Dr. Weisman: Welcome. You are listening to Doctor Me, First with me Dr. Errin Weisman, episode two. This is a podcast where female physicians come to have authentic conversations, get encouragement, and leave refreshed to take on our world. No more feeling alone in medicine because, here, you will find connection, community, and hope. I'm your colleague in medicine and coach in life, Dr. Errin Weisman and in each episode, I talk with an amazing female colleague and her one homework assignment is to come up with a word for which our conversation will revolve around.

Dr. Weisman: Today, I'm talking with Dr. Heather Hammerstedt and her word is layers, so here we go.

Dr. Weisman: Hey, everybody. It's Dr. Errin Weisman, back with you today and I have a very special guest that I want to introduce. Her name is Dr. Heather Hammerstedt. She's a MD MPH who's board certified in emergency medicine and a full partner and assistant medical director at Vituity at the Boise, Idaho location. She came to Boise in 2008 from Boston where she had worked as an attending ER physician for Harvard Medical Faculty positions. She completed her medical studies at Temple and did her post-graduate residency in emergency medicine at Beth Israel Deaconesses Harvard-Affiliated Emergency Medicine Residency Program. She holds a Master's in Public Health degree from Harvard School of Public Health with a concentration at international health sector reform and development. She is one of the founders and executive director of a non-profit organization called Global Emergency Care and she's gonna tell us more about it here in a little bit. She, also, is CEO of Wholist, which is a proactive, integrative health and wellness company focused around weight, fitness, women's health, and mind, body care. She keeps herself busy with all these projects, but she also has her husband, skiing, rafting, running, and chasing after two small boys and a big, chocolate Lab. You can find more out about what she is doing in the show notes, which I will post later, but let's go ahead and get on to the interview. Also, by the way, I wanna mention that she is my new kick-ass best friend because, I have been watching her videos on Wholist on Facebook and absolutely loving them. Hey today, Dr. Heather.

Dr. Hammerstedt: Hey, how are ya?

Dr. Weisman: I am doing wonderful. It's so great to have you on the podcast and I want you to tell our listeners a little bit more about what you're doing with your not-for-profit.

Dr. Hammerstedt: Sure. I'm the Executive Director and Co-founder with a few other emergency medicine physicians and friends of Global Emergency Care. We formed in 2007, after a couple of us ended up in rural Uganda doing some emergency medicine global health work and realized that there is a huge need for emergency medicine outside of the developed world. We formed a non-profit, Global Emergency Care, really on a whim and here we are 11 years later. We've been focusing on doing emergency medicine education and so we run a two year train the trainer program, which is now a recognized diploma program nationally in the country.

Dr. Hammerstedt: We train, basically, mid-level providers. We take nurses and what they call clinical officers, which are basically physician assistant levels and train them to be able to provide emergency care independently, and then consult with physicians as needed. What's novel and unique about this is that, there was no emergency medicine in the entire country when we started working there and ours was really the first program. There's now, we've helped one of the universities that we're associated with develop a physician residency program. That just started this year, which is really exciting. Now, there's emergency medicine physicians being trained. There's a couple other big, national movements that we're involved with with the government, in terms of increasing physician and mid-level emergency education there, as well. It's been quite a ride, a lot of ups and downs, and a lot learning points but, our staff there is really amazing, saving lives every day, and really working hard to train new folks. Even better that they're starting do the administration of the program, as well. It's really a sustainable model that we're excited about.

Dr. Weisman: That's so great. I just think it's absolutely amazing to not only be touching lives here in the US using your medical skills, but also abroad, and I just commend you guys for that. That's absolutely amazing.

Dr. Hammerstedt: Thanks.

Dr. Weisman: Before we got on the recording today, everybody, I always kinda like to pick a topic with everyone and you'll notice it's usually a one-word topic. Today, we are gonna talk about layers and how we came about this topic, like I mentioned earlier, I was listening to Dr. Hammerstedt's videos and one of the comments that really stuck to me about it is you said, how can we do our job when there are so many layers that stand between us and patients?

Dr. Weisman: Give me a little bit more about how you are approaching layers.

