As I age, I realize that a small subset of people are just good at living. These people notice things others do not. Their priorities seem properly aligned. They have opinions that matter and typically they are talented communicators. My guest today is one of those people. His insights come wrapped in humor. Learn life lessons while being entertained next on SoundPractice.
This transcript has been edited for clarity and length.
Mike Sacopulos: My guest today is Louis Profeta. Dr. Profeta is a clinical instructor of emergency medicine at Indiana University and Marian University schools of medicine. He’s a dynamic and highly sought-after public speaker. Dr. Profeta’s essays and book attract national attention. Louis Profeta, welcome to SoundPractice.
Louis M. Profeta, MD: Thank you. Thanks for having me.
Sacopulos: It’s my absolute pleasure. Starting off, can you describe your path to becoming a physician leader?
Profeta: I make no bones about it. ... I went into medicine for the money. We weren’t that well off when I was little. I saw these other kids going on spring break while I was cutting lawns and doing whatever I could do to make a buck. And they’d come back with these orange shirts and nice tans. The only ones that I knew had any means around where I lived growing up, their families tended to be physicians. So when you don’t have much, you want to try to get yourself to middle class. And that was kind of my motivating factor.
When I was younger, I thought I was going to be an Olympic athlete, and I fell and broke my neck. Couldn’t do that. And then one day I’m lying in bed in the hospital. My dad goes, “What do you want to do about college?” And I said, “I don’t care. Whoever wins this basketball game, I’ll go there.” And IU beat Purdue in basketball, and so I ended up going to IU. And if I had to apply now, I wouldn’t get in because my high school grades weren’t very good. So, I just sort of took all that drive to becoming an athlete, and I just locked myself in a library for four years and went pre-med.
Well, my parents kept telling me, “Hey, maybe you should do some business stuff.” I don’t think they thought I had the aptitude for it. So that’s my pathway to medical school. And along the way, I fell in love with emergency medicine. And it seemed to be the specialty that fit me the most. It was a fledgling kind of career. It was early in the years — early ’90s when it was just starting to come to fruition [as a specialty]. And then I ended up at the University of Pittsburgh and did my residency there.
Sacopulos: Brilliant. Well, Dr. Profeta, you’ve written a number of essays that have attracted national attention. How did you start to write?
Profeta: I had always had a kind of passion for writing. When I was in college, I took a creative writing class and wrote an essay called “Come Follow Me.” It was an essay about my experience as a spinal recovery victim. I think it was my senior year of college, and the professor at that time took the essay and said, “Hey, don’t take my class. I’m just going to screw your writing up. Why don’t you just write periodically, give me some stuff, and I’ll maybe offer some insights. But I don’t want to stifle what you’re doing.” And he submitted it for publication.
The first thing I ever got published was in the Journal of the American Medical Association in their creative writing section. And then it got published in their book later on. So, when I was applying to medical school, I’d already had a publication in JAMA, which was kind of a big deal. And that was my first real foray. And I just sort of kept writing through residency.
And then one day I wrote a book, and really, I didn’t have any preconceived ideas about what the book would do. It was called The Patient in Room 9 Says He’s God. And I wrote it for my kids and my family to sort of say, “Hey, this is who your dad is. This is what his life is like” — a way of explaining why sometimes I may be staring off into space or not as attentive a dad as I should be, or missing, you know, special events. And I didn’t really have any idea that it was going to be big.
And then I wrote an article called “Your Kid and My Kid Aren’t Playing in the Pros,” which was in a throwaway magazine. It was the early days of virality of social media. It blew up and became one of the most-read articles in sports, won an award from the Society of Professional Journalists. And literally overnight, my book became a bestseller. And then sort of the next thing you know, I’m on that pathway of people asking me to write and publish for them. And my articles started to get more and more traction.
