Join host Dr. Jonathan Weinkle and guest Jonathan Clemens, PA, on Healing People, Not Patients as they discuss the impact of work injuries on patients' lives and the healing professions. Explore how occupational medicine navigates recovery, loss of identity, and the dangers faced by healthcare workers, drawing on faith and compassion to foster healing beyond physical repair.
What happens when work breaks the body and spirit?
In Episode 9 of Healing People, Not Patients, Jonathan Clemens, a PA specializing in occupational medicine, shares insights from his work with long-term injured workers. With over 20 years of experience transitioning from IT to medicine, he discusses the challenges of balancing patient care with insurance, employers, and ethical dilemmas like malingering. Drawing from biblical texts and personal stories, they examine the loss of income, social connections, and self-worth due to injuries, the moral injuries faced by healers, and strategies for recovery and reintegration. Clemens emphasizes the role of faith in sustaining purpose and treating patients with dignity.
Top 3 Takeaways:
About the Guest:
Jonathan Clemens is a Physician Assistant specializing in occupational medicine in Olympia, Washington, with a background in family medicine, sleep medicine, pain medicine, and eating disorders. He holds a PA degree from Pacific University and a Doctor of Medical Sciences from A.T. Still University in Arizona. After a successful career in IT security, he transitioned to medicine at age 40, focusing on long-term injured workers in Washington's industrial insurance program. He met host Dr. Weinkle at the Conference on Medicine and Religion and shares a passion for integrating faith, ethics, and patient care.
Healing People, Not Patients explores ways to enhance medical practice by infusing it with compassion, humanity, and a deeper sense of purpose, aiming to help healthcare professionals rediscover the "soul" of their work. Framed around the four questions of the Passover Seder, it probes how to transform medicine for the better, promoting an empathetic and supportive approach that empowers patients to create meaningful, sober lives, while drawing on Jewish teachings about community and friendship.
"Our theme song, "Room for the Soul," is available on Bandcamp at https://jonathanweinkle.bandcamp.com/track/room-for-the-soul."
Dr. Jonathan Weinkle is an internist and pediatrician who practices primary care at a community health center in Pittsburgh. He strives to be a "nice Jewish doctor" focused on patient-centered healthcare, emphasizing effective communication and holistic well-being.
He teaches the courses, “Death and the Healthcare Professions” and “Healing and Humanity” at the University of Pittsburgh, authored the books Healing People, Not Patients and Illness to Exodus, and runs ‘Healers Who Listen’, where he blogs on healing and Jewish tradition. Once an aspiring rabbi, he now integrates faith and medicine to support other physicians and his own patients.
🌐 Website: healerswholisten.com
🔗 LinkedIn: linkedin.com/in/jonathan-weinkle-3440032a
📸 Instagram: @HealersWhoListen
📘 Facebook: @JonathanWeinkle
[00:00:00] Almost anyone who works for a living will tell you that sometimes they feel like their job is killing them. Take the job that most American kids have dreamed about for at least part of their childhood. NFL football player. Those guys have a minimum salary of a million dollars a year and an average career length of three and a half years due to injury and not making the grade, but far worse is their life expectancy.
In one study, they lived about seven years shorter than major league baseball players from the same era and as much as 17 years, fewer than the average American male. Closer to most people's reality, people that paint houses for a living fall off ladders. A guy I once cared for worked as an appliance delivery man.
He had completely torn both rotator cuffs. By age 40 nurses routinely sustained serious back injuries, trying to move patients. To say nothing of those who are attacked while doing their jobs, especially in emergency room settings. Last episode, we considered how the Exodus story can teach us about health, [00:01:00] illness, and the practice of the healing professions.
We learned about the first fruits declaration that's recited at the Passover Seder. It's only four sentences long, but one of those is the Egyptians dealt harshly with us and oppressed us. They imposed heavy labor on us. The word heavy labor farik. As related to the modern Hebrew word, par, crispy or crunchy.
And some days we feel like we're burnt to a crisp or just plain burned out from our work. Sometimes those burns and the other injuries that come with them are so severe we just can't do it anymore. I'm joined today by my friend Jonathan Clemens, a PA and Olympia Washington, who focuses on occupational health.
We'll talk about what injury recovery and the place of work in a person's life mean to our patients. And the dangers that the healing professionals face in our work, dangers we often ignore. Stay tuned.
Welcome back. I have with me my friend Jonathan Clemens. Jonathan is a pa working in occupational [00:02:00] medicine, but with a background in family medicine, sleep medicine, pain medicine, and eating disorders. So he has, as do a lot of folks in his field, moved around a bit to get some breadth of experience.
Jonathan's PA degree is from Pacific University and he also has a doctor of medical sciences from at still university in Arizona. And we met, I'm gonna put in a plug here at the conference on Medicine and Religion in 2022, if I remember correctly at a talk that I was giving, which was The original kernel of what became my book from Illness to Exodus.
So, we've spent a good chunk of every one of those conferences since then. Hanging out, comparing notes, talking theology and philosophy and work. And I wanted to have Jonathan on tonight to talk about work, not just his work and my work, but what work does to people. Welcome. And I wanna start by asking you a little bit about your practice of occupational medicine.
