Dr Andrew Greenland: 0:00

So welcome to another episode of Voices in Health Wellness, where we sit down with healthcare leaders who bring both depth of insight and practical experience to some of industry's most pressing questions. Today's guest is Dr. Charles Pollock, a clinical scientist and educator whose career spans emergency medicine, public health, and medical education. He currently serves as the medical director at Academic CME and holds an academic appointment with the University of Mississippi School of Medicine, while also contributing actively to continuing education in clinical practice. So, warm welcome to you, Charles. Well, thank you for joining us and welcome to the show.

Dr Charles Pollack: 0:33

My pleasure. Thanks for having me.

Dr Andrew Greenland: 0:35

So, can you give us a little bit of a snapshot of your current roles and how you balance academic CME with your ongoing academic and clinical work?

Dr Charles Pollack: 0:44

Yeah, so uh it's a bit of circuitous route. Uh I uh uh went to medical school on a US Navy scholarship. And uh so after medical school and exclusive of training, I had a four-year obligation to pay back as a naval medical officer. Uh I was fortunate to do that uh uh assigned to the U.S. Marine Corps uh back in the uh in the 80s. Uh it was during the uh the the Reagan buildup uh of the military in the U.S. And so it was a great time to be in military medicine. We had resources that uh military medical officers often didn't have before then and certainly don't have now. Uh but uh that was a uh a maturing experience for me. I uh I went through college earning uh three degrees in four years and uh didn't have a whole lot of social life, to be frank. Uh so uh when I was with the Marines in in Asia and the Far East, uh I finally got to have a little bit of a fraternity life, uh, which was fun, uh, and uh taking care of primarily a group of healthy young men, uh occasional women and the occasional uh uh family members uh who were assigned with their uh with their active duty relatives. Uh but uh it gave me an interesting perspective on life and and uh a great respect that we do have people who are willing to storm the beaches on behalf of the rest of us. Uh I uh I finished my time uh in in the military to pay back my my medical school scholarship. And uh whereas I left medical school thinking I was destined to be a general surgeon, uh during that payback time I decided that uh uh maybe that wasn't the life for me, uh particularly becoming friends with a number of surgeons who uh uh whose uh professional life uh completely consumed their personal life. I know not every surgeon is that way, but uh it certainly seemed to be a majority of them. Uh and I sort of happened upon emergency medicine, which when I was in medical school uh was a very young specialty. In fact, uh an emergency medicine uh elective wasn't even offered uh by medical school in in the early 80s. Uh that started about the time I graduated, but of course I was exposed to the emergency department uh when I was on other services, going down to sea patients who were being admitted to the hospital. And uh I matched to uh a general surgery residency uh at uh at uh the naval hospital in San Diego. Uh the second month I was a resident, I did an elective in the emergency department because uh the Navy, the military in general has uh uh a sense that their medical officers need to have broad training beyond whatever specialty they have. And I really enjoyed it. And uh from that point on, I was tilting away from surgery and towards emergency medicine. I actually did uh my emergency medicine residency as a civilian uh after my military obligation was completed, and uh was destined, I felt, for a career in academic emergency medicine. I was uh older than uh several or most of my residency colleagues because I'd done this four years of military payback uh between uh internship and residency. Uh so I had a little broader worldview than perhaps some of my colleagues did. I also had a number of publications that I had done uh from research that I conducted while I was still on active duty. And so it made me a little unusual in that uh uh I had uh more of an academic presence than my colleagues. Uh, to give you a sense, Andrew, of how young, I mean, you remember how young and uh undeveloped emergency medicine was at that time. My chief resident year in emergency medicine, I was actually the department's research director, uh, which uh is something that no one could conceive of today. But uh emergency medicine was so uh understaffed and and uh under academic at that time that I was able to fill that role and assist uh not only my fellow relatives but also some of our attendings with doing some clinical research.

Dr Andrew Greenland: 4:56

It wouldn't be interesting your point about emergency medicine being a relatively young specialty because it's so we've been bolted onto the College of Surgeons in the UK anyway. So it took a while for us to get our own status in our own college. So just feeding back on that point, which has happened in my lifetime as well, but do carry on.