Dr. Hammerstedt: I mean, I guess, when it comes to actual, clinical emergency medicine, when I think about the layers between me and the patient, they still exist even in clinical practice, where you don't have the time to sit down and really talk to folks directly more than just maybe even a few minutes. I think the way that I approach it in terms of ... There's techs and nurses and secretaries and can you please go in and tell so-and-so this because I'm busy with 15 other patients? I think the way that I approach it, at least clinically, is really making sure that those minutes count, right?

Dr. Hammerstedt: That I sit down and I make sure that I ask the questions that let me into the patient a little bit more, instead of just what they're saying that they're there for. I'm trying to realize what the whole context is. It's really important, even in an emergency medicine perspective, of you just don't understand what people are coming to the table with unless you really get in there and ask and try to make yourself as authentic and vulnerable as you can as a physician, as well, so that they feel comfortable talking to you about that.

Dr. Weisman: Absolutely. I think that's so true because, one of the first initial layers, at least that I feel when we're working, is not evidently that there's a hidden agenda but, there's a layer that you kinda have to go through with the patient, like the finding out why are you here?

Dr. Hammerstedt: Right.

Dr. Weisman: Some people are there because, they do have a physical ailment. They have a cut on their leg and it's bleeding. But, other people, sometimes it's not always something that you can always see on the surface and I know that's where we have challenges in our job.

Dr. Hammerstedt: It's interesting that that ... That's a really great point. Why are you here? It seems like an easy thing to answer, right? But, it is very complex and anyone who's worked in [inaudible 00:07:17] knows that sometimes you just can't figure it out unless you take the time to continue to ask questions. I like to think about it like, my three year old, every time he says, why, and I answer, and why, and I answer, and why, and I answer. Sometimes, you need to go down that rabbit hole, too, with patients to get through those layers.

Dr. Hammerstedt: It's like, just keep asking. I tell my trainees this all the time. If it doesn't make sense to you, it's not that you're not understanding and it's not that the person isn't able to tell you, it's that you're not asking the right questions. You just have to keep asking and asking and asking in different ways until it makes sense. Whether that's the chronological order of why someone actually got to you or whether it's the emotional aspect of why someone got to you, it's the three year old mentality I think you need to have.

Dr. Weisman: Well, and it's so hard, too, when you're just trying to establish a relationship with somebody who walks in there and, maybe, a lot of times I know that I don't process things the way that other patients do. For instance, most of us in the medical field, as physicians, we think chronological. We go back to the onset of symptoms and then, we move forward on that. But, so many times, I feel like with patients, they kinda wander around a little bit. Of course, then we come to-

Dr. Hammerstedt: A little bit, more than a little bit.

Dr. Weisman: The next layer, which is close family and friends. They are there and they wanna advocate for their special someone but, oh my goodness, sometimes that layer is the most abrasive that I find.

Dr. Hammerstedt: Yep. For sure. That's how I think of, clinically, of layers. If you wanna move on to administrative and legislative layers, that's a whole 'nother story but, I mean, I think that ... I've been in clinical practice now, out of residency, for about 11 years and I feel like I don't know whether it's just me growing and being more confident clinically, and so I'm able to open my eyes a little bit more and see the bigger picture, or whether it's all of my years of executive leadership running our business, our emergency medicine business, that has opened those eyes, or whether it's just the change in how medicine is over the last decade.

Dr. Hammerstedt: I have just really started to feel that there is a big chasm of space between the physician community and patient community. That manifests itself clinically because, you feel like your patients don't understand what you do as a physician and they don't trust you, necessarily. It also comes across in terms of how the media portrays physicians, how the patients perceive the physicians, and how we haven't really been able to advocate for ourselves in a way that makes sense to the patients because, first of all, we're just trying to take care of patients and we haven't tried to politically advocate for ourselves.

Dr. Hammerstedt: But, we also have the layer of nurse administrators. We have the layer of hospital administrators. We have legislation in the middle. We have lobbying organizations in between. We have-

Dr. Weisman: Insurance companies.

Dr. Hammerstedt: Insurance companies, just all these things that are between me and the patient. I wish and I'm hoping and I'm trying to, with my company Wholist, is to reach across that and get rid of some of those layers so that we can get back to what I feel like is most important, which is the physician/patient relationship, the provider/patient relationship in terms of how do we understand and know each other, where we're coming from, so that we can both come together and advocate for that relationship?