Specifically. What does it [00:03:00] take to do that kind of work well? Knowing that you're navigating relationships between patients, insurance companies, not just their health insurers, but often accident insurance, car insurance, et cetera, employers, the government, and still be able to truly care for that person while also not getting into any legal hot water.
Oh, well, thanks, Jonathan. that is definitely a big issue. It's what drives a lot of medical people away from occupational medicine. You're trying to serve multiple masters, right? I'm supposed to be doing what's best for my patient, but oh, by the way, I need to be making sure they're telling the truth.
Or if I detect them not telling the truth, I kind of owe it to the system. To not let them exploit it. if I know and can stop it. my particular niche is really working with long-term injured workers. Washington state's industrial insurance program, labor and Industries has an interesting thing that doesn't exist.
It's a whole lot of other places, is [00:04:00] they keep claims open until everyone is satisfied about everything or close enough to it. And as such, I have people who have had claims open for more than a decade. I've got a handful of people whose claims have been open for more than 20 years because they just have ongoing things that still need care that can't be addressed.
If the claim is closed and nothing further is paid. So by focusing on these folks it's much less about the rush of quick get somebody in and release 'em back to work. A lot of these people aren't going back to work anytime soon. And so, rather than doing a whole lot of pre-employment physicals and things like that my job is more like stewarding these interminably long claims. from. One specialist to the next. it's a great job for a PA because an MD or DO'S background would be wasted. all the extra training you guys get in physiology and, the ability to discern [00:05:00] undifferentiated diseases.
Mm-hmm. Very limited use for that in this role. In other words, you al you already know what's wrong and it's a matter of it being really hard to put right. And it just takes a tremendous amount of time. we still find things occasionally that somebody's missed. I had one patient, another PA at a pain management practice identified that he might have a hip labral tear.
And got the MRI and got that, got him. Headed towards that direction when he'd been dealing, I think for about three years with what was written off his back pain and somebody actually taking an interest in these patients and giving them every bit of diagnostic workup is not as common as it should be.
Mm-hmm. A lot of times medical people are writing them off as possibly malingering. It's kinda like emergency medicine. You can never trust a drunk patient one thing times. There's gonna [00:06:00] be something deathly wrong with them and If you shortcut anything, you risk their life and your license.
yeah. You know, it's interesting, you used the word malingering, which was in the next question that I had written for you. Obviously I have this interest in biblical text and in particular in the Exodus story. And there's a line in Exodus chapter five where Pharaoh turns to the overseers and task masters and he says, you shall no longer provide the people with straw for making bricks.
Let them go and gather straw for themselves, but impose the same quota of bricks that they've been making before. Now, don't reduce it for they are shirkers. That's why they cry. Let us go and sacrifice to our God. And I think that there's, I was thinking that there's a lot of pharaohs out there that are looking at the patients that we're taking care of with these long-term injuries and saying, not shiers necessarily, but they're saying things like malingering, secondary gain, non-organic illness.
You know, these are labels that you see in the chart and it immediately biases you against the patient. [00:07:00] But, I know that's not true. You just gave me a great example of that. So, I'm sure you have other stories also of. How you think about your patients and how they think about work.
So there are perhaps 5% of patients are actively trying to cheat the system that's statistically born out. And one of the challenges in being a principled and God-fearing inclination is that it's not my job to spot which ones are actually fake. So that's between them and God, my job is to render their care appropriately all the time.
And I take pride in treating people, even people who I believe to be treating the system with respect rather than scorn. They may have made decisions that are gonna have some very bad consequences, but it's not on me as a healer. Mm-hmm. To conduct punitive medicine. Not even administratively punitive medicine.
Mm-hmm. [00:08:00] So I'm not going to fill out a form that says, yes, you can do anything and go back to work. if that's not the medical truth, even if it might feel like a way I could insert myself in the process and punish them. Because that's not what we do at all.
Okay. But leaving those people aside, the ones who are actually trying to cheat the system I would say there is another 20% or so of the patients, excuse me who are downtrodden, who have lost hope, who cannot see themselves as becoming healthy again. And sometimes it's called disability fixation or whatnot.
But I think that speaks to what's been stolen from 'em. I mean, these people got hurt on the job. Some of them were doing things right. Some of them were doing things wrong. Some of them were hurt by other people doing things wrong. Yeah. But the common denominator when they're in my office is they can't work.
So what do they lose when they can't work? They lose [00:09:00] probably, I would say three things. They lose their income. The income replacement is inadequate. It's about 60% of their wages. if you know anybody who has 40% of their income as frivolous, disposable income, yeah, I'd like to meet them, especially people other than professional athletes who are working in jobs where they have a high likelihood of being physically injured.
Exactly. Roofers, orderlies, CNAs, these sorts of people, long haul truckers, you know, take your book. Exactly. Yep. None of these people have extra money and they're expected to live on less than two thirds of what they were taking home. so there's the economic, stress and oppression.
