I'm ZDoggMD, Stanford doctor turned rapper and host of Incident Report, the most popular live medical show on the internets, AMA!

An NYU medical student and resident committed suicide 5 days apart. We just brush in under the rug and continue on with our burnt out lives. When is enough enough? When are organizations gonna step it up and fix a very broken system? When are we gonna start valuing mental health instead of just treating it? Hell, when are we gonna start valuing LIVES as healthcare professionals???? The business of medicine sure as hell isn't gonna do it.

You nailed it. Stay tuned, this is a mission of ours. http://zdoggmd.com/against-medical-advice-037/

Starting second year soon, fingers crossed. Please let us know what we can do to help

Finish school, then join the revolution ;-)

How can I join? Social worker here

You just did. Or become a ZPac member at facebook.com/zdoggmd or zdoggmd.com/list

What do all residents need to know before starting as an attending, that you dont learn in residency?

Know how to quickly find information (Dr. Google? Up To Date?) and apply it to your patient at hand. Know what you DON'T know and when to ask for help. And always remember: you are modeling behavior for your staff, students, and PATIENTS every minute of the day.

Hi ZDogg! Student pharmacist here, love your stuff. I've heard you talk a little bit about it before but I wanted to ask you directly - What is your idea of a pharmacist that is practicing at the top of their license in a health 3.0 setting? I love this profession and how dynamic it has been as a healthcare role over the years. With the majority of pharmacists practicing with a PharmD these days, there is a lot of push from us to take on a greater role in healthcare. Legislatively that push for expanded responsibility (provider status being a big one) is often met with resistance by other organizations such as the american medical association. How do you as a doctor see the responsibility of the pharmacist being expanded in health 3.0?

I RELY on pharmacists to practice at the top of their training with regards to medication management, chronic disease management, anticoagulation, etc. It is a great tragedy that we've reduced 4 years of postgraduate education to the perception that y'all are just counting pills at a drive through pharmacy for CVS somewhere. Now the pushback usually comes when physician groups feel that their education and authority are being eroded. But medicine is SO complex now, you need a team with everyone practicing at the top of their game. The AMA hardly represents front line clinicians anymore, they are as calcific an org as any large org. "Provider Status" I feel is irrelevant; let's just everyone do (and be expected to do) what we are trained and licensed to do, no more and no less (most often, we're doing LESS).

Provider status is relevant in the sense that many organizations (hospitals, chains, clinics etc) will not continue to push for the expanded interprofessional team because pharmacists can’t be reimbursed by insurance companies for their clinical work. That’s why we need provider status. But I am a big fan and I am so thankful for your other comments!

Maybe we just need to get rid of insurance companies ;-) hahaha just kidding. Or am I?

Male nurse here, just want to say thanks for all you did recently for raising awareness for the violence that happens to us in the work place. I don’t think I have a single week that I’m not scratched at, bitten, kicked or verbally berated.

So I wanted to say thank you for that!

But hey... satisfaction scores right?

Thank you for all you do! And those who feel that healthcare worker violence only affects women, check out Jimmy's Story: http://zdoggmd.com/jimmys-story/

Hey! I love your stuff! I just watched your commencement speech and it was ridiculous!

I have spoken with so many docs that have been treated for depression at some point in their careers. How can we lift the curtain and take away the stigma?? People are afraid that docs on meds somehow can’t treat their patients, when in fact many are secretly being treated due to burn out. Who doesn’t GET TO attending good NOT being burnt out?

This is a crucial topic! We need to destigmatize mental health care in the medical professional and beyond. First step: remove the punitive questions on job applications and state licensing that ask about mental illness. They prevent reporting and people actually getting help. See also this interview we did with a physician suicide spouse survivor: http://zdoggmd.com/against-medical-advice-037/

It seems to be a real issue, and that the quite a few doctors self medicate, especially with alcohol. My father always told me how several doctors he worked with were functioning alcoholics, and it was just an open secret until it went too far and inevitably ended in tragedy.

YES. 100% true.