Sacopulos: Well, we’ll come back to your writing because that’s absolutely fascinating. And I think a lot of people would have done the mic drop on the JAMA publication and not gone on to write anything after that. But well done. Your specialty of emergency medicine really puts you on the front lines of humanity. The ER is kind of like the license branch — it’s impervious to socioeconomics. What insights have come from your years of working in the ER?
Profeta: Well, I actually did a TED Talk on this exact subject. In fact, I think it’s even deeper than the license branch, because when you think about the license branch, think about all the people who can’t drive or are mentally deficient or have disabilities and stuff like this. The emergency department is the only place in the world where every single facet of society — whether it’s a 26-week preemie just born in the parking lot next to a CEO of a Fortune 500 company, to a professional athlete, to an alcoholic homeless person — all come together in one place at one time under one roof. And then it disperses itself through the hospital. So, there’s no other place, even in the hospital, that has the exact same conglomeration of people at one location.
It’s a lot like medical Ellis Island. I mean, it’s the wretched refuse, the homeless tempest-tossed — they’re all in this one little area. I think that there is an unappreciated spirituality of the emergency department. And that is what drove me to that specialty, probably more than anything else. I think it is the most spiritual and enlightening environment in healthcare.
It is also the window into every problem, and every issue in society has its roots in the emergency department. So, there’s nothing that comes out in the mainstream press or in the media or that is discussed from a societal standpoint that hasn’t already been present in the ER, usually for years before. I’ve tried to utilize my platform to bring attention to societal issues and try to be that canary in the coal mine kind of thing. That’s why I love emergency medicine.
Sacopulos: What are some societal issues that you’re seeing manifest in the ER?
Profeta: Let’s take fentanyl. We were seeing massive overdoses, numbers of fatalities in the emergency department from fentanyl. We were sounding the alarm on fentanyl back in the ’90s when I was training at Pittsburgh. Nobody was discussing how fentanyl and heroin were destroying some of the poorest communities in America.
It wasn’t until it moved from Garfield Park and the trailer parks to Highland Park and started killing rich suburban white kids that all of a sudden, the mainstream press started paying attention to it. But we were shouting about these issues for years when it was tearing apart Baltimore and Chicago and New York and the trailer parks of southern Indiana.
So, issues like lack of vaccines, homelessness, food insecurity, domestic violence — tons of different societal issues that have their sort of hallmark can be found within the emergency department. It’s one of the things that I’ve been championing for years — so many of our doctors, whether it’s physicians or physician leaders or medical leaders, think that their sphere of influence somehow ends at the hospital door or at the ambulance door, and it doesn’t. We’re the voices of the problems in society and we have to be out there and we have to be championing these issues.
Sacopulos: Over your career, I imagine that you’ve probably seen some changes in patients’ attitudes toward physicians. Is that correct? And if so, how have those attitudes changed?
Profeta: I have in my office at home four or five giant leather-bound volumes of patient thank-you notes. “Thank you for saving my life.” People don’t write letters anymore. They don’t appreciate the care that they’re given anywhere near like they used to.
I think that you’re looking at a combination of things. I think it’s how we treat people — to be gracious, we just don’t anymore. I think there’s a sense of entitlement there, but I think that there’s also a generalized frustration that people in the ER are just angrier from a societal standpoint.
We have a hard time hiring doctors. We have a hard time hiring nurses. It’s almost impossible to see a family physician anymore or get in, and everybody defaults to sending these people to the emergency department. So, the wait times have just blown up. I’m in a financial place in my life that I don’t need to work, but I truly, seriously love being an ER doctor. And I love taking care of people, and I love taking care of the people in my community.
And I’ll go in and they’ll be mad, they’ll be angry, and they’ll start yelling about the wait and this and that. And I’ll say, “Listen, you know, you’re getting mad at the only person that showed up today to take care of you.” And they start to calm down. I explain that we can’t hire people. The number of docs per day is significantly less, the number of nurses. So, it’s all a backlog.