And then there is the social, whether it's with, their relationship with their spouse or the relationships they're missing with the buddies at work. the sad reality is it hurts somebody to be hurt because they lose their access to their friend group at work. And for the most [00:10:00] part the adage is born out that, as soon as you're gone,
everybody's forgotten you. and the third one, I think is probably the most important, and that would be the self-actualization part of it. Where, especially the people I work with who you've alluded to, tend to have more physical jobs.
They can point to things that they did. They can say, I built that, I reroofed that. Mm-hmm. And especially again in the construction trades, everybody who works says I did that, I built that. I earned my paycheck. And there is just something on a visceral level that says, I don't want to not work. It's not right for me to be getting paid.
I don't know how many patients have said some variation on that theme. I should not be getting paid, did not work. That's not right. Mm-hmm. I point out it's your payroll deductions that fund this. All this money is not coming from anybody but you and all the [00:11:00] other workers who are getting payroll deductions and you've been earning that money and it's been going into this great big pot paying, been paying for other people until now is paying for you.
I mean, I almost think of it as like, the soldiers who, if one of their comrades falls in battle, they pick them up and carry them because they know that the other one would do the same thing for them if it was there. Like there is this certain, like workers kind of looking out for each other in that way, even if they don't realize that's what's going on, but when they get separated for any length of time there's a period of months. So it's very hard to get people reintegrated. There's a big move to never take anybody off of work for any reason, for any length of time, because as soon as you do that, the chances of never going back to work just escalate.
They explode. Mm-hmm. Yeah. But at the same time, human bodies need time to recuperate, especially if there's surgery involved. And so one of the interesting things [00:12:00] about workers' compensation is. The evolution and recognition of the social aspects of going back to work where, we're focused on getting people to do something.
Because, sitting at home and watching Netflix is fun for two minutes and tolerable for two weeks, and after that, everyone's. Lacking anything to do. If they could do the honeydew list at home, they shouldn't be there. Right. and so finding people meaningful things that they can do while they're hurt.
One of the things I love that Washington State has done is broken out. What are they, let me get the acronym right. Actually, I'm not gonna try the acronym, but rather than just having a retraining plan where you can't do your job. Oh, skills enhancement training, I knew it could be.
Mm-hmm. Rather than just, being retrained into a different job. 'cause you're too hurt to do your original job when you're off work. You at the state's expense can go through GED classes, you can [00:13:00] get some basic computer training. Mm-hmm. You can take English as a second language. And these sorts of things are empowering.
It's like I try and teach my injured workers, it's like, you're not broken. You're on the injured reserve. Right. Like, like a professional athlete. The, you have to visualize yourself going back to work, lest your despair becomes self-fulfilling. my population is more in the immigrant refugee world, but certainly see a lot of people who are injured workers as well.
Many of them who came to this country and started working immediately without having time to go take e ESL classes and have been working very hard in furniture factories and all sorts of things like that. And then an injury happens and the despair that sets in now that I hear you describing.
What was the name of the syndrome? you used a clinical term that I had not heard before, but it's exactly what I, oh. disability fixation. Disability fixation. This the overwhelming feeling that I can't do [00:14:00] anything. Right. Not just can't work at my old job, but can't take care of myself.
Because all of their identity was tied up in whatever it was that they were doing. Often supporting the family often. supporting extended family, in fact, not just their nuclear family. So they were really, a pillar of everything that had been knocked down. there's all sorts of stories like that.
I mean, my population is 10 to 20% immigrant. So I'm reminded of the story of one woman who was working as an orderly, essentially a patient care technician in a mental hospital, was assaulted and was unable to return to work. And this was devastating for her because for the last eight years she had been legally working in America.
To try and bring her family over from, her home country in Africa. And so what she lost wasn't just her income for right then. But, the nest egg she'd been saving [00:15:00] up to bring over her. She left one of her children at about one years of age. And so he was now eight or nine and had not seen him in person, hugged her son just seen him on FaceTime or, computer stuff for that long.
And the amount of dedication and professionalism you see from these people even In their injury it is just heartbreaking. I had a, another gentleman, also an African, also a patient care technician, also assaulted. I get a lot of business from this place.
we're gonna talk about that a little bit later, so, okay. you wanna move on to the next question now? No, no, no, no. Keep, I wanna hear the rest of the story, but I'm just saying it out loud. So we both remember that we wanna come back to this. Sure. And his thing was he wanted to be a professional pilot.
So what he would do is he would work his shifts. I think he had roommates. It was living rather frugally and everything he made went into ground school and instrument ratings and flight time and things like [00:16:00] that. And then he got a concussion and he couldn't pass tests.
He just felt stupid. And this lasted for a period of months and it was very, very disheartening to him. it eventually cleared up for him, but there was a lot of emotional support we needed. To give him, to make sure that didn't take hold and become his self-conception rather than just his circumstance.
Yeah, I can really identify that running through a lot of the people that I take care of. for me, it especially seems to happen with folks who are. Around our age, people aren't watching on video, so they might think that we're, you know, young folks just outta school. But we both know that's not true who are so later in their working life and from cultures where people do tend to age at a younger age because they're coming from.