Insurance still punishes people w depression. I’ve been stable & doing really well on my meds for a decade and can’t get insurance to cover me if I need to go to an ECF because I have a history of depression. WTH?

Pound foolish and penny-wise...

Scrubs, house MD or Grey's anatomy?

SCRUBS!

The Keto diet for weight loss. Some doctors are for it, others are against. Where do you fall and why?

I tried Keto for 8 months. Lost weight, got ripped, my LDL went from 80 to 165 and my ldl particle count (a specialized test using NMR) went through the roof. Therefore I backed down to mediterranean/intermittent fasting and it worked well. Bottom line: it all depends on your personality and genetics, there is no one-size-fits-all answer that works for everyone (unlike what the people trying to sell you books and documentaries would have you believe).

Would you recommend it for diabetics?

Talk to your doctor, but it has shown great promise there (especially to prevent prediabetes from progressing)

Though honestly, any diet that cuts out refined carbs, processed food, and sugar can likely help (this includes vegan diets if done right)

Do you think it had to do with the types of fats you were eating, more genetics, or more just plain unavoidable?

I know some Keto dieters predominantly eat medium chain triglycerides like coconut oils, does that help?

I'm trying to decide whether to go keto - I'm trying to cut right now and the problem is that if you go too low on calories you eventually just drop below the bare minimum necessary fats.

When I switched to mostly monounsaturated fats, my LDL count dropped dramatically.

Any advice for novice nurses when when they have to page the doc? Many of my nursing students say this is one of their more stressful tasks in the first few months of work.

Also, what is the support from your hospital like for your videos? Seems like a great way to build a community relationship, but I can also see administration not being super supportive.

Our administration at UMC is amazing and enlightened and we can't thank them enough!

Re: calling docs, be prepared and organized, polite (a lot of times, apologizing for waking them up acknowledges their struggle, but stay firm about it being 100% necessary). Meet them, make friends with them, try to know each other by name, it helps immeasurably.

What is the most ridiculous patient encounter you have ever had?

Pretty much every drug seeker ever? LOL

Seriously, had a woman who smashed and swallowed a mirror due to a psych disorder. Completely denied it but the x-ray and endoscopy was quite "reflective" of the true issue ;-)

I had a patient with abdominal pain a few months ago.

Someone, not me, had ordered an abdo film.

First and only time an AXR has been helpful in undifferentiated abdo pain, as it showed an intact lightbulb in the rectum.

Patient denied all knowledge, naturally. Couldn't get it out in ED, so had to take them to theatre.

Even after all that, they still had no idea how it got there. Biggest mystery of my career 🤔

BRIGHT IDEA! lol that's amazing.

Ugh, Christ.

Months of puns in work. Was a struggle.

How many patients does it take to screw in a light bulb?

Depends.

(No literally, you'll be wearing Depends diapers after you wreck your sphincter doing that s**t)

ZdoggMD, love your stuff. Rural areas are going to telemedicine alot. What are feelings about that?

When combined with legit in-person primary care to coordinate, telemedicine can be a viable solution for our rural areas (and the only option in many cases).

But can Doc Vader force choke using telemedicine?

ABSOLUTELY! See: empire strikes back.

Why do you still think it's the shunt when we've made it abundantly clear that it's never the shunt?

:-P

LOLOLOL IT'S ALWAYS THE SHUNT!

I went into medicine with a plan on making creative content beside my medical practice. Now I'm close to getting my degree and since I have more time in clinicals I wrote a bunch of short stories on an app. Whenever I bring this up to my med school friends they make fun of me as I don't make much from ad revenue on the app, the fact I am creative is causing ridicule so I have stopped sharing me being creative.

A lot of my family keeps telling me I shouldn't be artistic anymore as it's kid's stuff, I need to act more grown up as I am starting my adult life. How did you deal with this? I'm still scarred to show others the real me as I know I'll be seen as not that bright due to my creative hobbies. I feel like I'm leading a double life sometimes.

I love ur Doc Vader content. It cheers me up when I get bogged down with studies.

