Amanda Brisebois: And if people know what the meetings are for, they can either attend or not attend. But often if a decision is made, People are going to go, especially if that decision impacts them, and that’s when I’ve seen the meetings most packed, as you know, you have the agenda item, and it says uh, you know, this agenda item, decision made, all of a sudden, oh, you know, you start seeing people come, come through, but you have to let people prepare for these meetings too.

Amanda Brisebois: It’s not like you can just say, oh, hey [00:11:00] um, we’re going to bring up this topic no one’s ever and we’re going to make a decision because lots of people don’t work that way.

Erik Sunset: Right. And that’s kind of like a small local government type meeting where there’s a surprise bullet point that there, you know, has second and third order consequences and nobody’s ever brought it up before. And tonight’s the night. We’re making choices today. Like that’s not a good way to operate.

Amanda Brisebois: And you hear this a lot in health care because we have operational partners and sometimes physicians will be at the table and all of a sudden, okay, we’re going to implement this project.

Amanda Brisebois: We need your input, but the project’s already done. So, you know, you get input at the end. So things are changing in that capacity.

Amanda Brisebois: How do you integrate? We working in these massive systems. Physicians are tiny little drop in this pond. Now, we are not a big drop. I was talking to our uh, Like management services laundry and food services and the massive numbers of employees, and then the physicians are this tiny thing. So we really have to recognize that and integrate [00:12:00] ourselves well, so that we can be assertive in our opinions.

Amanda Brisebois: And that’s not aggressive. It’s a, it’s assertive meaning, Hey, we can give our opinions and a really kind open way, but also saying that we want to be part of your conversation. And I think. You know, the more we evolve with those kind of partnerships on our teams, the better we’ll be too.

Erik Sunset: Well, and I think, You know, as a, as a group physicians really have to, and it’s two sides of the same coin that physicians need to express themselves maybe to a more aggressive degree, not to the point of unprofessional, but I’ve used aggressive purposefully. And then on the other side, healthcare organizations need to be potentially doing a better job listening. and the reason that I bring this up is that when you look at the factors for physician burnouts, we’re gonna talk about technology in a minute here, but technology is the number one driver when you look at self reported factors for burnout. also on this list, universally across all the different surveys that are compiled, lack of [00:13:00] autonomy, lack of control, lack of control over their own destiny in their own workplace is a huge issue for providers. when you look at both ends of this, the individual provider side of things, and then the healthcare organization side of things, what do you do to fix that? Because that’s something that’s fixable. You can change that. Not to say that it’s easy, but that’s something that you can fix.

Amanda Brisebois: You know, that’s really interesting because I see that a lot as well that, oh, I don’t have autonomy in my practice. I do think we’re living in a very different world. So I did my master’s in health leadership, and I sat with people from 50 countries across the world for 2 years in this and so you’re absolutely right.

Amanda Brisebois: We’re in this very much together and, and are experiencing very similar things this autonomy, though, we are not autonomous in the system. And physicians are trained that we are this. My master’s thesis was on the physician voice and where it is. We’re [00:14:00] trained still in that kind of old mentality that the physician voice is the pinnacle and that, you know, we make a decision and that’s definitive.

Amanda Brisebois: And we do things like that. We order tests and people aren’t supposed to question the tests we order. We write medications. We think those are the right medications. We work on teams though, big teams, and the radiologist may have input into what I ordered. Maybe that test wasn’t the best test for the patient.

Amanda Brisebois: The pharmacist may have input, the uh, you know, discharge planning, all this So, I do believe we have to change what autonomy means. I’m not saying that physicians shouldn’t have autonomy in how we treat patients. We really do need to have input in how we treat patients, and have our voices heard, and what we know, and we are full of knowledge.

Amanda Brisebois: But do we have autonomy in every aspect of our practice? We, we really don’t. And, and I don’t think we should actually, like I have physicians that have been around for a long time. And [00:15:00] during the pandemic, one said to me, why should I change my practice? I’ve been doing this for 30 years. And I just kind of went, wow, like things change over 30 years.

Amanda Brisebois: So we, we do have to evolve with the system. And would I rather be the top of the triangle, the pyramid with everyone listening to everything I say? I mean, I practice, I started practice 23 years ago and it was kind of like that. And you’re like walking down the hall and you’re like, I’m cool. I’m cool.