Dr Charles Pollack: 5:11

Yeah. So uh I uh finished my emergency medicine residency. Uh, became an attending at a large, very busy uh quaternary care county hospital in Arizona, uh, which was the proverbial knife and gun club. Uh, you know, great, great trauma training setting, uh, a lot of uh indigent, medically indigent patients who had very complex medical problems, very challenging and very satisfying place to work. Uh I was there for a number of years and then later moved to uh the University of Pennsylvania uh in Philadelphia and became the the first chair of the Pennsylvania Hospital, which uh many of your viewers and listeners may not know, but was the first hospital established in the United States. It actually is older than the United States. Uh, it was founded by Ben Franklin and Thomas Bond uh several years before the Declaration of Independence was signed. So a very uh uh uh prestigious and historical place, uh now again part of the University of Pennsylvania. Uh and I was there for a number of years, uh, continued my research career uh at uh uh subsequent time after 12 years, 13 years, I moved uh for a while to Thomas Jefferson University, uh where I was uh on the emergency medicine faculty, but was more involved in in education and university uh administration, uh becoming uh an associate dean and associate provost, uh becoming more and more involved in non-clinical activities, uh, and as often happens in in academic medicine, uh began feeling a little less uh content with with what I was doing. It wasn't really what I'd gone into medicine to do. Um my career path was interrupted in the spring of 2020, as were uh those of many of our colleagues when I contracted COVID uh fairly early on in the disease, uh was pretty sick, hospitalized for a couple of weeks with bilateral pneumonia. Uh took uh took quite a while to uh uh recover. And during my longer than I'd wanted convalescence, I uh uh went back to uh some of the work I had done with the pharmaceutical industry through the years as a researcher, as a as a key opinion leader, uh, as a consultant, and was able, while really not able to go back into clinical work, was able to amp up that work. And uh uh slowly became uh what I call, I think it's a made-up term, but a polyconsultant, uh, where I worked uh with multiple companies and groups in different spaces, um, not even always uh with an emergency medicine or urgent care medicine focus, uh, but uh most often with a cardiovascular focus. My research uh and my excitement from clinical practice in the emergency department came from from cardiovascular emergencies, particularly thrombosis, uh DVT, PE stroke, myocardial infarction, uh, atrial fibrillation with uh with thromboembolic stroke. Uh and um I uh was working in all of those spaces, uh, and my wife and I decided that maybe it was time to have a little bit less hectic lifestyle and just continue this for a while and see if it would work out for us, uh both in terms of satisfaction and and also in terms of uh you know earning a living wage, having been employed by universities for nearly 40 years, is a little scary to not be employed by anybody. Uh but uh it worked out fairly well. And uh early on, uh one of the consulting opportunities I had was to become the consulting medical director for a CME company uh with the uh uh very uh creative, I say that tongue-in-cheek, name of Academic CME. Uh and uh uh it's been a lot of fun to work with Academic CME because not only have I had the opportunity through that uh group, which does education in oncology, uh pulmonary medicine, uh dermatology, rheumatology, uh neurology, uh because I was part of the process of uh securing funding for educational programs and then talking to the thought leaders and doing that who uh became the faculty in those programs, it really greatly broadened my clinical perspective beyond what I had ever had or ever could have achieved uh in the emergency department. Uh so that was a lot of fun as well. And the other thing that I was asked to do was to try to uh come up with some new and creative uh uh platforms for the delivery of continuing education. And I think Academic CME has been successful doing that. Uh, for example, one of the uh uh one of the things that we sort of pioneered, and I think Academic CME does better than uh really any other companies in the space is the delivery of accredited education uh on what used to be Twitter. Now I guess it's properly called X, uh, although even on X, these programs are still referred to as tweetorials, uh, which uh is a uh it's it's actually very similar to a 20 or 30 minute lecture using slides. It's just that instead of the slides and uh spoken voice, you have tweets and graphics. Uh and uh that that's been very rewarding and and has captured a whole new audience of clinicians who like getting their education on demand and in small bites. Uh, so that's been another source of satisfaction for me. Uh and I've been very fortunate, I think, Andrew, that uh I've been able to identify these different areas by working with uh companies that are developing novel drugs or or uh or trying to optimize the use of drugs that are already approved, uh, and then uh having the opportunity to either directly or help educate my peers on on how this might impact their practice and and patient outcomes. And uh I've been able to satisfy my uh emergency medicine mindset, which I know from our earlier conversation that you share. We we all to succeed in this field, we have to have a a touch of ADD. Uh, and so uh to have multiple balls in the air at the same time actually works very well for me. Uh hopefully it's it's gonna keep my brain uh moving uh in an agile fashion, but that remains to be seen.