Just use me as an example of how important art/creativity is to healthcare and attempting to transform the status quo. Don't EVER give it up, and tell the haters to SUCK IT.

Hey ZDogg! Current medical student, love your podcasts and videos!

How do you envision charting in healthcare 3.0? Click boxes simplify manually typing, but I still want to die every time I'm just sitting there on a computer clicking and typing. How can we create a charting system that is both complete but not soul sucking?

Ideally you have a piece of technology (google-glass like, but not so stupid and douche-y) that basically records the whole visit, parses it through an AI program that then creates a perfect note, which the clinician can then just go in and edit/add plan etc. Allows us to get back to patient care while kicking ass on the documentation. We don't make Lawyers be their own court reporters, why should health care professionals have to do this?

Hey Zdogg! Long time fan!

My wife is going nuts. Ten year DO. Every clinic she works at, she does proper complete charting. All the other docs barely insert any info. She has found an over abundance of overlooked problems (like multiple blood pressure meds being taken together) and undiagnosed illnesses due to wham, bam, thank you ma'am docs.

Does anyone do proper health workups anymore? Is factory medicine ever going to end? What happened to quality instead of quantity?

The struggle is real. I think partially it’s a problem with our training system not quite vibing with the work that needs to be done.

How do feel about how Hashimoto’s disease is currently being approached? There seems to be a lot of bs out there (gluten is evil etc) and a lot of doctors only treat by supplementing thyroid hormone, which does nothing to address the actual auto-immune component of the illness.

From a frustrated Hashimotos sufferer. I feel human medicine is letting people down. (Veterinarian here)

There is a TON of woo around this disease out there. Stay tuned, we'll have some experts on the show to dig deep.

Hey ZDoggMD, I work in the Lab and your medi-moji video for the lab was spot on and hilarious to all of us Techs in the da lab. How did you know all the quirks/gripes or did you have inquirers from the lab help you out? That post was much appreciated during lab week BTW. Thank You!

Lab ZPac'ers gave me the best material! #Zpac4Lyfe

ZDogg, RN here. I practiced in ERs and ICUs for 18 years and left the bedside due to bad PTSD after 7 bad child abuse cases in a ten month period. Since I left, I’ve spoken to many healthcare professionals with similar issues. It seems to be almost ubiquitous.

What can we do to address PTSD in bedside practitioners?

Destigmatize it. Ongoing discussions and resources need to be made available to our front line staff. It is a REAL struggle and requires real management and solutions and resources.

Hey ZDogg, love your work. Keep fighting the good fight.

I'd love to hear your thoughts on Suboxone prescribing by primary care doctors in the community. I'm an Emergency Physician with an interested in addiction treatment and right know I'm trying to create a pathway to get our opioid dependent patients into rehab from the ED. The program revolves around the idea of ED suboxone initiation with immediate referral to a treatment center.

Have you worked in a primary clinic that provided Suboxone or have you put thought into doing it? It seems like the uptake in the primary care community has not been as robust as anticipated and Suboxone prescribing is remaining in drug rehab centers or addiction medicine practices (despite the original intention of the DATA 2000 waiver to provide primary care physicians and family doctors the opportunity to treat opioid dependent patients in their community clinics).

This is a GREAT topic, beyond the scope of AMA, but thank you for the work you are doing! We'll have to do a dedicated show on this with some specialists such as yourself.

Hey, it's you! I used to be a Turntable patient before I moved.

I always wondered -- how often did a typical Turntable patient come in, and were they all young hip downtown tech people? I was a member for a few years, but I think I only went in a couple times. Which seemed like judicious use of medical resources to me, since I know there's only so many appointments a doctor can do in a day, but the very nice staff was always like "you should come in more often!"

The trick is: have people come in a fair bit at first, get to know them as people, then you can do phone/email/text skype to keep it convenient for the patient and manageable for the docs. Thanks for being a part of our clinic!