Amanda Brisebois: Everyone’s following you. And we still do that, of course, with residents and students and trainees. Um, But it’s just, it’s anymore. So I think we do have to learn how to shift and how do we get this new autonomy? And as you said, how do we ensure we’re at the table? And how do we, without being, we call it in mediation positional, like saying, it has to be this way.

Amanda Brisebois: How do we say, I really feel that if we look at this other way of doing things. We may progress faster, and so people don’t feel too challenged by it, they want to embrace it.[00:16:00]

Erik Sunset: Well, that’s you’re hitting on to me at least is sort of the work of Carol Dweck growth growth mindset versus a fixed mindset and to relate that to our conversation that when you look at any group, and I don’t mean to pick on physicians here, especially not our present company, but any group, whether it’s physicians or electricians or, you know, whatever, pick your occupation. on the whole, you’d have a fairly mid to low agency group responding to a survey. You know, very few people are very high agency, at least the folks that I’ve come across. Some say that they aren’t out there, but very high agency people you don’t come across every single day. So when you look at these self reported factors for burnout, some of them are technology.

Erik Sunset: And, you know, part of my background is in selling and managing electronic health record organizations here in the U. S. Where you want to provide training because you want to have happy clients when you have a provider say yeah I have to use this and in the case of the US Medicare is gonna pay [00:17:00] me less if I don’t use the software But you know, I’ll give you like 90 minutes That’s the best I can do and I’ll give you 90 minutes over the course of two weeks, you know So you’re spending 20 minutes at a time with the provider to use the software But doesn’t want to spend any time learning it and then says my life is miserable because of the software that’s very a very fixed mindset at least in my Unprofessional opinion How do you get a provider who undoubtedly is being made miserable by their technology most of the time?

Erik Sunset: I shouldn’t say undoubtedly, but for the vast majority of cases, technology does slow down their ability to practice medicine the way that they would like to. But if it’s a necessary evil, you can either complain about it until you’re blue in the face, or you can try to get as good at using it as you possibly can so it’s as A little of a burden to you as possible. How do you flip that narrative? Because there’s a lot of, whoa, is me. This technology doesn’t work, there’s also been no time invested into learning [00:18:00] it.

Amanda Brisebois: I’m just laughing because I live this, I live this a lot, and it’s, um, it’s hard for me. So I’m a techie I’ve been using a health record for my patients and all, all my work since I started working 23 years ago. And in Canada and Alberta, where I am now, we just institute a province wide health record.

Amanda Brisebois: And so you have to use it if you’re in in hospitals, and they’re all connected. The outpatients are yet to be connected, but people want to be connected. People all still complain about it, exactly like you’re saying. Um, and I would say your opinion is professional opinion. But look, I’m of that mindset that technology helps patient care, in that I’m a patient, so I have a chronic illness, I love being connected to my record, I can see the reports before my doctor gets back to me by weeks, I can, you know, let them know if I think there’s [00:19:00] something on there that I’m curious what they think before they get back to me, I can see it’s normal.

Amanda Brisebois: Um, I can have families to me when I’m doing consult. I connect to the family beforehand and make sure they’re there. There are just so many. optimistic things about technology, and I don’t think you can go backwards. There are physicians that feel that it’s causing them a lot of trouble, and it is, because of those efficiencies.

Amanda Brisebois: But you’re right, you know, what you put in is what you get out, and how do you fine tune things, and I think there’s a lot of opportunity for quality improvement, and people, I think, are feeling so burnt out and just So unmotivated to be proactive that they’re like, I don’t want to do that quality improvement piece.

Amanda Brisebois: And I’ll give you a very simple example. I do consults and they’re making me write this 15 page consult, which has lots of good information, but sometimes we get very overrun [00:20:00] with consults. I can’t do 15 page consult and see 15 or 10 consults a day. I feel I could modify that efficiency to give the person who’s asking me for opinion much less, document much less, and it would still be very efficient.

Amanda Brisebois: And as a group, though, people haven’t wanted to embrace just sitting down and doing that. Like, what do we want to do? When do we agree to write that really long one? When do we just do a little one? Like, what does this look like? How do we get a consistent practice? And this is the same with daily notes and all of these sort of things.

Amanda Brisebois: So, I think there’s a lot of room to make our lives better with. The medical record, we just have to sit down, though, and logically say to whomever we’re answering to, you know, whether it be the patient or our colleges that are licensing us that this is what we want to do. Is this makes sense? Is this okay?