Societies where there wasn't a lot of medical care early in life and things were a lot [00:17:00] harder and a lot more dangerous. And so if somebody gets injured on the job at 55 or 57 or 58, that's probably the end for them. And they quickly move into this situation of being a dependent young elder of their 30 something children, who are now suddenly in the sandwich generation and.
It is a, it, that loss of identity, that loss of worth that you talk about is very real. And there's a depression and sort of cognitive decline that rapidly follows the injury. In those cases, economically, those folks can suffer some of the worst because a lot of pension plans are based on your highest last years of income.
And, The last couple of years before retirement can make a big deal. on your economic positioning for the rest of life. Some of these folks don't necessarily have kids who made it good. We live in a society where there's a lot of nuclear [00:18:00] family, disintegration alienation, and we don't have the extended family infrastructure to care for folks.
And so these become compounding tragedies without that sort of thing. Yeah. And I actually have a number of patients who were over 70 who kept working. one gentlemanWas a contractor for the military. he runs the full size simulated machine guns. So they're, doing squad automated or squad level machine guns or whatever.
And, and his job is to keep the pneumatic fake guns. They're full weight and full size, but they don't actually fire real bullets. And so this was his patriotism. You know, he wants the soldiers at Fort Lewis training with these things, so they won't get killed if they're deployed somewhere.
he was gonna retire any year now, but working well past 65 and because he felt a calling to that job and just a connection and a [00:19:00] pride and a benefit. That he was doing something that made a difference. Mm-hmm. And so when he tripped and fell really hard on concrete that was a career ending injury when it might not have been for us, and certainly would not have been for a, you know, a 25-year-old.
Right. Because as people age, we just don't bounce back as well. Yep. For sure. So that brings me to my next question, which is not the one that I alluded to a second ago, but we'll get there. Which the truth is that a lot of the people that you see wouldn't need your help if it weren't for the work they do.
And the same work that you're trying to help them get back to, which is dangerous work, work where people are likely to get injured. And I'm curious what lessons you've learned from your patients about what it's like to do work where you're sort of really constantly having to watch yourself against that possibility of.
Real harm, real injury. One of the [00:20:00] sadder conversations I have is with nurses, RNs, LPNs, CNAs. Who have suffered back or shoulder injuries and they're nontrivial obviously. Otherwise they wouldn't have come see me. And I said, when we get done with this surgery and rehab, are you gonna be able to let the falling patient hit the floor?
What I could never do that well realize if you grab a falling patient and especially with poor body mechanics, if you make that split second decision to cushion their fall, you may be you're hurting yourself again in a way that you're never coming back from. And so that's definitely a loss when it's like.
When you
confront the patient with the ugly reality that things can't ever quite go back to normal. even if they get through the situation now, they, typically can't go back to floor nursing and. If there are many paths in nursing, [00:21:00] but the people who are er nurses are generally not the people who want to be case managers.
and so they, they may technically be able to work within their field, but it's not what they were good at, not what they wanted to do. there's often a loss. other times, I tell people, well, can you get, can you be an instructor? Can you be a manager? Can you be a supervisor?
Is there some way we can take the burden off of your body and use the knowledge and skills and use your brain. Mm-hmm. Even though this is blue collar work for the most part. there are things, you know, there's. Stuff you've absorbed that you could teach the young kids, the ones who have the strong backs and the, lack the experience that you do.
Yep. But unfortunately it's not as easy as all that to just try and get somebody to pivot them into a little bit less involved job. That mm-hmm. They could [00:22:00] still do in their chosen career field. I had one gentleman was a lumber grater for a mill, and his mill closed while he was out injured.
That's not something you can go to another mill and do. That's something that you have to work your way up from the bottom to and to get to. And he is like, I can't possibly do that. Even if there was another lumber mill that was hiring. Kind of thing. That job is something that you have to be trusted by your management.
It's not something you can just walk from place to place and say, see, I've got all these advanced certifications. I mean, you and I can get credentialed in a different medical system. And there's a standardized set of things they look at in our past experiences. Oh yeah, you can do all these things 'cause we know you've done them before.
and in fact, I know for a fact that if I wanted to move to Olympia, there's a good chance I could become chief medical officer of a clinic there. I just don't, oh, yes. I don't wanna move across the country as much as I'd like to be able to hang out with you and, you know, shoot the breeze every week.
But so yeah, [00:23:00] you're absolutely right. Some jobs are portable and some just really aren't. Yeah. so either the job. The tasks of the job are too dangerous to return to. Or the milieu the situation, the management trust And organizational position are just something you can't recover.
And so that's very disheartening to a lot of people because, I got a little bit of a perspective on that, switching into medicine at age 40. Mm-hmm. Right. I had to. a reasonably successful career in IT security management, and by the time I quit, I was writing policy for a Fortune 100 company.
I was speaking at national conferences occasionally, and then all of a sudden I'm the low man on the totem pole, right? The, one who doesn't know what he's doing, who has the imposter syndrome? I'm doing a di, an entirely different job. And none of the 20 years or so I spent in, it really helps me do anything more than tame the EMR.