Hey ZDogg! I’m a medical technologist and laughed so hard at your music video pertaining to lab life, as well as your video where you use the bear emoji from the iPhone. I feel like there’s a lot of disconnect between the lab and the nursing staff at many institutions. Do you have any tips to possibly help nurses understand why we do what we do (as far as being strict on collection) and how to help them understand we don’t just cancel stuff all willy nilly?

We need more group potlucks to get to know each other, walk a mile in each others' shoes.

Why no love for social workers/discharge planners/case managers? We get people out of the beds so you can fill them again. I feel like we totally deserve at least a song! If not an AMA episode. :)

We shouted y'all out here: http://zdoggmd.com/it-was-a-good-call-day/

Hey there, I saw your video where you react to that vegan movie and people basically brigaded your video and left a bunch of hateful and uninformed comments. How do you think we can stop the fast-growing trend of pseudoscience in this country?

Nutrition is like religion; once we recognize our unconscious, conditioned biases and beliefs, we can be more open to the actual underlying science around nutrition...which is limited, sparse, and crappy. So find the diet that works best for you and lose the dogma, right?

Would you consider making shortened videos for those who love your shows but just don't have the time to watch the entire thing? Currently a medical student and I really enjoy the perspective and humor that you provide, but as you can imagine watching more long videos is not high on my to do list!

Stay tuned, podcast is always available too, and transcripts are coming soon. Once we get bigger staff, we can start editing into highlight reels!

ZDoggMD love your stuff. I am a muggle, but my Fiance is an RT and we have great discussions while watching your content. My question is what direction should a 34 year old new father take to get into a healthcare profession? I want to help people and also provide a good living for our son at the same time. I just feel a bit lost and overwhelmed.

You could always start as a medical scribe and feel out what you are passionate about from there!

My favorite thing you've done is Ain't The Way To Die, honestly one of the most moving things I've ever listened to, tears every time.

I carried my grandmother in my arms, into her house from the hospice car with a terrified look on her face. When I put her into the bed, she pulled my uncle to her without breaking her horrified gaze and asked him "Who is that man"? Stage IV lung cancer that hit hard and fast, whacked from drugs.

I sat in her house and listened to her death rattle for hours, pulled my dad into the other room eventually and told him to get everyone out of the house and have the nurse leave the morphine on the table. He told me "You know you can't do that"...

Everyone justified it by the fact that when she did happen to pass after hours of that, my uncle was rubbing her feet. She stopped gasping, looked up, smiled, and went.

And I fucking hate it. Nothing beautiful about it, no final peace moment can erase that.

So this is less of an AMA question and more just an opportunity to thank you for giving me some catharsis for my sorrow and anger.

Actual question would be, how the hell do you manage to not only have the time to produce such fantastic quality, but the time to learn how to have done all the things you do on top of being an MD?

Thanks for sharing the struggle, and sorry for your loss. Re: balancing all the things, I have a wonderful support network/family that helps me try to do too much at once ;-)

Hey /u/ZDoggMD, what are your thoughts on the big nationals (Team Health etc.) replacing retiring ED docs with mid-level practicioners to save money? Do you have any qualms signing off on a 20 charts at the end of your shift for patients you never saw that you have liability for? How about NPs introducing themselves as doctors to patients?

Oh, great questions. I think we are in the throes of some serious Health 2.0 transition shit that needs to be sorted on a deep soul-searching level. Stay tuned, we'll be doing a show on this.

Are there any longer term studies around prediabetes to diabetes progression? I know I've seen 5-year studies that show around 1/2 of people go on to full T2, but i'm curious to hear what outcomes look like for the other half.

Also any info on what can be done about pancreatic beta cell destruction. Are they truly gone in T2? Suppressed? What's the likely state of beta cells for those in a prediabetic state?

This is out of scope of this AMA, but I will say this: prediabetes is a warning sign and full diabetes can most certainly be prevented, often with lifestyle adjustments in many cases. Stay tuned, we'll be doing future shows on this.

Hi ZDogg!! My mom is your biggest fan. She's always showing me your videos. She's an RN in the process of switching from hospice nursing to travel nursing. What is your opinion on travel nursing? Any pros or cons I can tell her? TIA. ❤️

I think for many it's a great solution. I spoke at TraveCon this year in las vegas, and those were some happy nurses!