Amanda Brisebois: As far as patient care goes, and if we don’t do that, [00:21:00] the program won’t get better. I can’t go back to my, the provider who the platform whose program this is without any information say you guys suck. I really should go back, and this is what we do though, we should go back to them and say, Hey, you know what?

Amanda Brisebois: We’re trying to improve efficiencies and this order entry is super difficult. So, can you guys look at that order entry piece or those three pieces of order entry are making my lives tough. Because they can fix definitive things. I always say in mediation, we say that uh, you have to have a clear, neutral, solvable issue.

Amanda Brisebois: It can’t just be I hate technology or technology is making my life bad, but it can be the order entry on this section is very clunky and onerous. Uh, we want to help you make it better. That, that’s solvable. So, I’m a big believer in us taking some responsibility. And as I said, I wasn’t always like that, but even having that mindset can change your attitude at work.[00:22:00]

Amanda Brisebois: I remember once I was sitting in a really boring lecture and um, the lecture after talking about lectures. He was talking about giving PowerPoint presentations and he said, if you’re bored in a lecture or something, spend the time thinking, what would you do differently? to make it a great lecture.

Amanda Brisebois: And I’ll always remember that guy because I think that’s so true. Like when you’re sitting there at your computer, rather than, I hate this isn’t complaining, etc. Why don’t you think about what could be different and write somebody? It honestly doesn’t take that long to write to whoever is in charge of what you’re doing and saying, I saw this problem.

Amanda Brisebois: Maybe I’m a little too optimistic, but I have seen it work. So now I’m on that. Road to just trying to get people to realize that we do actually have power.

Erik Sunset: A hundred percent. And whether it’s through the fixed or growth mindset lens, or whether it’s high or low agency in that perspective, think of who who this quote comes to us from. [00:23:00] I’m not generally a big quote person, but whether you think you can, or you think you can’t. probably right and your mindset has a lot to do with your own outcomes and I am certainly not don’t have the qualifications that you do, but when people come to me and say, Oh, you know, how bad is this?

Erik Sunset: Or I don’t like this, you know, I’ve kind of had to check my own reaction to go in immediately into problem solving, like, Oh, well, you don’t like it. What don’t you like? What can we do to make it better? You know, what, what about this? What about that? And do you, do you want to be problem solving Erik right now, or do you just want to vent? Like, do you just want to get some frustration out? Cause we can do either. We’d love to get your take on that because there’s certainly a time and a place to just vent. Or maybe you disagree and it’d be interesting if you did, but in my opinion, there’s a time and a place to just vent, say, man, that stinks.

Erik Sunset: I really wish that didn’t happen. but then dwelling on it, you probably get into a negative place as opposed to going straight into let’s fix it. Let’s make it better for next time. All

Amanda Brisebois: I know it’s [00:24:00] totally cool. I’m completely agreeing with everything you say, and you absolutely don’t have to be trained actually to be good at this stuff. Um, you know, what happens is I call it the rant. So you got to do it. I don’t think people can actually just have a bad experience or a difficult experience and then just be like, yeah, I’m going to fix it.

Amanda Brisebois: I think we’re just normal. So I say to people, go have the rant, do it wherever you like. If someone, if you both rant to each other or whatever it is, if you write the email rant, perhaps don’t send it. Those are, that’s a whole nother thing, but you know, write it down or whatever it is, do it, you have to do it.

Amanda Brisebois: The problem is, is if you do that rant. In your head over and over you create what’s out there in literature. That’s called this self narrative. It’s a vortex. I have a great slide. That’s this huge vortex around your brain and you create a situation that may not even be completely factual. In fact, usually it’s not [00:25:00] so you create this huge vortex of what you think to be so awful in it.

Amanda Brisebois: I swear our neurons develop that vortex into truth in our minds. And this is where lots of conflicts come because two people or teams are deeply rooted in this vortex of truth, which is somewhere in between what all of them think. And so it becomes a big problem. So I think you do the rant, you get out of it.

Amanda Brisebois: You’re like, okay, I’m going to do that. I’m going to take an hour, half an hour or whatever it is. And then I’m going to go for a walk. And I’m actually going to sit down and have a process and realize, okay, now I’m going to dissect what the issues are. And then I’m going to look at, you know, why I care.