Dr Andrew Greenland: 11:58

Amazing, very interesting, um, very interesting origin story and uh journey through emergency medicine education, public health, academia. Um, you actually just mentioned that you know this whole thing about balancing lots of balls in the air. Yeah. I mean, medicine today often demands clinicians wear too many hats. How do you see that playing out across you know mainstream medicine, academia, and CME in your world?

Dr Charles Pollack: 12:25

Uh well, for me, I've uh sort of seized control of the narrative and I've been fortunate to do that. But again, I'm I'm fairly senior. I have a lot of experience in these different spaces, so that that's made it easier. I mean, I I uh just was asked last week to chair uh uh a DSMB, a Drugs Uh Safety Monitoring Board, for uh a big clinical trial, uh, which is another view of you know how drugs are developed, how medicine advances uh with uh attention to patient safety, which uh obviously is a is a very critical element these days, which lay people are, I think, more concerned about than ever before. The uh sort of uh paternalistic approach to medicine doesn't seem to fly much anymore. Patients uh will uh will do their own research, they'll compare some shop, uh, they'll uh they'll come to you with ideas that uh uh that they want you to consider. One of my uh least favorite experiences as a clinician in the emergency department is when a patient comes into the ET visit with 20 pages printed out from Google about uh about their symptoms and what they think I should do about them. Uh but on the other hand, patient empowerment, patient engagement is very important. So um I I think again that there's no, at least in U.S. medicine, there's no avoiding, even outside of academics, this need to wear multiple hats. Uh, because the practice of medicine, the physical practice of medicine, uh and uh being compensated for practicing medicine and managing patient expectations uh is so much more complicated than it ever was before. I like to tell people I finished medical school right at the end of the uh the Marcus Welby era, uh when uh when uh physicians would still make house calls. Uh and it's interesting that now, because patients demand it, we are seeing more and more physicians, whether they're concierge care physicians or or uh uh hospitalists or or externist, as they call themselves sometimes, again making making house calls because that's where they feel like they can uh impact patient care the most. I think uh even if one doesn't want to, one must wear a lot of hats. Uh in clinical medicine. If you add to that academic medicine, uh, which of course involves uh not only administrative responsibilities, but teaching students, teaching residents, uh uh role modeling, um uh taking the lead in uh sometimes in initiatives, quality initiatives that may not be one's cup of tea, but uh uh has to be done to make sure that we're doing the best we can for our patients. Uh involvement in in hospital committees like uh IRBs, um, and uh uh again quality improvement, performance improvement committees. Uh these things are sort of expected now. And I'm not sure we're doing a great job of preparing people for that in medical school. Uh the uh yeah, I guess it remains to be seen over the next few years. In the U.S. again, right now, there are some uh different sort of ideas percolating through organized medicine uh coming from from Washington down, uh, that uh uh are not things that ordinarily those of us who trained you know 20, 30 years ago would would embrace. But uh there's a cohort of patients out there that are embracing them. And uh we're gonna have to deal with that and different expectations of physicians. So we're we're in addition to being clinicians, we're we're often in the role of uh being uh sounding boards and and sort of managers for for patients, which uh again we don't necessarily have the training for and often is very time consuming and therefore can create frustration among clinicians who uh who want to take best care of their patients, but because of the different demands they have on them, they may not have the time to do that.

Dr Andrew Greenland: 16:20

Thank you. I guess you've seen over your career path the the massive rise in credentialing and certifications and admin layers that are all um put upon us as clinicians. Do you think that's really um helping or hindering clinician wellness in your in your eyes?

Dr Charles Pollack: 16:34

Well, in emergency medicine, it's often referred to as the merit badge mentality. Uh, you know, we're we're uh uh we have been in the past expected to uh take uh advanced pediatric life support and advanced cardiac life support, advanced trauma life support, and uh you know, have all of these uh certificates and wallet cards that are are current. Uh we often are asked to uh to do other training that the hospital mandates back uh to go back again to the HIV epidemic, we all had to do the training safety and and uh the enhanced blood and body fluid precautions and personal protective gear and all that sort of stuff. It all carried a certification that had to be in your record uh at in the medical staff office that you had all of these things. Uh, I think it's very easy uh to expect too many merit badges to be fulfilled uh and for the standard uh to be expanded beyond where it needs to be. Um something's obviously very important. We have to demonstrate currency with important concepts, but the idea of uh uh of taking a course or completing a certification for something that uh may not be often used or may not really contribute to one's either uh patient care approach or one's satisfaction with their career, I think can can be harmful. Uh, but there's again this this this move to demonstrate uh competence and capability according to standardized testing and uh and standardized courses that uh uh is sort of foisted upon us. And I'm not sure that it it always has benefit.