Hi there! ABSN nursing student here, love your videos so much! I found the video on NP role as a provider really interesting. What are you feelings (really) on mid level practitioners, do you think their prescribing power should be taken in or given more autonomy? PS please do more medi-moji videos they are HILARIOUS.

http://zdoggmd.com/incident-report-106/ it's here ;-)

That letter from the anesthesiologist is unbelievable. I'm a physician and come from a family of physicians and other healthcare workers (6 docs, 1 RN, 1 NP, and the black sheep JD.) The general consensus in my family is that most frustrating clinical problem is not a matter of competence or treatment but rather it is dealing with other professionals with shitty social skills. I would much rather work with an affable mid level who will come to me with appropriate consults versus a clinically competent asshole MD who makes my day that much more stressful due to his personality.

I feel you entirely. Physicians are their own worst enemies. We hate each other and yet we are the only people who understand each other. It starts as premeds and just gets worse from there.

ZDogg, Zpac RN here, if you were an RN, what type of setting would you want to work in?

ICU or ER ;-)

Or Hospice.

We saw your video of "EHR State of Mind" for a presentation at work about GPO's last week. I've been sharing w/ friends and family that have been in healthcare for decades. Everyone loved it. Do you have any more TEDMED's coming up?

All my events are here: ZDoggMD.com/events

What are your opinions on the direct primary care movement? (Doctors providing direct care for fee without the red tape of insurance and government reimbursement) https://www.facebook.com/Reason.Magazine/videos/10155699393379117/

I'm a big supporter: https://www.facebook.com/ZDoggMD/videos/10156239361697095/

On a scale of 9-10, how badly do we need to overhaul the physician reimbursement pathway? CPT madness, payer obfuscation of benefits, public's understanding of said benefits, etc.

11

This AMA is such an important one and I am glad you are here Dr. ZDogg. My questions are more about your art as a rapper and the positive influence it has on your personal and professional life.

1. How do typical 'business suit' doctors respond when they learn of your duality. Like do they sometimes feel that such a diversion might detract from your professionalism?

2. Your videos and craft are obviously making a huge, positive impact. Would you ever consider academia, or perhaps speaking engagements?

Thanks in advance.

It’s a mixed bag with some doctors. Some get really pissed off and see it as heretical. Others feel like I am saying everything that they want to say but can’t. Regarding speaking engagements, I do many per year. ZDoggMD.com/book-z and ZDoggMD.com/events

Any thoughts on you doing a show about advance directives and encouraging your Z Pack to fill theirs out?

I am an NP and the healthcare organization I work for is passionate about advance directives and has had a large internal campaign to encourage employees to fill theirs out and it has been successful. I am 30 and healthy, I have a 5 Wishes document filled out and have asked my parents to do so as well.

Do you think it would benefit society to encourage as many healthy adults as possible to fill out something like the 5 Wishes document?

We've done MULTIPLE shows on this ;-) see here: http://zdoggmd.com/tag/hospice/

How do you feel about the petition to retire the SSC guidelines?

People I deeply trust (Scott Weingart, Paul Marik, and others) support this petition and so do I. https://emcrit.org/pulmcrit/ssc-petition/

Intellectually speaking, what is sacred about medical practitioners that cannot be slowly encroached on by AI?

Very little, intellectually speaking. From a human standpoint though, there is healing purely in knowing another human being has witness and heard your suffering and cares enough to try and help.

Hey ZDogg! HUGE fan! Cardiac PCU RN here in my first year of practice. I work for a semi-teaching hospital. We get nursing students, but no residents unless an attending decides to independently take one on. This leaves us with an attending based model. We are getting residents in July, and I'm excited about this, but many of the older nurses I work with aren't optimistic.