So when [00:24:00] we ask patients, it's like, oh, well you've got 30 years of logging experience and your back is pretty much broken. So, we can put you in an Associate's program and get you a general business associate's degree, and you can go work as an office clerk. That's a loss, even if there is some new meaning to that. The people I work with tend to have a sense that I was right where. I wanted to be, or where God put me if they're religious. It's like, you kind of flail around for a little bit at the beginning of your career and then by the time you're 40 you found your calling, what you're good at and so you just stop switching and you just get real good at doing what you're doing and then something happens and that's interrupted.
Yeah, that's true. You know, when you talked about some of the folks in nursing and. Pivoting to a role in leadership or education? One of my favorite stories, and I'm telling a story that I've heard told [00:25:00] publicly in front of a large audience twice by this person. So, I know he's okay with it being out there.
My old med school Dean, Steve Canter, He is a neurosurgeon by training and fairly early in his career, developed arthritis in his hands and arthritis in a neurosurgeon is you can't operate in something that's that delicate. and he goes to his chair and says, listen, I have a problem.
And explain to him what's going on. He's like, wow, Steve, that's terrible. what are you gonna do? What do you wanna do with the rest of your life? He's like, well. I think I'd like your job and very quickly worked his way into leadership positions in medical education, which is how he ended up at the time that I was training as one of the deans of the School of Medicine at Pitt and then at Kansas University Medical School or at whichever branch of the Kansas Medical School is in Kansas City, and then eventually at one of the schools in the DC area.
So, he's done quite well for himself. But it was that. I can't do the thing anymore, but I can teach other [00:26:00] people how to do it. And not just the hands part, but also the brain parts. that is so heartening when it happens. Mm-hmm. But it's not super common. I have one patient who was an electrician his job at the time was moving well dealing with UPS batteries.
And those being heavy, he just did something wrong one time and tweaked his back and eventually needed surgery. But what he did was trained to be an electrical administrator. So instead of actually doing the stuff, he's doing the permitting, the paperwork. And he has, the state requires electrical administrators on jobs.
They're the ones who are making sure things, are done well. Right. And so he identified what he could pivot to and he crushed the testing for that. He got nine out of 10 when passing was seven. I think it, regardless it was an impressive feat. 'cause these are not trivial questions.
Mm-hmm. and these [00:27:00] are scenario based. And he was justifiably proud of himself. Now he's still dealing with pain. And we're working at that, but at least we've solved the work problem. he can sit and stand, he can work from home, and he is contributing more and he is getting paid at least what he was getting paid before, because that's a step up from just an electrician to an electrical administrator.
Right. But, those sorts of things, they don't always exist. Yeah. I had one gentleman who was trying to go from being a plumber to a union plumbing instructor and there was one position and I don't know how many different guys applying for it. And the sad reality is, I bet you a lot of 'em had either were off work or had an injury.
Or were feeling that their body was, were breaking down with age. And sometimes we have a paucity, we just don't, we don't have enough positions like that for the people who can benefit from it. Mm-hmm. Yeah, the [00:28:00] problem with everything being sort of pyramid is that, there's, by nature of the shape of a pyramid, there's a lot fewer spots on top than there are in medicine.
Like your example, oftentimes the administration is seen as a punishment, right? Alright, who drew the short straw? you have to be department chair, right? rather than any sort of prestige it becomes, you mean I have to do this instead of real work?
Because when you're taking care of patients, taking care of schedules and HR complaints and things like that is anything but endearing. Right. So, being, that I'm doing a lot of both of those things right now, I can, yeah. I'll just say yes and move on. So now back to the story you told me about those.
To patients of yours who had been assaulted at work. There's been I would say, belated attention the last few years to clinician burnout specifically. And there's all kinds of hazards that are contributing to it, right? There's the violence that you talked about, not just in the [00:29:00] er, which is what I was gonna bring up.
because everybody who's listening to this has been watching the pit, so they've seen it on screen. But resident work hours before the, both, before and after the Bell Commission, unreasonable demands and volume in primary care, which is my world. and then the increasing dominance of the electronic health records, which basically pushed the relationships to the side and the record becomes your relationship.
And yet a lot of us, I think maybe willfully fail to realize that we're as much risk for a workplace injury, even if we're talking about moral injury or cognitive injury instead of physical injury as the people were treating, So you started a little bit about your work with medical professionals and some of the effects that's had on them.
But also just thinking about yourself, your colleagues, people that we've met in the community. what do you think about the effect of our work on us and maybe tapping into the well of your faith, which I know is a deep one. What do you think we might be able to do [00:30:00] about it? I couldn't do what I do, any of it.
Mm-hmm. my Christian faith is why I left a very lucrative career in it security in retrospect, when you get great, you get gotten rid of. So it was my inclination, led led me outta a danger zone that I wasn't really aware of at the time of, of being declared, we don't need you anymore.
You're too old to have an opinion. and into caring for people. The idea that there are people walking around I don't get a whole lot of saves, I don't have. The trauma surgeons will have people come back and thank them years later for saving their lives that it's not gonna happen to me.
But I have people who thank me for getting them back to work. The ones who wanted to, we're gonna do it. And the ones who can't get back to work, we, we legitimately get them pension. Mm-hmm. And either way, it's, I view ca taking care of other people as my. It is my sacred duty to [00:31:00] God.
