Knock Knock Eye: I Survived the U.S. Healthcare System. Barely.
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Hello, everybody. Welcome to Knock Knock Eye with me, your host, Dr. Glockenflecken, your one-stop shop for all things eyeball related, ophthalmology related. Spell ophthalmology real quick right now. Do it.

Did you get O-P-H-T-H-A-L-M-O-L-O-G-Y? See, you're learning. You've learned so much from me over the years. And I'm sure that's probably on the list of things as well. I'm so excited for you to join me today. This is a special episode. First of all, if you're watching me on YouTube, at Glockenfleckens, by the way, I probably look a little haggard.

I look a little, maybe the bags under my eyes are maybe a little bit worse than usual. And that's because I am jet lagged. I came back from Australia yesterday. And it's one of those, when you fly from Australia back to the U.S., you basically live the same day twice. So I left at six, I want to say like nine o'clock in the morning.

And then I arrived in LA at like 930 in the morning, something like that, something ridiculous. And so you live the same day twice. And the result of that is just very tired, especially just going east, just going east. It just is the worst.

But I have no one to blame but myself. I got myself into this situation doing all the speaking and stuff. But it was a wonderful trip. I enjoyed the Australians are great. I gave a talk called Dr. Glocken's really fun and incredibly uplifting guide to US health care.

I, I, I talked, it's, it's great. I love it. This is like my favorite thing to do now. So I'm going to do it every time I travel internationally to speak, which is not that often. Really. I, I, I do maybe, maybe a couple international trips a year, but, um,

I love this talk because, especially in countries that are thinking about exploring the private sector a little bit more with their healthcare system. And I'll give this talk because the U.S. is a great example of what happens when you have an unregulated private sector.

Basically, you can do almost whatever you want. And by you, I really, it's the corporations that can do whatever they want, you know, like United Health Group, private equity firms, for-profit hospital corporations. You know, they have, they don't have, they can do whatever they want. The physicians that like own their own practices or even the few that still own hospitals, you

They have much more regulation than the corporations because it's only physicians who are subject to corruption, which is silly, to conflicts of interest. It's ridiculous. So anyway, I gave this talk to the surgeons of Australia, the Royal College of Surgery.

And just, and the great thing is I'm just, I'm just going over basics. I'm just talking about how it works. And, and it's, it's impossible to listen to someone talk about how the U S healthcare system works without coming away horrified. That's just, it's, it's scary to, to, to, to hear it. And I started out by, by talking about,

but this is the piece of advice I gave to all my Australian colleagues is like, if you are thinking about pursuing a change to your healthcare system, and this applies to really any healthcare system around the world. If you're thinking about some change, whatever it is, you know, you and your country people are, or politicians or whoever it is, physicians, you're all arguing back and forth. Should we do this? Should we do something different?

Before you decide on this change, whatever it is, ask yourself one question. Does America do that thing? If America does that thing, then no, you should not do that thing.

Very simple rule of thumb. That's it. That's it. If America does it, then like, I'm not going to say do the opposite, but you could consider that. But just in general, just don't do it. Do something different. Try something different because it doesn't work. It doesn't work. And I really like the system that Australia has now.

where they i'm kind of i feel like i'm talking like an australian i'm i'm kind of at the end of every sentence i'm my inflection on my voice goes up a little bit i love how they do that because they all sound happy and they could be insulting you although they don't insult anybody but you could insult somebody and then you just you just put a little little upward inflection in your voice and it all of a sudden sounds a little bit happy anyway wonderful people the australians the aussies and um and so

I like the system that they have. They have a robust public, basically, they call it Medicare. So it's available to everybody.

The difference between our Medicare and Medicaid and theirs is that they actually fund it. I think part of the problem with Medicaid and why it's so painful to use for a lot of people in the country or just it's not available or for physicians, it's difficult to get reimbursed. That's why so many physicians don't take Medicaid.

Although I think they should, even though you don't make as much money from Medicaid. That's not really the point. It's a service you're providing to your community. But the reason why people are so frustrated by it is because it's not funded. We send a lot of the burden on funding also to the states.

It's a federal program, but there's been a lot of intent and action on transferring money.

if i having trouble getting words out today it's just because i'm very tired but uh anyway it's like the burden is put on the states right and a lot of states have defunded i've attempted to defund medicaid and so you really see the difference when you go to a place like australia where like they're they're very proud of of a lot of aspects of their health care system uh but they they actually they put a lot of of of resources behind their national health program

And that's the way you do that kind of thing. But they also have a private system on top of that.