Dr. Hammerstedt: I can't take care of someone if I don't understand where they're coming from and they don't understand the training that a physician has, the situation that the physician is in, what expertise that physician has in terms of their specific family medicine, emergency medicine, cardiology, whatever that is, or what does an acupuncturist do? What does the massage therapist, what is their specialty? If we don't understand all of that about each other, we're not gonna come out with a successful outcome without understanding what the expectations are. Does that make sense?

Dr. Weisman: Absolutely. Well, for instance, when a tech walks into the room and a patient doesn't understand that they are not a nurse. They have a different role than perhaps what they perceive in their head. Tell me, how are you getting across this chasm and fixing the patient and physician relationship with Wholist? 'Cause I'm really interested to hear your take on that.

Dr. Hammerstedt: Yeah. I am a new CEO of my own company, Wholist, and I'm about five months in. I started the company as a plan to do health coaching around weight and fitness and mind/body health. With all of my preface of everything else we've been talking about in terms of the problems in our health system, I really realized that there is an opportunity to integrate teams of providers and physicians together, outside of the regular healthy system to create better health and wellness for our patients.

Dr. Hammerstedt: In a way, I feel like I'm a health curator. I feel like I'm really good at coming up with ideas and putting together other people's expertise into programs that make sense that nobody's done before. Also, figuring out a way to create a novel way of approaching health that's ... Break the mold, in a way. The bigger picture of Wholist is that, patients can come to us and we will create a health and wellness plan for them, short, medium, long-term. Then, put together a virtual team of practitioners and physicians that can care for them but, also, in-person, in their communities.

Dr. Hammerstedt: I have a tele-health platform that we pull everyone together into one place. We can have group calls, coordination between all of the folks on the team, as well as keep centralized documents so that we can share all that information. What comes out of that is really, we have an opportunity to amplify our own results by using and piggybacking on other people on the team. Say your team is an acupuncturist, a family medicine doc, maybe you have a functional medicine doctor who's assisting. You have a personal trainer. Whatever your team looks like, that team knows what everyone else is up to, and so can really take those results and work off of that.

Dr. Hammerstedt: It's pretty exciting. Right now, the main program that we have is a weight wellness program. It's a 12-week program where folks get daily podcast information on weight science and mindset and mindfulness around their food relationships. They have a personal coach that they have video calls on every week and they also have the opportunity to have the addition of a meditation guide, hypnotherapist, or a life coach on top of that. The folks who have been super engaged and excited about this program have all been down eight to 10 percent in 12 weeks body weight and really feeling like they've changed their life.

Dr. Hammerstedt: This model, I think, is gonna be reproducible in terms of fitness and women's health and mind/body work and I'm just super stoked.

Dr. Weisman: Yeah, it sounds like a innovative hybrid off of patient-centered home. It sounds like it's more what people are really seeking out, instead of what we built as the vehicle in healthcare. I know one of my questions as I hear your talking is, okay, so that's all well and nice. We've got all our specialists and all or people on board but, what's the payment model? I'm just thinking, as a physician, I'm like, oh, if I'm going to be a collaborator, I wonder what this is like.

Dr. Weisman: Give me just a for instance. Mostly, we're talking to an audience of physicians here. What is the collaboration that goes along with it and what are your expectations as far as financial? Is it a one-time fee per patient? Is it a retainer? Let me know your thoughts on that.

Dr. Hammerstedt: Yeah. I think it depends. From a physician perspective, it depends what role someone wants to have, right? Say you're working in your office in your outpatient setting. You have patients that come through every 15 minutes and you know they need to lose weight. You know they need mindset work. You know that their body needs work. You know they need to lose weight, get off their diabetes meds, all of these things. You might, A, maybe not know how to tell them to do that and, B, you certainly don't have the time.

Dr. Hammerstedt: That option is, is that you can just refer someone to us and we bring you back a more well patient and then, the payment for that is the patient to wholist and we bring you a more well patient. Whether that comes back to reimbursements from you for payers and things like that, or their outcomes would be great obviously. The other option is that, physicians can become part of the Holist network, which means that they would receive clients from us for care. It depends on what your specialty is. It's mostly, would you wanna be family medicine? That's a telemedicine sort of relationship where, obviously, it's state dependent where you have your licenses.