Right. We're all, all made in his image. And even if somebody has nothing in common with me, I am responsible to him to take care of him. And so that means, no matter how annoyed I might get, I can't take it out on the patient. I just say, you know what ? This is my lot in life, and this is the negative things are the trade off for getting the awesome privilege of being a healer or working with people.
I think it also helps me navigate the ethics. I'm responsible for, again being. Helping the patients at the same time, not trying to cheat the system or help them cheat the system to get them stuff that they're not entitled to. It's a broken system and I can't change the fact that sometimes it's unfair and capricious, but what I can do is be human and sit with people.
Listen to them. Okay. Who wrote a book about that? I'd like to meet him someday. Yeah. when I do a new patient intake, again, these are people [00:32:00] who've been off work for a while. I allocate an hour. just to understand their history and what they've been through to date.
And I let them tell me the story and then I'll go back and read the chart. 'cause I don't want to be biased by what their last clinician thought they were cheating or mm-hmm. Ing or whatnot. I want them to be able to give me their story. And then honor that, right? So that's kind of how I see, how I see faith interacting.
It's like, obviously we're not proselytizing in the office, but we'll absolutely pray with people, excuse me, who, bring up their faith as something that's getting them through. You know, I have seen secular patients, a couple of 'em. Yeah. Find God. In their injury. They, have nothing else they can do.
And so what they do is
reopen a search for the divine. That, that, normally that's something you, you see in, young people. But, old guys like me, [00:33:00] injured on the job can sometimes say, I need to take stock of my life and assess my relationship to the eternal and transcendent and yeah. Multiple stories of people getting reconnected with their faith or finding one that they find fits 'em better.
Per the joint commission, we're supposed to actually take a religious history of our patients. Yeah. Most people don't, and we kind of do as much as it, as much as it matters. But that's often very subtle. Like, who is your support system now that you're not working.
Mm-hmm. You have a community group a faith community, extended family, and, we. definitely encourage people to get back to whomever their faith community is. That's where they, That's where they really should start with the people who kind of knew 'em hoping that they are more positive than the, uh, than the public in general.
Injured workers often are treated with scorn. I can't see what's wrong with you. You can stand up. Okay. [00:34:00] I don't see why you're leaning on that shopping cart. To push it through, and why are you here in the middle of the day? Don't you have a job? So hopefully the communities of faith are going to be more , better neighbors Yeah.
To the injured workers than as a whole. But doesn't always happen that way, for sure. It doesn't. I'm interested in thinking about. All, you know, many of the professions that you talk about have come a very long way. Professions and trades that you're talking about in becoming safer, right?
That guy who moved up the ladder in the electrical industry, right? Those folks exist. So that the workers that are doing the frontline work aren't getting electrocuted on the job. And also that the people whose houses they're working on aren't burning their houses down. Yep. And we don't let pilots fly longer than a certain number of hours per day.
And we don't let truckers drive longer than a certain number of hours day. There's all these, even the athletes that we talked about, right? I mean, all the changes to the rules and the helmets and everything in football. And yet I think that a lot of us, you and I and our colleagues feel like we are.
[00:35:00] Just being told, well, this is the way the system is. Even if the injuries, the wounds aren't physical, you're just gonna have to deal with it. Certainly the way in primary care it sounds like for you, your faith and your belief that what you're doing really matters, has protected you in a lot of ways against feeling.
Harmed by that. But there are occasional times when the system seems unjust, when I think somebody should be pensioned and instead they're told, Nope, yours, as good as you're get gonna get, you're given a trivial amount of permanent partial disability payout and sent off.
And that happens, I'd say that actually happens about as often as the people who've been lying to my face. So those are the ends of the spectrum. Where this is, Injustice. Because somebody has been, oh, I can't my back.
Yeah. And it turns out Watch hours of surveillance video at five times speed, watching them use a post hold digger for an hour or two at a time. Yeah. As opposed to, I've said my piece, I've [00:36:00] explained why I think they these people are legitimately hurt for workplace condition and the system just does not agree with me and I can't change that outcome.
Yeah. And so there is certain amount of moral injury in that. And, certainly a lot of frustration. But I still have agency. and I have tried to connect people to the extent one can within the confines of, barriers, right? Professional barriers, to get people connected to community resources.
That might be able to help them when the state-based workers' comp insurance system would Which I can help with them with is denied to them, at least temporarily. So that's probably the biggest part of moral injury I have in my job is watching people's claims get denied when they absolutely are legit.
And it sounds like you are blessed to have the time that a lot of us lack in our interactions There's a little bit more room for you to have these conversations and to find out what you need to [00:37:00] know. So the good news is that these are relatively well compensated visits.
I mean, it's much, much, much better than Medicaid. And as such the system also allows billing based on time. So if I need to sit and talk to a patient, and the state pays us for that according to 2021 rules, I think. and so I don't have to be spending the entire visit trying to check off things at EMR.
I'm just watching the clock as we talk about what's going on in their lives, what the specialist said, how PT is going what they want to do next their dream for a retraining job, if they have to have one. All these sorts of things. Used to be counseling could count for half of your time.