Amanda Brisebois: And this is what mediators do. And we don’t do this in real life. We don’t spend much time thinking why we care, but mediators do. And that is so important. Because it’s not just that, you know, the computer system is bothering me or that order entry is a problem. It’s that I’ve got eight patients to see and I really want to give good patient care.[00:26:00]

Amanda Brisebois: I also really, it’s important for me to get home for dinner. And it’s also really important for me to be able to make enough money that I can, you know, go on my trip or whatever it is, you know, whatever the things we care about. But we don’t talk about that and we don’t usually share that with people.

Amanda Brisebois: All we talk about is. You know, this thing’s bothering us. So you kind of have to get through this process and go and start moving forward so that you can get past the rant. And I actually can see when I’m working with individuals and teams, when people can’t get past the rant, then you need other supports.

Amanda Brisebois: Go see a psychologist. I think we all need one. I have one. 9 1 1 psychologist. Somebody outside your circle. You know that you can talk to if that’s your thing, or, you know, just have some way to get out of that piece. If you can’t get out of the past, then you’re going to need more support to, to move forward in whatever it is that’s blocking you for sure.

Erik Sunset: That’s um, That seemed to be a very positive development in my [00:27:00] opinion going through COVID and then coming back out the other side is people’s willingness to seek that type of help, whether it’s a therapist or trusted confidant and just I don’t really like to phrase it this way, but being a little more in touch with your feelings and like understanding why you feel things that seems to be one of the few silver linings coming out of the pandemic, at least that I’ve seen.

Amanda Brisebois: Well, and just the recognition that our heads are actually attached to our bodies, you know, that illness does all of us. It doesn’t just uh, you know, illness isn’t from here and then all of a sudden your head uh, you know, Put back on. I don’t Somehow we think that they’re different, but it’s all one.

Amanda Brisebois: It’s all one thing. Uh, so yeah, we’re deeply ourselves. And if we disregard what’s going on in our brain, how can our bodies be well? And I have seen so many people who are in bad places with respect to their thoughts and even just talking about technology that they get sick. They get physically ill and it really does happen.

Amanda Brisebois: So. We do have to be okay that, hey, my [00:28:00] brain can be unwell and I’m a cool person and I’m fine. Um, I’ll get through that. I’ll get I need and it impacts my body. So I’m going to have a, I’m going to try to work on having a different approach. Whatever it is, like, as you said, you know, go to a psychologist or uh, go play basketball or whatever it is that helps you clear your mind out.

Amanda Brisebois: Use those things. We got to have those strategies.

Erik Sunset: Well, I’m going to change gears a little bit on you here, Dr. Brisebois. There’s a, there’s a strategy that, you know, I haven’t seen it at a macro level yet. There’s some ideas on the micro level, and I want your opinion on both. But we are coming up on an outright cataclysm with the regard to physician availability.

Erik Sunset: We have tons of physicians and providers of all types retiring much earlier than anybody planned for. everybody needs to do the right thing for their own life, but when you look at med school throughput to physician and to provider, you know, we’re just a handful of years away from not having nearly [00:29:00] enough, nice use of the English language there.

Erik Sunset: We’re just a few years away from being incredibly deficient for enough providers to treat the amount of patients that both Canada and the U. S. have. Everything that we’ve discussed so far can help a provider sort of stave off that feeling of burnout in their practice or when they’re working as part of their healthcare organization. So what would you say to these two ends of the spectrum of keeping more providers practicing longer? And then on the macro side of things, how can we get more people interested in medicine again? Because this is just a quick anecdote. I waited eight months for an annual physical here in Miami, Florida, for no good reason other than there just weren’t any appointments. That doesn’t seem sustainable to me. And, you know, thank goodness I don’t have any issues that need or require more immediate attention. So what would you say to all that?

Amanda Brisebois: Well, I think if you fix the first one, you’ll get [00:30:00] the second one. So that’s the easy answer. People don’t want to go into it because what’s on the news? No physicians. Physicians hate their jobs. You can’t get appointments. This is a terrible place to be. You work all day, you work all night, and nobody loves you.

Amanda Brisebois: So,

Amanda Brisebois: who’s going to sign up for that? I have uh, I have sons 20s, in their 20s, and they’re all like, you work all night? Like, are you… Honestly, the words they say about that kind of behavior, they’re just like, I don’t know what’s wrong with you guys. Uh, and why would you accept that? And I, think that has to change.