Dr Andrew Greenland: 18:11

Thank you. What about work-life balance? Where are we at with work-life balance in 2025 for clinicians? Is this more of a um system design flaw or is it a cultural expectation issue, do you think?

Dr Charles Pollack: 18:22

I think it's both. Uh, you know, people from within and outside medicine will tell you that uh uh the internet is is both the worst and the best thing that ever happened to them. Uh the uh the fact that you have Wi-Fi wherever you go, including at 35,000 feet flying over the ocean, uh, means that it's it's hard to disconnect these days. It takes a conscious effort to disconnect. Uh and no matter how much one loves one's career and one's work, um uh there has to be a time when you can sort of uh uh forgive the pejorative, but zone out. Uh just just relax a little bit. Uh that that fosters creativity and and uh and new ways of of uh uh of thinking about problems that maybe have vexed you in the past. Uh and I think being disconnected from one's uh career uh occasionally and for limited periods of time, uh I think is very important. And I think we're often discouraged from doing that. Uh the on the personal side, uh the demands of sort of 24-7 access through email and and uh text and and other contacts, I think can't help but impinge on personal time. Uh people who have uh families, spouses and children and grandchildren perhaps uh with whom they want to spend time, I think find it harder than ever to uh quarantine that time away from work responsibility. It involves doing things that are sometimes antithetical to us, like turning cell phones off or leaving them behind for a couple of hours while going out uh for a hike where you know part of you knows that there's good bandwidth out there on that hike. You could have your phone with you. Uh and so it takes uh a conscious effort, I think, to try to maintain some sort of work-life balance. I don't think any of us are particularly good at it. Um, and I think that uh I hope this doesn't sound bad. I think the better one is at work-life balance, the more guilt one may carry uh about uh having left something behind on one side or the other. Uh, because I don't think there really is a safe balance. I think it has to be a very uh uh uh fungible uh and and flexible thing that uh varies from day to day and requires a lot of self-discipline that many of us who are very driven in our per in our uh uh careers uh have a hard time uh have a hard time doing. That that uh that flexibility always seems to come at the expense of something else. And so we're constantly making value judgments and trying to decide which value is going to drive this decision. I think it can be can be very anxiety-provoking and and uh and frankly very difficult.

Dr Andrew Greenland: 21:15

Yeah, I agreed, especially with the conscient, we're all conscientious people's clinicians, and so I take your point about having that guilt feeling about sort of taking all this on, and you know, and frankly, you don't want a physician or a clinician who's not uh conscientious about what they're doing.

Dr Charles Pollack: 21:29

Uh then again, your your your spouse doesn't want a spouse who's a spouse who's not conscientious about maintaining a relationship and putting in the work needed to do that. So it's uh I think we're all being pulled, and again, this is by no means limited to healthcare providers. I think we're all being pulled in in many different directions these days that 15 or 20 years ago none of us could have ever anticipated.

Dr Andrew Greenland: 21:50

Thank you. So, what are some of the structural bottlenecks that clinics are facing today, especially those who are trying to do it all, perhaps much like you have, with your various things that you've been involved with during your career?