And now it can pretty much be the entire visit. I mean, there's some paperwork to do and there's, there's this and that, but I do a lot of patient education and as well as maybe not quite unconditional positive regard, but really trying to [00:38:00] support the injured workers where they are.
Mm-hmm. Because if you don't believe in them, who will? So, I love hearing that. One of my favorite stories to tell is every good Hasidic story attributed to multiple different Hasidic rabbis. The one that I heard it told about was Rob Zha of hpo who said I would rather give money on the street to a hundred charlatans so that I would not accidentally leave one truly deserving beggar penniless.
Then leave. Then, not give money to a hundred, you know, deserving beggars so that I avoid being taken for a ride by one charlottean. So those 5%. The system is built around not allowing fraud, like the reason it's so difficult. We know this to be true with, any kind of government benefits.
And certainly private insurance benefits as well, that the documentation is so onerous to discourage people from taking that [00:39:00] amount of time to try and score a few easy bucks, but it ends up hurting. The exact people you were talking about who, no matter what you do, and no matter how much you believe in them, can't seem to get over the hump.
The ones that are the most difficult to catch are the ones who have no motivation. And are perfectly happy to stay at home and do nothing. And I, I don't understand that at all. Right. But that is the ones that get caught are the ones who say, oh, ow, ow I'm hurt, and go out and work somewhere else.
and they will be caught on camera by employment security somehow, somewhere they get found. Mm-hmm. part of working in the system is accepting that I can't guarantee all my patients are gonna be needy. Truly needed. But in order for me to do my job right, I have to treat them all.
Even knowing that one in 20 is gonna be a fraudulent, I have to treat them all with respect, [00:40:00] and I can't see what their job site looks like. Mm-hmm. I, I wasn't there. If there was surveillance footage of the actual incident, great. Otherwise I kinda have to take their word for things. Mm-hmm. And so I know that I have been fooled for quite some time by people who are eventually caught and that makes me sad.
But I'm still doing the right thing for the vast majority of people who are playing it straight who do need that. And I think that's a really great approach to the whole effort, whether it's your particular type of medicine or what I do. I hear similar things for people that work in addiction treatment and various other things.
You, you have to assume that most of the people you're helping really need your help and treat everybody as though they're in that category. Yeah. And I think that in medicine in general, if you're trying to be a gatekeeper that's just a miserable place to be.
Yeah. To try and try. I mean, 'cause if you're a gatekeeper, then either you are not caring about getting it wrong, or you care about getting [00:41:00] it wrong, and you can't sleep at night worrying that you got something up and denying somebody who really needed it. Yeah, exactly. Exactly. And you know, we, we get not just gatekeepers for the insurance system or the workers' comp system, but gatekeepers to decide who gets the MRI or who gets to see the, very very busy and hard to get into specialist and who gets the particular expensive medication.
And that's a really exhausting part of. Certainly my job as a primary care physician. Absolutely. 'cause a lot of the job has become that and I didn't sign up to be a cop. I signed up to be a doctor. Speaking of big conversations like this do you mind if we put in a plug together?
Not at all. The conference. As I mentioned, Jonathan and I know each other from the conference on medicine and religion. Because I didn't raise my hand fast enough to say no. I am now the chair of the executive Committee of the Conference on Medicine and Religion, which has been meeting for more than [00:42:00] 15 years at this point.
Coming up on 20, I believe. And we are meeting this year March 22nd through the 24th in Houston, Texas. And if you are so inclined, can find us online at.
medicine and religion.com and if you go to the homepage, it will give you the dates of the conference, the location at the Hilton Houston Post Oak in Houston, Texas. The times you can see the schedule for the conference and registration is now open. It is still early enough until February 22nd to register for the conference with the early bird.
This episode should air on the 17th, so you are still getting in on, in time if you're interested. The people that present at this conference are brilliant, thoughtful, caring physicians, chaplains nurses, students, people from across the healthcare spectrum, really looking for not standing back from.
A thousand feet away and looking at medicine and [00:43:00] religion is phenomena, but people who are practicing one or the other are both trying to figure out how they support one another and interface with one another. and it's a really inspiring time to share thoughts and meet with people who may not share your particular version of faith.
But as my friend pastor Richard Freeman likes to say, we come from the same tree and just have different bark. Jonathan, it's been a pleasure, this conversation. Anything else you want to add before we call in a night? The one proverb I was gonna work in, we didn't actually end up talking about his story, so I'm going to just throw it in there.
Great. Some of these people are, the people who got hurt are, do stuff that, is phenomenal. And so not only are they out of work, but they're out of master work. Mm-hmm. So I actually have one patient who did some wiring work for Bill Gates. And so that, that called to mine, Proverbs 2229.
Do you see a man skillful in his work? He will stand before kings. He will not stand before obscure [00:44:00] men. So there is a good bit to be said for the spectrum of people. There are certainly people who come from very humble jobs that anyone can do, but even the most skilled person out there, is not immune to getting hurt at work. And so I love it because it's an experience, it's common to demand. Young old I've had 20 20-year-old women who had congenital hip issues that came up when they were chasing a, a shoplifter as a security guard to mm-hmm.
the greater than 70-year-old men I talked about before. So I don't get, I don't get to see kids, but it still really draws on the family medicine background in terms of, of seeing people throughout that, even though they're, yeah, 50 to 70-year-old men is the major part of my, clientele.