Amanda Brisebois: So, so that’s one thing. But we need more people. We need to sort of change what it looks like to be a physician. We need more support in manpower, and if it’s not affordable, because that’s kind of what countries are telling us, that physician manpower is not affordable at the, at the rate it is right now, then find what pieces of work that we’re doing that don’t need our skills.[00:31:00]

Amanda Brisebois: and find other people. And we’re starting to do that. We are starting to have clinical associates which have less training or maybe not the same specialty as you’re in. We have nurse practitioners, we have nurses. Look, AI, if I had AI on rounds or in my clinic and that could create a note for me, that would save us, I’d be able to see two or three more patients a day.

Amanda Brisebois: So there are so many, and this goes back to efficiencies, use physicians. Make sure there’s enough, but before you do that, because there may be, look at the system and see where can we get support from brilliant people who are not physicians. So, you know, oh, geez, I wish I had all these brains, right, that you could fit in here, but AI is going to be massive.

Amanda Brisebois: People who actually can help with note taking, people can help with data entry. So there’s a lot of stuff that can make things better. Quality improvement projects. I’m working with [00:32:00] a lot of teams, and I think you do not have to be a physician and probably shouldn’t be, actually, if you want to help us work through this issue that we’re facing with um, maybe distribution of something.

Amanda Brisebois: You know, where in the system are the gaps? Get us somebody at a much lesser rate of pay, or that there’s more of those people that want jobs in those areas, more trained people, and bring them in to help out. And there are, there’s a huge opportunity to do that. It’s just a matter of having these health systems recognize it and put money towards it.

Amanda Brisebois: There’s a lot of money put towards the organizations themselves. Like lots of money and leadership and structuring and even in the nursing profession, they have much different supports and huge companies like Apple and all these big companies, they do this stuff. I get bring those kind of expertise into healthcare so that we can get support being coming more efficient.

Amanda Brisebois: And I think that will make a difference. And once someone comes and they go, Oh, physicians, oh, you have help with that. Oh, [00:33:00] that’s super cool that you’re in your clinic and AI writes your note and it picks the important things that you want to say there. And you don’t have to have someone call the patient because they’re connected and they just see their appointments automatically, you know, all of these things, then I think people will go, Oh, I get I actually get a weekend off.

Amanda Brisebois: I want to be a doctor. That’s cool. So I think that’s really the answer is getting, getting human resource where you need it, getting the supports for physicians where you need it, getting extra people in there who aren’t physicians as part of the team to help Thank you. Help change things, but really paying attention to what people are saying and I think I just talked to a team yesterday and they said, look, we’ve been doing this for so many years.

Amanda Brisebois: It has to stop. And what happens is if you take it on the chin, I’ll take more patients. I’ll take more patients. I’ll do it. I’ll do it. I’ll do it. They’re going to want to just give you more patience

Erik Sunset: Right.

Amanda Brisebois: because you’ve done it for so many years and you’ve been on call for 72 hours in a row for so many years, [00:34:00] why would they look for other resource if you’re just going to do it?

Amanda Brisebois: So we have to say that it’s not sustainable and that we can’t do it and we want to help with the solution, but we’re not the, we aren’t the solution. Like, we’re part of the solution. And I think we do have to take a stand about it.

Erik Sunset: Well, to your point, healthcare organizations, since time immemorial have viewed problem solving as just throw some employees at it. More people will fix this, but that doesn’t really fix anything. That just puts a bandaid on patient throughput or staffing levels or whatever, but you’re just. Taking that pain and putting it on somebody else. It doesn’t fix the actual issue.

Amanda Brisebois: And this is in industries all over the world in all different capacities. Um, all of a sudden some work comes up, to so and so,

Erik Sunset: Yeah.

Amanda Brisebois: they’ll do it. But then that, that degrades the system because there’s no process as to why that person got that work. That person may have multiple other things going on [00:35:00] that, that they’re feeling stressed about not being able to do that work.

Amanda Brisebois: That person may be highly effective in that organization and leave. Because of that lack of process, you know, oh, I always get the extra work. So and so’s not doing it, blah, blah, blah. I mean, it’s just a pervasive thing that we don’t pay enough attention to why we do, like, what’s the process around why we’re deciding something?

Amanda Brisebois: We got to do better about that.