But I can see that younger doctors have a hard time addressing those issues — not necessarily fighting back, but standing up for themselves. And then with social media the way it is — you can save 20 people’s lives and the person is going to post on Reddit or Yahoo, Google reviews about somebody who didn’t get their lab audit or didn’t think that you listened to them as much as you should. And then they have no issue about dragging you all over social media.
Me, I’m tough enough to handle it, but our young docs aren’t. And it is incredibly stressful to them and weighs heavily on them.
Then when you have hospitals turn around and come back at these younger docs and say, “Hey, there was a Google review we’re a little concerned about” — I think they need to just shut that stuff off and turn it off because those docs can go anywhere.
Sacopulos: Let’s talk about the younger physicians. Let’s talk about younger docs and residents who come through your ER.
Profeta: Boy. This is the issue that I’m going to write the most passionately about probably when I retire. We talk about burnout in medicine. Everybody’s burned out. Well, you know what? I’m 61. I’ve got almost 200,000 patient contacts under my belt, 37 years in a very busy ER. I don’t feel like I’m burned out. Now, there’s a physical exhaustion where I just can’t do certain aspects of this job, like nights and everything. And I also just don’t have the drive to work 15 shifts a month anymore. But I don’t think I’m mentally burned out.
When you look at studies of burnout from, say, pre-2000 to now, there’s probably 10 times the amount of articles and studies about burnout in the last 10 to 15 years as there were in the previous 100 years in the medical literature because everything’s about burnout.
But what you will not find is articles that deal with the physicians who don’t burn out. We don’t have a really good understanding about — I don’t want to say people like me — but people who have been in full-time clinical practice for 25, 30 years, because you have to be able to identify those people in the pre-med phase to see if they’re capable of doing this job.
And we have gotten aptitude confused with ability. A lot of people have the aptitude to become doctors, but not nearly enough have the ability to be doctors. There is a big difference. And we are not doing a good job at screening pre-med students for ability as opposed to aptitude.
I like to point at the Navy SEALs as being a good marker for this. And I actually have interviewed some Navy SEALs about this topic. And they’ll tell you, when you go in at the start of the class, everybody tends to have the same degree of physical fitness. They pass the same psychological test. They have the same letters of recommendation from their commanding officers, etc., etc. But then you have an attrition rate of 60, 70, 80% by the end of BUDS training. I ask them, “What are the differences between people who graduate from the Navy SEALs and the ones who drop out?”
They say, the ones who graduate say, “My country needs Navy SEALs,” not “I want to be a Navy SEAL.” It’s a different kind of mindset. That’s sort of how we need to look at medicine. You have to have people say, “My community needs ER docs. My community doesn’t need another chart reviewer for Anthem. It doesn’t need another med spa.” But this is what they do: They drop out, they go part-time, they look for administrative positions, but they’re not in the trenches taking care of the masses.
And we don’t give pre-med students enough insight into how hard this job is. We put them into financially insolvent positions where they end up taking out ridiculous amounts of student loans. They get two years into medical school, and then now they’re trapped. And we have to be better at this.
You look at medical schools all around America, you’d be amazed how few doctors actually are interviewing medical students. They’ll have social workers, they’ll have nurses, they’ll have other medical students. I don’t think anybody should be interviewing a medical student who hasn’t been practicing medicine for 20 or 30 years. There’s 1,000 ways of fixing this problem. But I think that we have not done a good job in screening for abilities. And I place that fault squarely in the laps of medical schools right now.
Sacopulos: Fair enough. I’d like to get back to your writing, because it’s absolutely fascinating. The essay “Your Kid and My Kid Aren’t Playing in the Pros.” Can you talk a little bit about that essay?
Profeta: There were a lot of issues involving that essay. No. 1, it was sort of an indictment not only of society and the travel sports culture, but [also] I was also pointing the finger right at myself about how I fell into that trap with my own kids. And I wrote that article sort of making fun of myself and all these parents who think that their kids are going to get college scholarships or go to the pros and the amount of energy they’re spending and how they would bring these kids to the emergency department with their injuries. And the most important thing to them was not the injury itself, but how soon could their kid get back onto the playing field. So, it was a tongue-in-cheek sarcastic look at that.