I work night shift so it's rare that I see the attendings. I have no problem calling a doctor for a pressing need, but many times there are little things that don't warrant a phone call, but do warrant mentioning. I always pass these along to the day RN, but many times our docs don't even check in with them and sometimes it can be days before things are addressed. I find this totally unacceptable and realize it needs to change. Our administration is trying to make it mandatory that attendings find the nurses caring for their patients, but they're getting a lot of pushback both from the docs themselves and from the older nurses who think it's a time suck on an already stressful day. We do utilize Doc Halo (essentially a texting service that is HIPAA compliant) but many docs refuse to use it. I'm to the point where I've only been practicing for 8 months and I'm already disgusted. I feel that we provide our patients good care, but that we owe it to them to provide GREAT care. Any ideas? How do you implement changes in Healthcare 3.0 without getting tons of pushback?

I'm personally a big fan of interdisciplinary rounds. They take longer, but everyone has a voice and the patient benefits (sometimes we include patients family members on those rounds, especially in ICU)

What's your favourite sandwich?

Anything toasted!

Hi ZDogg!!! I’m an Emergency RN and a pretty large hospital system in the Pac NW. One of the big slogans of the hospital nursing administration is to “Create a Culture of Safety”. Focusing on safe practice, blameless error reporting and such. All good goals but really focused on our practice and not reciprocated, at least vocally, by other practices in the hospital. Do you think that the current system of residency fosters a culture of safety? It sometimes seems to me that it is the last large bastion of organized work hazing and accepted less-than-safe work practice (ie 90hr shifts and such). Thoughts? And thanks for all you do. You rock Z!!!

We have a LONG way to go on this, but it's crucial to optimize Health 2.0 so 3.0 can emerge. Slogans are one thing, process improvement and science is another.

I’m currently an RN in the military deciding what to do next. I either want to do ICU then CRNA, or go a different route and become a surgical PA. Any thoughts/advice?

Ooh, beyond my ability to advise...

Opinion on Trump's plan on drugs that was rolled out? https://www.hhs.gov/sites/default/files/AmericanPatientsFirst.pdf

How would you change medical education?

also step 1 advice pls

Haven't had a chance to dig in enough, stay tuned. Re: Step 1? Do a LOT of practice questions and have fun with your friends studying (we played a lot of Legend of Zelda Ocarina of Time while shouting out mnemonics for different obscure conditions, all of us then aced the boards LOL)

Current massage therapist struggling to work around constant quackery, if I were to change careers paths into the medical field what area would you suggest?

I would be a massage therapist! It works, it isn't woo in it's best manifestation, and it helps people! http://zdoggmd.com/hippies

Scenario- You are the president. What would you do to help solve the opioid crisis?

Step 1: don't pick Dr. Oz for your counsel on nutrition and fitness LOL.

Also: convene some smart addiction specialists, along with pharma, physicians groups and other important stakeholders and start hashing out ways to change policy in a manner that actually alters incentives and behaviors without wrecking the care for people who have legitimate pain (or forcing them to turn to heroin).

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I posted about it on Doc Vader's page, so y'all know it's me ;-) https://www.facebook.com/docvadermd/posts/950596051769353

Hi ZDogg! I watched your violence against nurses (and other staff) video with my heart in my stomach. Have you seen any positive changes come about since your video?

Yes! This is now a national issue, even the press has piled on. More awareness = hopeful progress

Saw you last year in Houston at an athletic training convention. I am leaving a well paying position where I must "kiss the ring" for a lower paying position that supports my growth and mission. Unfortunately, this is causing me to leave an area of the country I love. Any tips how how to come to get over leaving money and location on the table?

I did it, so can you ;-)

My husband is a medical student, just ending his 3rd year and going into 4th. Lots of residency rotations and interviews coming up! What’s the best way as a wife, to support him while he’s gone for months? We’re both overwhelmed. What tips do you have to help us go through this as a family?

He’s thinking IM too! He loves working at the hospital vs the clinic.

Oh man, it's hard. Listen to him, be there, but also don't forget about your own needs.

How did you get into Stanford?

I cheated. #KobayashiMaru

What are some ways that docs and hospital management can sincerely appreciate their nurses (specifically for nurses week next year)?