Erik Sunset: Yeah. Throwing employees at it isn’t, isn’t a process at all. That’s not a solution. That’s a no good really comes from that.

Amanda Brisebois: No, not for sure. And also, and I’m going to add this because I’m, my specialty is chronic illness care. Uh, we need to change our about what health care is. And that is an Also another whole different discussion, but our expectations of what does it mean to be healthy and what are our um, what do we access to?

Amanda Brisebois: And I don’t mean that we don’t deserve things, but what, how do we want to live is more the question. And do [00:36:00] we really want to live if I don’t recognize anyone that I know? You know, these are really hard conversations. So I do palliative medicine and I was asking my parents, they’re in their 80s. I was asking the other day.

Amanda Brisebois: Um, you know, if something happens to you, live? And this is what I do for a living. I’ve talked to them lots and they’re like, huh? So it’s very hard to have those conversations, but we do need to have those conversations and have people understand that we can’t do, actually, we can do everything that’s going to help them live a better life, but that everything changes over the continuum of your life.

Amanda Brisebois: And it’s that messaging that’s, that’s hard. And if we start fine tuning that too, we will have more money to put into more resource. That is appropriate. It’s really finding what the appropriate resources are too. So these are huge, like brain shifts for people. It’ll have to come at some point, I think, because we’ll, we’ll hit some sort of wall where you can’t keep everyone.

Amanda Brisebois: This, this, the pandemic kind of brought this forward too.

Erik Sunset: [00:37:00] Oh, sure. And you know, the, the lowest hanging fruit at least in my mind’s eye and. You know, I’m not a physician. I won’t ever, I won’t ever be one. But when you look at population health, we have a lot of very sick people and that are unfortunately sick through the choices that they make every day for what they’re eating, how they decide to live, the substances that they intake to their body. Unfortunately, this population clogs up all of health care. I mean, you look at so much of the costs and you know, the, the trillions that the U S spends on its own healthcare each year. And forgive me, I don’t have Canada’s stats offhand. I know it’s a different different mechanism for payments obviously. bUt when you look at all these disastrous numbers in healthcare, we go back to high agency again. Would you rather be treated because you’re sick or would you rather just stay healthy?

Amanda Brisebois: Yeah, and, you know, it’s kind of interesting. I was just saying this this morning. Um, I can tell other people to do All I want and, you know, reframe what you, how you take care of yourself, et cetera. [00:38:00] I haven’t been taking good care of myself. You wouldn’t tell by looking at me. And so I get away with it.

Amanda Brisebois: I’m like, okay, you know, I’ve gained weight. I haven’t been exercising. I’m eating crap. You know, I sit in front of the TV and I’m eating the chocolate. What try, what snack? I love snacking. Oh, I’m going to have a snack and eat the big bowl of popcorn. And uh, I’m just not healthy. And wouldn’t know by looking at me.

Amanda Brisebois: So then I go tell someone else, well, you really shouldn’t be doing this and this because it’s going to make you sick. And there’s a stigma with that, but I’m doing it too. So that is really interesting. We kind of look at. We all do have things that we do that aren’t good for us. Maybe it’s our mental health, maybe it’s our physical health, or maybe it’s supporting someone around us who has those things.

Amanda Brisebois: We all do things that aren’t ideal. So how do we actually get ourselves on track to do some of it? Like, you know, you don’t have to do all of it, but how do you make those small steps so that you actually are [00:39:00] proactively doing better for yourself? Uh, and that’s not easy because we have so much available to us in, at least in North America.

Amanda Brisebois: I mean, we are so lucky and some countries don’t have those um, affordabilities to be able to, just have all these perks in life that we have, but we have to think about how we do better too.

Erik Sunset: Well, this is a tough segue here, but you, you mentioned a sort of a dog whistle for me on the DocBuddy journal, which is AI and healthcare, we’re we’re kind of coming up on the close of our conversation. Would love to get a your firsthand perspective on what you’re seeing. Are you seeing AI?

Erik Sunset: Deployed in any meaningful way or even in a not so meaningful way at maybe a smaller scale. What are you hopeful for? I know you mentioned the efficiency of documentation and how something like an LLM may be able to assist you there. What’s your take on AI and health?

Amanda Brisebois: Well, I’m, I love these kind of technologies and things. Um, in Canada, it’s interesting. I [00:40:00] in the US training and you’re always ahead of us with the technology, which is interesting. I’d come home and I’d be like, Oh, I want some of that stuff. Um, we don’t have a lot of AI inserted right now into healthcare.