Well, that article blew up and it was talked about on ESPN, on Fox Sports News. I got emails and correspondence from professional athletes and D1 coaches all over America thanking me for writing that article. But what was tragic about that is the amount of emails that I got from grandparents saying that travel lacrosse stole my grandkid from me. My grandson didn’t come to their grandfather’s funeral because he had a soccer match in Ligonier, Pennsylvania. I had a woman say, “My brother didn’t come to my wedding because their daughter had a volleyball tournament.”
On and on, these stories about how travel sports had stolen grandchildren away from their grandparents and how they had to sit and pretend like they liked sitting on a bleacher in the middle of the summer and walking a half a mile across a parking lot to go watch her kid in center field wave their mitt and go, “Hi, grandma.” In a lot of ways, the travel — the baseball diamond or the basketball court — had become the Sunday night table for dinner.
And also, how many families had driven themselves into financial destitution because of the cost, how many affairs were happening, how many marriages broke down because of this. Because when you have one parent in one city at a volleyball match, another one in another city at a lacrosse match, and now guess what? The kids are all hanging out. And what do the parents do? They end up at the bars or at the hotel bar and one thing leads to another. It is destructive to some families and we need to rethink it.
It was an interesting article and I didn’t realize what an impact it would have. I think a lot of it has to do with just how I wrote it.
Sacopulos: Well, it certainly touched a nerve. Dr. Profeta, let’s talk about your book, The Patient in Room 9 Says He’s God. You write in the preface, “This is a collection of stories about my search for God and how I found him in one of the most emotionally charged environments imaginable, the emergency room.” Did finding God in the ER make you a better physician?
Profeta: Yeah, I think so. I’ll tell you what made me a better physician, a better person, was my son got cancer when he was in college. He fell ill with leukemia. And I sat next to his bed for seven months at Sloan Kettering Cancer Hospital, New York City. And to watch how he interacted with nursing staff and other physicians, that was probably an even bigger impact on my sort of search for spirituality than anything else. He’s doing great, thank God. And he’s my hero. But watching that unfold was far more dramatic.
I have tried to make it a habit of trying to find that sort of divine nature in every patient, whether it’s a homeless person sitting in the hallway or — you know. ... There’s a Talmudic discussion that the world is full of some righteous people and that you don’t know who they are on a daily basis. And the last thing you want to do is dismiss that person. And then one day you have to sit in judgment before the Lord and have him turn pieces of your life back to you and say, “Hey, remember that person that was one of my righteous and you dismissed them or you didn’t pay attention to their pain or you didn’t offer them a blanket or, you know. ...”
So, I’ve tried to do that. Certainly, I get tired at times and I falter as a human being, but I try to put that at the forefront of my consciousness when I work. And I think it’s made me a better doctor. I hope it has.
Sacopulos: As you know, medicine is both an art and a science, and your book speaks in part to the art of medicine. Can that art be taught? And if so, how?
Profeta: I look back at my career and certainly I had doctors whom I tried to emulate. People like Austin Gardner, who was a vascular surgeon at St. Vincent’s back in the ’80s and early ’90s, Bill Nasser, Jim Strickland, who was president of American College of Orthopedic Surgeons. I remember watching how they used to interact with patients and how they talked to them and how they made them feel special and listened to, even though they may not have really known who the patient was. They faked it really well. So, there are certain parts of that you can teach.
I’m heartened by how many of my young doctors call me up and say, “Hey, could I get together with you for a cigar or a drink or just sit and pick your brain?” And the talks tend to be not talks about how do you get through the ER or how do you order this or that, but how do I live a life like you that keeps me liking this job for 35 years?
I gave a talk at the Emergency Department Practice Management Association conference this year that I’m really proud of called “Lessons from an ER Dinosaur.” It’s just sort of taking you through what I think we need to do for these younger physicians to get them to really appreciate this job and love this job.