Dr Charles Pollack: 22:02

So uh I think forever, you go back to the beginning of my career or where I am now, that the bottleneck is time. Uh the bottleneck is is time management and um the ability, I think this is particularly difficult for many of us and academics, the ability to say no. Uh when a colleague with whom you've done work in the past, uh, or even if you haven't done work in the past, if if you know that that colleague is doing something meaningful and interesting, and ask you to be involved, uh, I think many of us have a very difficult time saying no, thank you. Uh and uh the the problem is, of course, these things uh pile up on each other. Uh and very soon we run out of time to do any of them particularly well. Uh and while I do like the idea, we already had the the metaphor of juggling. Uh while while I do like being involved in multiple things at the same time, uh I have to really try from a self-discipline standpoint to limit the number of uh of projects on which I'm involved, no matter how much they appeal to me or how important I think they are, because I'm not doing myself or whoever's running the project uh uh uh you know a lot of good if I'm not fully dedicated to it. Uh but in academics, we're we're not usually taught how to say no. I always admire people who uh who do. I've I've had colleagues, close friends, in addition to professional colleagues, who I've asked to become involved with projects uh that I'm running in the past. And uh it's it's a bit of a blow when they say no. Uh and uh I I think we're all programmed, you know, clinicians, we're always taking histories. We you know, you can't help but ask why. Uh, and if the answer is, you know, I I just don't have enough bandwidth right now. Uh I I think that degree of honesty and that degree of of self-reflection is very important, but I think it's hard to achieve. Because Andrew, my my response typically uh when someone says I have too much on my plate, is for me to say you need a bigger plate. Um and uh, you know, at some point that that takes a toll, whether it's on your your physical health or your mental health or your relationships.

Dr Andrew Greenland: 24:21

I hear you. So when you think about clinician burnout, because we've been sort of alluding to that as we've been talking, what part of the system in needs to be fixed first, do you think?

Dr Charles Pollack: 24:31

Well, it's interesting because uh, you know, over the past 20, 30 years, whenever you hear physician burnout, people say, oh, ER docs first. Uh and it's because of the the stress uh of the the uh the unknown, never knowing what's coming in the door next. And it could be something as mundane as a sore throat or as as uh uh life-threatening as a gunshot wound or multiple trauma or a stroke or heart attack or whatever. Um a system standpoint, uh, I think the only two things that can be done are number one, to try to achieve, if you're if you're running a system, uh to try to achieve for your providers uh uh a structure in which there's a little better balance between the delivery of care and all of the administrative efforts that have to go around that delivery, uh, whether it's charting or billing or you know, committee participation at the hospital or or uh uh other activities that are clearly part of the job description of a clinician in practice or in a hospital, but but don't bring the same level of satisfaction and often have uh with them a time commitment that is uh is just untenable. Uh so I I think um for for people who run healthcare systems to understand the stress and strain on physicians, whether they're emergency physicians or pediatricians or obstetricians or whatever, uh, and recognize that the uh the pressure and the stress that come from taking care of patients is very different from the stress and the pressure of completing paperwork. Uh now, completing paperwork is a necessity for uh getting compensated, and getting compensated is a necessity for keeping one's practice or keeping one's hospital open. So it all has to be done. But I think a better recognition of the effort required uh is important. Uh and in emergency medicine, a lot of times we're we're addressing that now with, for example, uh voice-to-text uh documentation, or I think something that's uh that's been very effective for uh the emergency department is having scribes uh who often are are um medical students or or paramedics or people with a little bit of clinical knowledge who are attentive and who can distill uh almost like a court reporter, uh distill the communication back and forth between the patient and the provider in real time, so that later then the clinician can just read over those notes and edit them, as opposed to having to generate them de novo, which of course takes more time and effort and and uh uh under time constraints is stressful. The other thing that we need to do besides appreciating and trying to compensate for the the uh the pressure of different uh responsibilities, uh, is I think we need to to, and this is hard for me to say, I suspect it's hard for you as well. Uh, we we need to be more respectful of the need for clinicians to share their burdens. Uh, you know, in a typical ED shift, you or I will see 40 patients, maybe more if we're proctoring residents and fellows. Um, and our job is to hear those patients' complaints, uh, try to synthesize uh um uh an explanation for those complaints, and then with uh often very limited information, uh craft a plan for what to do moving forward. Uh that is that is stressful, and you multiply that over a 12-hour shift by 20 or 30 or 40. Um, and always with the nagging sense that you know, have I missed something or have I taken the residence history too literally? You know, there are questions I should ask on top of that. And at the meantime, in the meantime, you you hear buzzers and beepers going off telling you you've got other patients to see. Um, I talked earlier about having some time to disconnect. I think many of us, uh, though we may be loath to admit it, many of us may need some help in zoning out and addressing these issues. And uh the only way that's going to happen is if we start to remove or at least uh attenuate the stigma that many healthcare providers feel about asking for help. We're the ones who help, we're not the ones who look for help. Uh and I think the sooner in one's career one realizes that that's not a stigma, that that's not a negative, that it's not a sign of weakness. Um, I think we'll all be more healthy people and therefore be able to be more healthy providers. Uh, that's within a system where uh when I did uh my internship uh on surgery, and we were told we'd be on call. This was before all the current resident work hours that are in effect now, we were told we'd be on call every other night uh for those two months. Uh and I remember the chief resident saying to me, you know what the real problem is with being on call every other night? And I thought, okay, I'm not sure how I should answer this because he's a surgeon, so I mean he's gonna be real gung ho about this. He said, before I before I had a chance to craft an answer that might or might not have worked, he said, It means you miss half the good cases. So that's, you know, when that's the mindset, it's very difficult to carve out space for yourself to reflect and recover. Uh, you know, it need not be a prolonged time. Sometimes uh five minutes of quiet meditation uh is enough to just sort of reset. But but I think often we're we're conditioned, again, particularly in emergency medicine, uh, that uh that there's there's no need for that, there's no time for that. Get out there and see the next patient. You know, you gotta, uh, in the expressions we use, you gotta move the meat uh, because there are hospital administrators and insurers uh and the public through in the U.S. Public Report of Metrics who are watching what the wait time is in your emergency department uh waiting room, uh, or what the throughput time is, uh, or how long it takes you to get a CT scan result back. And then the question, if it's really long, the question becomes, well, did you really need that CT scan? Because because you ordered that, you kept the patient around for an extra three hours. Uh yeah, the three-hour wait for the scan and the interpretation may not be your fault, doctor, but you did order it. Did you really need it in retrospect? Uh when everything's being questioned and the pressure is there, it's it's uh it's really important that one have some escape valve uh that's hopefully not associated with uh with alcohol or illicit drugs to uh to just reset from time by time. And and I think that's challenging for many of us.