Okay. You've left me inspired. I really appreciate that. Thanks so much for coming on this evening. Well, if you let me put in a plug, I would say that. Great. Go for it. anybody who [00:45:00] is considering working in occupational medicine you need to have a little bit of tolerance for paperwork.
The good news is once you learn it, it's usually very repetitive. So once you've mastered a form, it's not like you have to learn something new every visit. there are people out there who are at the mercy of people who could not do anything other than occupational medicine.
In the grand scheme of prestige, family medicine is probably right in the middle with pediatrics, a little lower women's health about the same. And then above that you've got. All the various specialties all the ologies are up to you. You know, cardiothoracic, surgery and neurosurgery at the top pinnacle of respect.
And compensation. And where's edd? The compensation's not bad, but the respect's pretty low. The question is, oh, you're doing edd. Well, what did you want to do? Because there are jobs and for principled people who. Are willing to and this is one thing I'm glad to bring up [00:46:00] is rather than just treat, transfer, or discharge, I've got a fourth one, which is sit with the patient while the administrative stuff resolves itself and just see the month after month not making a whole lot of progress, but trying to keep their hope alive in the process.
Mm-hmm. There is so much beauty here. In fixing people from these workplace injuries it's nothing I would've ever picked for myself. But finding it, I can't. I see. I don't get why people hate it. obviously being lied to is not fun, but hey, if you're in emergency medicine, you're gonna light too anyway.
we just have a lot lower key saving lines. and soif you're a student, if you're a PA looking for an elective rotation, come work with me. It's a part of medicine that I think is very human centered. And there's absolutely science and journal articles and whatnot behind it.
But it is down in the trenches with where we need to [00:47:00] be seeing and listening to and just conversing with people on a very human level to help 'em thrive when all of the other, support systems have gotten kind of knocked out from underneath them. You are speaking my language. Thank you so much.
That was a great plug. Hope to have, many more conversations like this very soon. And I can't thank you enough for being on this evening. Thank you very much.
[00:00:00] One thing a lot of dangerous work has in common is the temptation that draws us into it in the first place, like those million dollar salaries for playing football in medicine. That could be the financial reward or the hero complex that many of us have about being able to save or rescue people. Other jobs, promise, adventure, great benefits, easy hours, or work from home.
Once we're in, things look really different. Remember that word, far hard labor that I mentioned in the cold open? Rabbi Yohannan Travis taught many years ago that this word is a combination of two shorter words, soft mouth. The work didn't start out as enslavement. In fact, Travis's story goes that Pharaoh actually went out into the fields and foundries and worked alongside the Israelites.
At first, he was like an ancient Egyptian episode of Undercover Boss speaking with a soft mouth full of encouragement. Look, you are pitching into a very important national effort for the good of Egypt. [00:01:00] I'm right beside you, but the work got harder. The words got harsher, and all of a sudden Pharaoh was back in palace.
The Israelites were still hard at work. Another commentator used some fancy numerology tricks to suggest that the word farik hints that the Egyptians imposed every type of work that the Jews now abstain from. On Shabbat, they were making the point that only free people get a day of rest. There would be no rest for the enslaved Israelites.
I thought of this when I attended the ribbon cutting ceremony for Duquesne University's new medical school in 2024. The university president Ken Gormley told the story of the founding of the school by the spirit. 10 Order of Priests close to 200 years ago. Those priests dug clay from a bluff overlooking the Monongahela River and baked it into bricks in an oven.
The same backbreaking work that the Israelites were told to do in that verse. I quoted to Jonathan during the interview. But the Spiritan weren't serving Pharaoh. They were serving a higher power and took that work on themselves willingly. [00:02:00] Same work, different master, different results. When we do hard things with a whole heart, we don't burn out.
Instead, we're like the burning bush that Mosha encounters in the desert of which the Torah tells us the bush was not consumed. We're so used to thinking of burning out because we use up our compassion or our mental energy, or our ability to care about what happens. But trauma therapist Brian Miller in his CE Cert program for preventing secondary trauma and helping professions reminds us that intense hard work isn't what burns us out.
It's feeling helpless and overwhelmed in that work. Faced with challenging work and given the tools to do it well, we thrive. We're not consumed. We feel like masters. We become like the spirit ends and the bricks, they baked, strengthened by the fire. The trick is getting to that place of having the tools and the time to do our work well and safely in many places.
Neither healthcare workers nor the people we care for can honestly say [00:03:00] that about our work. As a healthcare leader, I'm constantly struggling against becoming my own version of Pharaoh saying, just work harder, and instead, looking for ways to provide the straw, make baking the bricks easier. And roll up my sleeve side by side with the people on my team.
New technology, different schedules and extra hands will never make the work easy, but it can change a person's frame of mind, giving us hope That as the saying goes, we can do hard things.