Dr. Hammerstedt: Whether it's you're coming on as a coach, whether you're a functional medicine person, it depends. You come in as a network, you'd be an independent contractor. We would pay you your fee per patient visit. It's all non-insurance based. It's all direct care.

Dr. Weisman: That sounds phenomenal on both sides. I know both, as being a referring physician to tell people, hey, you need to do this because they're gonna get in your grill and I don't have time to do it. Also, on the other side, for people who are potentially looking for other ways to find fulfillment in medicine because, this is a big world but it seems like more and more we're getting so much more interconnected, that we have these availabilities.

Dr. Weisman: For instance, where I'm at in rural Indiana, I don't think there's a functional medicine doctor within 150 miles. That would be great to be able to have that kind of collaboration with that.

Dr. Hammerstedt: Obviously, we have a patient wellness problem, right?

Dr. Weisman: Mm-hmm (affirmative).

Dr. Hammerstedt: We have a problem where they go to the doctor to fix sick problems, but there is not a good method of us to create preventative wellness. This is an opportunity for patients to be able to seek that out in a way that they know they can trust the providers and the physicians that are in the network because, as you've mentioned, people are seeking this out. They're putting up their hands to go to acupuncture. They're putting up their hand to go to massage. They're putting up their hand to go do X, Y, and Z. They don't know if their money is worth it. They don't know what the evidence is for. They don't know who these people are and, certainly, those people are not communicating.

Dr. Hammerstedt: This fixes that problem but, in addition, we have a physician wellness problem and you eluded to this. We are unwell. We are frustrated. We've lost autonomy. The layers between us and the patient are heartbreaking and we all went in to take care of patients. We all went in, we trained our whole lives to do this, and we have physicians that are depressed and physicians that are burned out and physicians that are killing themselves. If we can provide an opportunity for us to remove those layers and just get back to let's talk to the patient. Let's figure out what's wrong. Let's figure out the problem and do it in a way where we control our own schedule, we control our own pay, we control our relationship.

Dr. Hammerstedt: That sounds fantastic to a lot of us.

Dr. Weisman: Absolutely. I really like it that this is a physician-led innovation because, so many times when patients are looking for complementary alternative medicine, it is a little off the cuff and it makes you scratch your head and go, is this snake oil or is this good? Your program also alleviates that 'cause, if one of your consultants is doing something cray-cray you're gonna see it in their charting and you can have that discussion with them, which I think is phenomenal.

Dr. Weisman: The other thing, too, is you can utilize people in the best ways possible. Having your dietician, your dietician doesn't evidently need to be doing acupuncture. They need to specialize in what they're doing and vice-versa really plugging people in to where their expertise is.

Dr. Hammerstedt: Yeah. I've been pretty excited here, locally in Boise, pulling together folks, different health and wellness practitioners that I know and trust in our community and coming up with, what are the credentials that some of these out of the conventional medical system practitioners are? What is best practice acupuncture? What are the things that we have the best evidence for? Studies are hard to do on all of this but, what are the best that we can do these for? When we have all that layered out, it's easier to grow into other communities and other markets because, we can say, this is what you have to be able to do to get in.

Dr. Hammerstedt: I'm not an acupuncturist. I wanna figure out people I can trust to make those decisions. I'm pretty excited about that. Our Boise community is growing really well and, once we have the model all fixed here, I think it'll be really easy to grow.

Dr. Weisman: Yeah, that's absolutely amazing and you're gonna have to keep us up to date as you guys are getting launched and growing. There are no failures in life. There's just learning opportunities.

Dr. Hammerstedt: Absolutely.

Dr. Weisman: As you go through this-

Dr. Hammerstedt: I think I said that to my husband last night. I said, well, if nothing else, I'm learning a lot.

Dr. Weisman: You're learning so much from it all and I just think it's so great that you're so willing to be open about it because, I know, many times as physicians, we don't evidently wanna be vulnerable because, it's then, well what will my colleagues say? I totally appreciate you being open with that, and that was the last thing I wanted to hit on in our conversation today. We talked about patient layers. We talked about administrative layers. We talked about the big chasm that just keeps building between us and patients.

Dr. Weisman: I think one that's really important to address is our own, personal layers. It sounds like, through your career, you've done a few different things. Tell me a little bit about from faculty work to Executive Director and the Head Physician of your group. Tell me about those layers a little bit.