Amanda Brisebois: I do believe it’s going to be massive impact and I hope it will be a massive impact for all of those reasons that I’ve said for the positive. I think that AI will at least support the word replace wanted to come out of my mouth, but I think it will at least support some very important things such as making diagnoses.

Amanda Brisebois: Process, we study all this stuff and memorize all these medications and um, differentials, meaning what, lump on your chest x ray, all the things that can be, I don’t need to do that. That should be something that AI can go, these are the things you need to look at. Why should I spend brain space or time on those sort of things?

Amanda Brisebois: And I was actually telling somebody the other day or talking [00:41:00] to them about my job is mostly talking to people and really hearing them and integrating their experiences. And I thought, well, at least my job is protected from AI because a lot of this medicine I don’t think will be. And they said, and I don’t know this study, so I’m going to have to go look it up.

Amanda Brisebois: But they said there was actually a study out there. I think it was a psychiatry study where they were doing these kind of conversations and AI did better. So I just went, Oh, no. Uh, so I do think that we’re going to supplement it and realize. We’re going to have to study what does AI do better and what capacity is going to evolve every single year.

Amanda Brisebois: You’ve seen how fast technology evolves. So we’re going to have to evolve with it and really realize what can we do better? How do we work with it? Where can it help us? Not try to block it, but where can it help us? And if it helps us into our communities, who can we get to pay for this so we can bring it into our community?

Amanda Brisebois: Our work environment, because that’s a huge limiting factor in Canada. Like, even if [00:42:00] you had AI to do my charts, who’s going to pay for that? Because if I have to pay for it out of, you know, whatever I’m making, I might not do it because you have to pay for that. And then you have to pay for the system and you have to, so who pays for these efficiencies, I think is a big deal.

Amanda Brisebois: But I think AI will be able to. honestly insert itself almost into every aspect of health care all the way from managing hospital systems. Like think of it being able to determine where efficient, where the gaps and efficiencies are. Um, I, I think it’s a massive When I was young, if you had said, I don’t have my phone in front of me, but if you had said, That I would have this phone or we would be sitting here and I would be connected all across the world and I could see what was happening and I wouldn’t have to study all the encyclopedias for my exam.

Amanda Brisebois: I would have thought that you had lost it. I would, I couldn’t imagine such a thing. And so I think we have to imagine big and I have high hopes. So hopefully if people are listening in this [00:43:00] area uh, help us. Because I think all industries, but especially health care, because that’s how we survive um, can really benefit from this. maybe it is picking the pieces that. We can um, I, I say decide, you don’t, you can’t decide, you know, how a person is going to be cared for, how they want to live, but you can help provide what’s going to help benefit them the most at different stages in their life too. And that could really help people maybe understand that it’s not just about living forever um, or physicians doing everything, you know,

Erik Sunset: Well put, very well put. I

Amanda Brisebois: It’s a law, I mean, you can talk forever about it, right?

Erik Sunset: Yeah, you really could. And it’s, um. The thing that’ll be interesting here at least stateside, and again, this isn’t a comparison between north of the border, south of the border, I just pay much more close attention to our laws, obviously, as a citizen of the

Amanda Brisebois: Yeah. Yeah. Yeah. Yeah.

Erik Sunset: protection laws around [00:44:00] AI yet. We will, some states are contemplating it, some states have some sort of rough laws that are being proposed. absolutely zero for patient protection with regard to the use of AI in their treatment. unfortunately, in such a litigious society, we’re probably going to have to get there. We’re going to have to get to the lawyers and the compliance folks allowing the use of AI in the treatment of patients, you know, with respect and governed by some federal or state law. And I think in some cases, that’s probably for the best. If I went to my primary care and they said, you know what?

Erik Sunset: The doctor’s not going to see you today. It’s just talking to this box. They’ll say. I don’t think so. That’s, that’s not going to happen. Like, I’ll, I’ll wait for the doctor.

Amanda Brisebois: I’d be like, okay, cool, I’ll try it, but I have enough knowledge to know if they were wrong. So that’s, that’s,

Erik Sunset: well, yeah, the difference between you and me, right? I’m just a, I’m just a guy.