Dr Andrew Greenland: 31:22

So it's all about self-care and looking after each other. And I was nodding and smiling there because this all resonates. So I'm still working in an emergency department, and all the things that you just mentioned about the pressures are so true and reflect everything you've just said. So if you were mentoring a younger clinician or educated a day, what would you advise them to do perhaps differently from what you did?

Dr Charles Pollack: 31:44

Well, uh, you know, to be honest, the system has changed. And uh a lot of the things that I've done uh wouldn't necessarily be feasible uh right now for someone just coming out of training. Uh again, the the residency work hour requirements have changed. Uh the uh the intrusion, and I don't mean that by any means to be all negative because some of it's very positive, but the intrusion of technology into practice has changed the way we do things. Uh the uh the the diagnostic testing that's available to us now, uh it can very much uh shorten or streamline the path to a diagnosis, but at the same time it it can create more questions. Uh and so uh the ability to uh, as I was able to do particularly early in my career, to sort of sequester my clinical time, and I was always in an academic environment, so I always had protected time for other things, but my clinical time for the other things I wanted to do, research, teaching, um uh uh other activities that uh you know, working with uh patient support groups, that sort of thing, uh uh working on an IRB and reviewing research protocols. Um a lot of times now there's just uh there's just not time to do all those things. And so uh while I was able to do many of those concurrently, uh I what I would tell someone come, what I do tell someone coming out of training now is to work very diligently to identify one or two passions uh beyond whatever you're doing, if you're you know, surgery if you're a surgeon, delivering babies if you're an obstetrician, uh uh plotting out uh chemotherapeutic regimens if you're an oncologist. I mean, that's that's you don't want to if you pick the right career path, you you don't want to escape from that. So you've got to do that. But I think it's really important instead of thinking that the the other parts of your career uh and the personal satisfaction you get from that career are like a uh a buffet table or a smorgasbord, and you can take a little here and take a little there. I I think uh if you do that, you're you're destined to be disappointed uh in either what you can accomplish, uh frustrated by by the lack of time to do multiple things, uh, and then ultimately uh disappointed in yourself, which is which is not positive. So what I would say is particularly early in your career when you're trying to establish yourself and practice and establish your own practice routines, don't try to take on too much else. If there's one or two things that really get you excited, you know, whether that's research or teaching, whatever, by all means uh try to pursue that uh in in the time you've available to you. But but don't try to do a little bit of everything because you'll end up, number one, not doing any of those elements well. And number two, it'll probably boil over into your your primary role, which is as a clinician, uh, and and damage either the amount of time you have to put into that or the amount of satisfaction you get from it. So I think uh that you know the the key piece of advice would be to uh uh find a passion and then ration your time appropriately. And of course, that's just on the career side. There's the whole issue of personal life as well. And I can tell you, no matter how satisfying your your scientific or clinical career may be, if you're not finding happiness at home, whatever home looks like for you, uh it's just not going to work out. It's not sustainable.