Empower them. DEMAND critical thinking instead of the rote box-clicking that occurs now. Also: they should have a ZERO tolerance policy for nurses who bully other nurses. We have to encourage culture change at every level.

How does health 3.0 accommodate individuals with pre-existing lifelong diseases and illnesses like type 1 diabetes? Obviously, they require far more check-ups and attention than normal clients which would decrease margins. I love the idea of health 3.0 but I don't know if it can work for everyone.

Health 3.0 is shorthand for re-personalized, re-humanized, tech enabled and supported, team based care. People with chronic disease MOST benefit from this model. You can use the tech/big data side to find best practices, but then you have the time and latitude and tools and team to apply it to the unique patient in front of you.

I absolutely adore you! This is kinda long but weighing heavy on me right now.

Do you think there is a sustainable solution to the jail/drug/hospital/jail cycle that so many of our patients get into when they just need access to mental healthcare, appropriate prescriptions, and attainable follow up care?

Specific example... We’ve got patients who come in for mental health and get a bed in a facility but they have warrants out for random nonviolent things like “failure to appear” (probably from when they were hospitalized) so when the sheriff comes to transport them they get sent to jail instead and never get the mental health treatment. Rinse and repeat. WTF is that and how do we fix it?

We talked a bit about this with a frontline psychologist managing these patients: http://zdoggmd.com/incident-report-mobile-weaver/

I'm currently studying for STEP 1 right now and it sucks some serious dick. I'm talking Ron Jeremy proportions...does it get better?

100% it gets better. Then worse again. Then better. Then worse LOLOL THEN BETTER!

How to improve my concentration doc and what are pitfalls in stanford?

Meditation is a great way to train attention (and peripheral awareness at the same time). Even folks with severe ADHD can do it!

Hello, thank you for your time

What are some neat tricks you use to categorize mentally diseased coworkers?

Example: Spotting sociopaths in the wild versus identifying borderline personality

I'm gonna stay away from this one LOL

Hey, about to start 4th year of med school.

Q1: What are your thoughts on volunteer work on the resume/ERAS? I feel like so many of my classmates just do it to pad their resume rather than being passionate about it. Can you see right through it?

Q2: hypothetical... A bunch of residents form a union. They don't want to harm patients in striking to petition for better working conditions so they stop filling out ROS so the hospital can't bill Medicare/Medicaid. Genius or stupid?

Q1: we see right through it ;-) I did nearly zero in medical school beyond caring for my patients.

Q2: Ooh, hit 'em where it hurts! Genius (and stupid, which is why I love it)

What do you think drives your "everyone look at me" need for approval?

Probably the same thing that drives your narcissistic need to leave this sort of comment ;-)

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When I started in medical school at UCSF I felt for the first time in my graduate education that I was back in high school. Many of my classmates, myself included, behaved like childish pieces of shit. I think it’s because we work so hard to get there that our social development was definitely stunted. The problem is this continues into our professional careers. Doctors are by far some of the biggest assholes I have ever met. They are also my closest friends and the only people who understand me truly. There in lies the paradox. The best bet: find a few friends that you like and can tolerate and get close to them. Ignore the rest. Keep a close touch with your creative side and you’ll get through it.

Hi.

What's your favourite textbook in medicine?

Up To Date lol

I just recently started watching your videos and I love them! I am in a doctoring medical profession (audiologist) and there has been a lot of audiologist saying that the MDs (or hospitals) that they work for won't let the audiologists use doctor before their name.How do you feel about non-physicians using the title of doctor?

They've earned the title, but the tricky part is confusion in a healthcare setting that it can create for patients.

Agreed, this is why I always say "Hi, I'm Dr. OK-la, I'm the audiologist working with you today" My issue is that the MD is doctor, the optometrist is doctor, the podiatrist is a doctor, and most of the time the chiropractor is a doctor but the audiologist is the hearing aid girl.

The struggle is REAL!