Dr. Hammerstedt: Tell you about how I manage them or how they feel or-

Dr. Weisman: Yeah, how they feel. Just, you've been doing it for over a decade now, so I would love to hear-

Dr. Hammerstedt: I know. I feel old.

Dr. Weisman: You're not old. You're totally not old. Old is a state of mind. Oh, I have to share this is that, someone told me a birthday is like leveling up in a video game. You're just leveling up every year.

Dr. Hammerstedt: I love that. I just had my 40th level up, that's awesome.

Dr. Weisman: There you go, 40th level up.

Dr. Hammerstedt: Yeah. My layers. I have done a lot of things. I like putting my hands up to try new things. The thing that I'm excited about right now, and I don't know if it's because I'm mid-career or where it is in age or getting babies into toddlers into school, all these transitions in my life right now. I feel like things are coming together, those layers are coming together into a place that makes me feel really professionally and personally well. I didn't always feel that way. There are parts of my career that have been difficult.

Dr. Hammerstedt: Running a private group and being the person who's talking to insurance companies and hospital administrators about contracts, those things are hard and they were not easy for me and I didn't like it. I'm please to have released some of that. Then, I think about, it is hard to overlay those layers in a way that make you feel not just overwhelmed. I think that is something that is going to continue to be a learning process for me. I can say, at least personally, that I am really, really lucky to have a spouse who fully supports all of my random ideas and excitement and busy life.

Dr. Hammerstedt: We call him the Director of Household Operations. He's a DoHO and stay at home spouse. That is my base layer, right?

Dr. Weisman: Right.

Dr. Hammerstedt: I'm hopeful that I continue to find a way to weave the layers together that work. You were saying you were appreciative of me just being able to be open and talk about it. I think that's something that I've realized in the last couple of years is that, putting a layer over, a sheen over yourself is not helping you. It's not helping the patient. It's not helping your community. It's not helping the physician community because, the more that we sit here in our imposter syndrome and pretend like everything is fine or we know everything that's happening, no one else gets in there and understands what the problems are and, also, doesn't understand how unique and what we have to bring to the table.

Dr. Hammerstedt: I think that the most important thing that we can do as people is to be authentic and vulnerable. I also think that, as physicians, our patients need to see that. The hospital administrators need to see that. The insurance companies need to see it. Our legislators need to see it. We need to be able to be like, this is me. This is my life. These are the problems. These are the things I love about what we do because, we can't bring things to the table, we can't bring ideas that work to the table unless we're being honest about what the situation is.

Dr. Hammerstedt: No one knows how the physician world works except for us, right?

Dr. Weisman: Absolutely.

Dr. Hammerstedt: Yeah.

Dr. Weisman: Well, when we show up and we show up as ourselves, as our authentic selves and not trying to pretend to be what we think everybody thinks that we should be, like you said exactly, imposter syndrome, then that is when creative and innovative juices really get flowing. That's what I think we really need right now in medicine because, honestly, physicians are some of the most brightest and creative community that you will be around. When we get boxed up and when we get covered up, we lose those sparks. I think that's what we're seeing so much with burnout, with physician turnover, even with physician suicide when people feel like they have nowhere else to go but out.

Dr. Weisman: I am 100 percent on board with that and I [inaudible 00:28:25] call of action, as well, to figure out where, maybe, you can peel off that layer that you're hiding behind.

Dr. Hammerstedt: Well, yeah. The thing is, too, is that we always think that people are gonna judge us, but we are our worst judge, right?

Dr. Weisman: Absolutely.

Dr. Hammerstedt: We are the ones who are ruminating in our own brain. We are the ones who are thinking about how we're the imposter. We have all of those things. We're choosing to have those thoughts and, if you choose not to have those thoughts, you are able to accomplish a lot more but, also, you realize that when people watch you or listen to you or here what you're doing, they're not hearing the small things that we ruminate over afterwards, right? They don't even see it.

Dr. Weisman: Right.