And what is amazing is that if you go back and look, for example, at Medscape’s study about physician burnout, they’ll talk about EMR, hospital administrators, overcrowding, malpractice, any number of one thousand things. But I’m going to tell you up front that almost all the issues that lead to burnout have nothing to do with the problems in the hospital and have everything to do with how people live their lives outside of the hospital. Because you fix those problems and you maximize those joys, nothing in the hospital will bother you from that point on.
So, I try to get young people to focus on their wives, their kids, their spouses, their free time, how they view medicine. As I say on my LinkedIn profile, “just an ER doctor, but mostly a father and a husband.” When I die, I want to be remembered as a father and a husband. I don’t care if I’m remembered as a physician. That’s secondary. That’s what I do for a living. But being a dad and being a husband is who I am.
Sacopulos: Do you think that this is a problem throughout medical education? That the focus is perhaps in the wrong place or at least misplaced?
Profeta: In the wrong place? It’s the biggest problem in medical education. One of the articles I wrote that I encourage you to read is called “These Four Words That May Offend You May Also Just Save You.” It’s one of the articles that I’m most proud of. And it goes back to when my son got sick. I dropped everything, hopped in a car, drove like a bat out of hell to New York City. Nothing in my world mattered other than my kid’s cancer. Nothing mattered. Because that is who I am. I’m a dad to my son, Max. Nothing mattered. This job did not matter.
You’ll hear people say, “Well, it’s a calling. It’s a passion.” Listen, we can’t do our job without registration. We can’t do our job without housekeeping. There’s 1,000 jobs in this world that keep the motor of medicine moving. And if I drop dead in that ER, I’m going to be replaced 15 minutes later by another doctor, but I’m going to be irreplaceable to the people that care about me.
And so you have to have that paradigm shift that a doctor is what you do. It’s not who you are. It’s not who I am. And I think that when you make being a physician your personal identity, then every attack, every post on Reddit, every Google review, every nasty letter coming down from administration cuts deeper. And me, I just toss it in the garbage. I know the job that I’m doing.
That’s the lesson that I try to impart to younger people: Do a good job, but do a job. Do a good life — and the life is somewhere else.
Sacopulos: And by flipping that priority, it seems to me that it would actually make you perform better in clinical settings.
Profeta: Absolutely, it does. And I’m a thorough believer in it. You see all these posts from people lamenting different issues in the hospital that I literally would have just brushed right off of me. Wouldn’t have even given it a second thought. But they get so bogged down into it because it becomes sort of a personal attack on them and weighs them down.
When I wrote that article, I couldn’t believe how many people sent me emails saying that that article literally saved their careers and lives, that it was a paradigm shift and they thought, “Oh, my gosh, you are so right.” In fact, that article was published in a cookbook in Australia for veterinarians. Because I guess veterinarians have a huge burnout rate in Australia of all places. So they called and asked if they could take that article and put it front and center in their cookbook, something like Food for the Human Soul or something like that.
Sacopulos: As our time together comes to an end, I’m interested, what can we expect from you next?
Profeta: I think I want to work at Home Depot. Seriously, I’m going to be one of those guys who’s always going to have a job. I was actually looking on their online platform to see what I’m going to do after I get done with medicine. I have always wanted to work in a hardware store or a deli. I think that would be cool. I’m going to be that old guy that people are going to come up to and ask for a toggle bolt or a light bulb. They have no idea that I wrote a bestseller, did a TED Talk, have like 200,000 patients to my name, went to Israel during the war and served in a combat hospital. I want to be that guy. Sort of fade into the woodwork one day.
Sacopulos: Well, I’ll be on the lookout for you the next time I’m at Home Depot. And I’ll be the guy that looks completely confused. Dr. Louis M. Profeta. Doctor, you are a true physician leader. Thank you so much for your time.
Profeta: My pleasure.