Amanda Brisebois: yeah,

Erik Sunset: that’s on one

Erik Sunset: side of it. Like maybe it’s

Erik Sunset: for the best. Maybe we do need to sort of rough out [00:45:00] at least a framework. Like where can a machine or a software treat a patient as opposed to medical decision making of, of a fellow human?

Erik Sunset: I don’t know that on the other end, I’m all for innovation. I’m all for the free market. And if there’s a solution to be had, somebody should just go make it and get it working. So I’m kind of on the sideline because I’m not developing any, any AI, myself. And what we do here at DocBuddy isn’t necessarily an AI driven solution, though there is quite a bit of machine learning that goes into the back end of it. But all that to say, we will see, because we’re on the cusp at least with the large language models, the generative texts like ChatGPT, those are iterating in on themselves very, very quickly. There are several EHRs that now have it embedded into their software for things like patient communications, which is massive. And it’s just so unhealthcare like that. We’re adopting new tech as quickly as we are. And I think that’s cool. I think that’s a [00:46:00] good thing for everybody.

Amanda Brisebois: well, there has to be regulations and all of these things I think about self driving cars. Like, we may have technology, but where do you use it? For sure. Those are going to be a lot of team conversations with multiple stakeholders involved for sure. Um, but how exciting will it be? To see what happens and hopefully I’m here for it, but I don’t know, maybe some days.

Amanda Brisebois: I’m not sure I want to be so uh, I mean, it is a tough world for people now. There’s it’s a different place than it was um, without all of this technology it, but it’s definitely a different place. So we have to figure out how we’re going to work with it and how we can be happy working with it, which is a big one too.

Erik Sunset: Yeah. To bring us full circle, how to manage your own mental health and your own levels of agency in a world where your attention can be divided a million ways, every second that passes.

Amanda Brisebois: Yeah. Yeah. It’s easy to disengage and that’s part of it. Like here we ask people to engage at work, but you [00:47:00] just go home and I’m the same. I can click and I can binge watch some show that just came up all 20, all 20 shows in one night, you know, and you just sit there and it’s uh, it’s, you’re not really attention so that it’s very easy to translate that to your work life.

Amanda Brisebois: And just go there and of course works not going to be as exciting as what what happens on TV to my mom was a teacher and she always said she always was expected to do, you know, Indiana Jones or something in the classroom. And she’s like, I’m not that exciting. And that is a problem because it’s just not as exciting as some of these things that we can watch on TV.

Amanda Brisebois: So why would I want to do this quality improvement project? It seems kind of drab. Um, and that is a problem too, I think, because have so many. Cool things out there.

Erik Sunset: Instead of taking that in the sort of the sad way,

Amanda Brisebois: know.

Erik Sunset: to take that in the

Erik Sunset: happy way that life will be what you make it. And if wish everybody happiness and, you know, as we come to holiday season, especially so. Make [00:48:00] it exciting. Make your own life exciting.

Amanda Brisebois: I always say that. I said, it’s your life. You, you do have control. And that’s something that people feel that they have no control, but you actually do no matter where you are, no matter what position you’re in, you have power within yourself to make decisions for yourself and also to share how you’re being impacted by other people’s decisions.

Amanda Brisebois: It takes vulnerability. It takes strength, but do it. It’s amazing when someone actually listens, and people usually do, that things will change.

Erik Sunset: What a great note to go out on. Before we say goodbye though, Dr. Brisebois, how can our listeners connect with you? Are you active on any social medias?

Amanda Brisebois: Yeah, I’m on, my Facebook was just hacked, so I’m, I’m a little shy off that, but I’m on LinkedIn uh, AmandaBrisboisMD, a website, AmandaBrisboisMD. com, and I um, have links so you can connect check out what I’ve been doing, and I love talking to people, so if you’re going through anything, just…

Amanda Brisebois: [00:49:00] book and say, hi, I like hearing people’s experiences.

Erik Sunset: And for our healthcare organization listeners, our administrators, our executives, our owners, definitely give Dr. Breesbois a shout. I know many of you are going through many different sorts of issues around staffing, availability of staffing, and so forth. So, Dr. B, thanks so much for joining us today.

Amanda Brisebois: You’re welcome. It was great. Have a great day.

Erik Sunset: Really enjoyed the conversation and on behalf of the entire DocBuddy team, thank you for listening. We’ll catch you on the next episode of the DocBuddy Journal.

Amanda Brisebois: Bye everyone.