Dr. Hammerstedt: I've been doing tons of these educational videos with Holist Facebook, particularly doing a lot of live videos on my own and a lot of interviews with other, mostly female, physician entrepreneurs on what they're doing and putting yourself out there like that is very vulnerable, but people love to see us, as physicians, opening ourselves up. I really want to add to your call of action. How can you, in your own world, open yourself up, take off that layer, be more authentic with yourself and your patients, but also come and put yourself out there on, whether it's social media, or anything? Just to get your voice out there so our patients hear it.

Dr. Hammerstedt: If anyone wants to do that with me on Wholist, I would love to have you on our Facebook lives. I'd encourage anyone to reach out to you and do something and be vulnerable and bring it out there because, we really need that.

Dr. Weisman: Absolutely. I could not have segued into conclusion any better than that and that is so wonderful. If you wanna find out more about what either one of us are doing, check out the show notes. Particularly if you're interested in Wholist, you can go to holisthealth.com or any social media outlets and use the handle @wholisthealth. Also, if you're interested in medical education in Uganda, make sure you check out globalemergencycare.org.

Dr. Weisman: Well, Dr. Hammerstedt, it has been phenomenal. This has been a wonderful conversation and I hope that our listeners get even just a spark of what I have heard today because, I am ready to go take on the world.

Dr. Hammerstedt: Great, let's do it together.

Dr. Weisman: Awesome, thank you.

Dr. Weisman: So, something corny that I think about whenever I hear layers, I think of the movie Shrek where he says ogres are like onions. They have layers. But, Donkey says, what about parfaits? They have layers, too. Well, when I think of layers, I don't think of either one of those. I think of bedrock layers and why that is is, I grew up in Southern Indiana where we, surprisingly, have quite a few oil mines and oil wells, I guess I should say. Growing up around that, actually, I remember in elementary school learning about the different layers of bedrock that we have here in Southern Indiana.

Dr. Weisman: Surprisingly enough, several months ago I heard another fellow, female physician coach, Dr. Katrina Ubell, talking about oil wells and I got real excited. Essentially, what she was saying is, so many times in our life we start a project and we start digging and we get to something hard and we hit a level that just doesn't seem like we can get through it and so we're like, oh well we tried hard enough so let's go to the next. We leave it and kind of turns into a pothole. Instead, what we should be doing is drilling oil wells.

Dr. Weisman: When we get to that hard place in our life, we've been digging through, we got through the soft mud that maybe was the easy stuff to push through, and then we get to the hard stuff. Instead of using the same tool of a shovel, we need to change to a different tool. Man, we need something with some power. Give me a jackhammer. Give me a dozer, something big time. Essentially, what I think of when I come back to these different layers is that, we need to expect that we're gonna get to a level that's gonna challenge us.

Dr. Weisman: Lord knows, as physicians, we have been through the ringer. We have been challenged. We are tough, but life always seems to throw a new curve ball at us. Don't you agree? Don't you feel like, oh my God, I've been through Hell and back again and now I'm in a different Hell? Well, I wanna encourage you to say that you can get through this. Maybe you just need a different change in tool. Maybe the thing that you've been using for so long is blunt and no longer sharp and it's just not gonna get through it. Maybe you need to check something else out or you need to ask for help from someone that you haven't thought of. Maybe you need a different change in situation.

Dr. Weisman: All in all, you need to make some small changes so that you can punch through this layer and get down to that good, thick, rich oil. Maybe, if you're doing a diamond mine and you're trying to get the sparkly stuff at the very bottom. No matter what it is, I wanna encourage you and say that, yes, life is full of layers. They're so complex. They're so difficult. But, with a little work and a little time and some help, you can most definitely get through it and enjoy the next level which is, hopefully, easier and much more satisfying. You hang in there and, if you need help, make sure that you always reach out.

Dr. Weisman: Well, that's it for today's Doctor Me, First. I so appreciate you staying around and listening all the way through the conversation and encouragement. Hey, I wanna ask you a favor. Would you please share this podcast with your favorite doctors in your life? My goal is to get this to as many female physicians as absolutely possible because, four years ago, I needed this. I needed this podcast to know that I wasn't alone in medicine, that the burnout I was feeling was not a personal failing, that help and support truly were available, and that change was going to happen in my life. I so hope that this podcast can bring those things to other female physician's lives. If you need anything, get ahold of me. There's my link in the show notes where you can find my website or hang out with me on social media.

Dr. Weisman: As always, remember your life, your calling, your pulse matters.