Dr Andrew Greenland: 35:16

Thank you. So finally, what over the next year, what's something you're particularly excited about, whether it's a project of academic CME or education or broader reform?

Dr Charles Pollack: 35:26

Um, I I think uh I think maybe what's most exciting is trying to couple medical education that we do for physicians and nurses and pharmacists and NPs and PAs with patient education. Right now, I think those two are completely disconnected. Uh we have uh you know established systems of of medical education, uh, some of which are changing now. You know, they're they're they're schools that are trying to go from a four-year curriculum to a three-year curriculum, uh, or changing residencies from three years to four years. You know, we it it it's there they're but basically they're just modifying around the edges. There, there are no real uh uh huge changes in how we train clinicians. I think not in the next year, but going forward, we need to re-evaluate those more critically and in this time of greatly enhanced technology compared to when the Flexner report was published uh you know 120 years ago uh and and residency review committees were set up 100 years ago or 60 years ago, whenever it was. Um, you know, we we we've got to change the institutional training of clinicians. But once they're out, once they've completed that, they have whatever that degree is, whether it's uh PharmD or an MD or uh an RN or uh an MSN, um there is a need for continuing education. Uh and that has to be done in a way that is consistent with the pace of medical advancement and with what patients expect from the system. At the same time, patients have a right to expect more than they ever did before because patients are aware of the advancements in technology and and uh and drug development. Uh, and yet, for the most part, because clinicians are so pressured in their practices, have so little time to talk to their patients beyond collecting an immediate history and making an immediate decision and then moving on to the next step, uh, what patients are left with, at least in the US, is something that I think is uh not particularly helpful, and that's uh so-called DTC education. Uh so direct-to-consumer education, what it really is, is direct-to-consumer promotion. So in the US, uh you can't turn on the television, whether it's to watch a sporting event or a cultural event or a movie uh without multiple interruptions uh about uh uh about drugs uh that are, you know, in the US by definition approved by the FDA. So they're approved drugs. And of course, what they can say about those drugs is limited to what's in the label, uh, but these are promotional nonetheless. Uh and I think it's it's information overload for patients, particularly towards the end of the commercial when they always start talking really fast about the side effects you have to be alert to. Uh, and uh and and I think they can can set up uh false hopes for patients, uh, perhaps even about a diagnosis they they don't even have. You know, there are lots of migraine commercials these days. Uh there are patients who view those who come in to ask about those therapies when in fact they don't have migraine. They have they have another source of headache, even if it's a different type of vascular headache. Uh, you know, those migraine beds that they're seeing advertised don't necessarily help for cluster media cluster headaches, which may be what they have. So I think if we can prepare clinicians to address patient questions and needs about their diagnosis and their care, uh, outside of the context of the type of uh promotional information they're receiving on their own when they're not talking to us, I think that's a very important disconnect that we can try to reconnect. And I think technology will help us there. Uh, if you can have a continuing medical education program presented on X, uh, and you can have a patient education program presented by a trained educator clinician presented on TikTok or Facebook or someplace or Instagram where the patient is, uh, and deliver sort of a unified message at the appropriate level of medical literacy, then I think we can really advance care. And I think we may be primed right now to, for the first time, consciously and deliberately, and I hope successfully couple ongoing medical education with uh commensurate patient education so that expectations can be more readily met and patients feel more empowered to uh be uh more active participants in their own health care. So maybe maybe a year is too optimistic a timeframe for that, but I think we need to head in that direction. And this is one of those areas where clearly we can harness technology to help us get there faster than we could have in the past.

Dr Andrew Greenland: 40:19

Agreed. Charles, this has been so insightful. Thank you so much for sharing your experience and thoughts on these different matters. I know our lessons will resonate with your perspective, especially the layered reality of balancing patient care, education, and academic responsibilities. Thank you so much for your time. Really appreciate it.

Dr Charles Pollack: 40:34

It's been my pleasure. Thanks for the opportunity.