ZDogg, I love your stuff! Never any love for respiratory therapists though. At my hospital we have a very wide scope of practice (vent management, inserting and managing A lines, bladder pressures, bronch assist, intubating neonates, ECMO, HBOT, etc), but at other hospitals the scope for RTs is much more limited. Any thoughts on our role, specifically in the ICU setting?

I really HATE it when RTs message me this shit. We've shouted out RTs innumerable times, yet you guys continue to whine that I've done nothing for you LOL. When I try to get y'all and your societies to fund raise for Ventilate (our Warren G/Nate Dogg regulate parody for RT), it's silence. But bitch bitch bitch. Just SOME of the videos where I've shouted out the importance of RT: http://zdoggmd.com/tag/respiratory-therapy/

SO SHUT THE HELL UP ALREADY lololol *ps I love you.

You are right about empathy. How can I flip that switch off? Any suggestions??

Practice COMPASSION rather than empathy. It's a practice. There are great compassion meditations that can help (they really do work!) Compassion is a kind of detached "love and concern in the face of suffering" as opposed to "feeling" someone's pain and taking it as your own. http://zdoggmd.com/incident-report-047/

What’s your opinion on ADHD meds?

COCAINE IS A HELLUVA DRUG CHARLIE MURPHY!

Hi ZDoggMD- what are your thoughts on Primary Care-Mental Health Integration and what do you see as the biggest barriers in implementing this model? How have your experiences been with mental health professionals embedded into medical settings?

Thanks for your thoughts!

At turntable we started with a LCSW who did mental health. It was KEY.

Hi ZDogg - I just watched your TEDMED talk and your 7 years video (http://zdoggmd.com/7-years/) and I want to help you create Health 3.0 however I can. I'm an experienced software developer. How can I help?

Go find a company that's doing something amazing in the healthcare space and offer your services! I was just at the HLTH conference in Vegas, everyone was dropping catch terms like AI and blockchain but know one really knows what they're doing. Help them!

Hi doctor ZDogg, what do you think about PCHM 2.0 and the effects it will have on primary care physicians? It seems that PCPs will become responsible for a massive amount of information such as collecting all consultation reports from specialists as well as be held accountable for patient preventative care even though some patients simply won't get their proper screenings done (lack of time, concern, interest, etc)

This will make burnout worse. We need to tool, resources, and latitude to make use of the PCMH model, otherwise it's more click boxes and noise.

Who are your favorite rappers? East coast or west coast? Do you think Suge killed Tupac?

Regarding the medical community, it's a business revolved around money, and they should be accepting of alternative therapies IF they work.

But thank you for all YOU do.

I like a mix. Jay Z, Kanye, Tupac, E40.

Been enjoying your videos, thanks for the good work you’re doing!

In brief, any thoughts on the state of EMS/paramedicine in the US? You’ve made mention of “practicing at the top of your license but no further”, but as a newly credentialed medic, I’m worried about the state of EMS, both as a contributing component of the larger healthcare problem, and as a stand-alone issue, but I feel like it’s being ignored or at a minimum not focused on by stakeholders.

It’s obvious to me that it’s incumbent on paramedics to take ownership for real change to happen, but I’m interested to get thoughts from other healthcare movers and shakers about which direction we collectively could or should start off in, rather than just shooting from the hip.

stay tuned, there'll be a show on this soon

ZDogg! Hope you’re doing well. As a soon to be pharmacist, what is something I can work on to improve my practice and work towards Health 3.0?

COMMUNICATION! Always remember a fully resourced pharmacist practicing at the top of their training can contribute immeasurably to patient care, so make your voice heard on the team!

Hi Zdogg!! I love your videos.

How would health 3.0 affect physician salaries?

Why is management of hormone replacement for transgender people not taught in IM or FM resodencies and how can we change that?

What tips do you have to get me through step 1 dedicated period?

in 3.0 we get paid to do the RIGHT thing (doing well by doing good for our patients). Whether it's outcome based or bundled payments, doesn't matter. Even some fee for service has a place. Re: step 1, see my answer elsewhere, re: transgender hormone, education around this topic is increasing exponentially so I'm confident it won't remain a black box for long.