So if you, if you can afford it and talking to some of the physicians, you know, it can cost from, you know, 400 to $600 per month. And then you also have some costs on top of that. So it's not, it's not, I mean, there's a significant cost to it for a lot of people. Um, but they have a lot of people that use the private health. It's not so unattainable. Like when you compare it to some of our healthcare costs in this country. So, and what that does, the private system, um,

It helps to decompress the public system a little bit. And here's the important part. A lot of physicians, they have, I'd say most physicians are in both worlds, right? They see some private and some public. And here's the most important part. Both systems, they have access to the same medicine, right?

the same resources, the same imaging, the same lab tests, the same surgeries. So you're not getting like subpar medicine. You're just, if you're using the public system, you're waiting a little bit longer, you know, maybe a lot longer. And in general, you don't have the option of choosing which doctor you want to see.

So that's ideally what their public system allows you to do in Australia is you can get in very quick to see a doctor and you can choose which doctor you want to see. So that's what you're getting. That's what you're paying for. Efficiency, speed, and choice. But you're getting still the same health care. That's really important.

So I like the way they're doing now. They're not without their problems because no healthcare system is perfect. And I got to hear as they kind of debated with each other about different things, you know, they're having trouble with getting access to rural, you know, healthcare. We have, you know, rural healthcare issues as well. They talked about like trainees and indigenous populations. And what I thought was very interesting in hearing some of the debates about that they're having in their country is their issues are

A lot of the same issues like we have in our country, in the U.S. The problem is we are always so focused on fighting insurance policy and corporatization, the awful private stuff that comes with extreme privatized healthcare, that we never get to those problems. That's what it seems like.

It's like, yeah, we have all these problems too, but we get sidetracked. We get distracted by trying to fight back on all the prior authorization issues and vertical integration of healthcare, PBMs, and all the harmful policies they just make up out of thin air to hurt people. We never get to talk about some of the other things to actually move us forward. We're just trying to...

We're treading water. We're basically just fighting to stay where we are so that we don't lose ground, but we're not moving forward. They have a little bit more possibility of moving forward because they're not having to deal with a lot of that kind of stuff.

But there are some people in their country that are like, oh, maybe we should expand the role of health insurance. Maybe we should, you know, a little bit more privatization. And so I was there in part to say, don't do that, please. And look, here is why. And he really liked it. It wasn't the most uplifting talk that I gave, like 45 minutes of

just really laying it on, um, about everything that health insurance companies are doing. Uh, and, and, but I think, I think I got my point across to them. So I tried to include some, some fun skits and jokes and things whenever I could, but it was a pretty serious topic. Uh, so anyway, overall, awesome. I hate a lot of good food. I went by myself this time. So I ate some like

you know, lots of like Thai and they've, they have fantastic Thai Indonesian food, obviously like Thailand and Indonesia, like right there next to Australia. So it makes sense that they'd have a whole lot of really good food from that part of the world. Um, and my kids, they don't like that kind of, they don't like spice, like heavy spices. So, uh, I really enjoyed eating around Sydney. There's so much good food in Sydney. Um,

Great trip. And, um, hopefully I get the opportunity. I'd love to, to, you know, give this talk to other, other countries that are interested in learning a bit about the U S healthcare system. Um, cause it's just, it's so complicated and people are, they hear me, they see my videos that I put out there, but, um,

um it's it's uh it's hard to really wrap your head around the concept of like prior authorizations and peer-to-peer reviews i got some gasps from the crowd when i mentioned that peer-to-peer might mean that you as a surgeon are are getting asking for permission to be paid to do a surgery from like an internal medicine physician

Who hasn't practiced in 30 years. Like that was shocking to this crowd of Australians. Like what? How is it? Like, honestly, I heard like a, it's like, yeah, that's the reality. That's what these companies are doing. We know ProPublica, they, they did an investigative report on this, all the prior authorization on, on the medical directors, the quote unquote medical directors that they hire, uh,

That showed that like they, yeah, they're technically, they have a license, but they haven't actually practiced medicine in years and years and years. And often not even in your specialty. Imagine like having to do a, get a, do a prior author, a peer to peer review for someone about some like immunotherapy. That's only been around for five years. And you're talking to someone not in your specialty who hasn't seen patients in 20 years.

In what world does that make sense? But that's the reality. That's the reality. So, all right. So we're going to do something a little different today. After the break, I'm going to, it's a very special occasion. This is the five, we've just passed the five-year anniversary of the time that I died. So we're going to talk about it. And so let's be, I'll be right back. Take a quick break.

Hey, Kristen. Yeah. If I could give one piece of advice to like brand new physicians or even like med students, early career folks, it would be to get yourself some life insurance. Yes, that is the time to do it before you start having all sorts of health issues. Like a cardiac arrest. Or cancer. Yeah, the cancer scares. You never know what can happen. You don't. Right? And so having that peace of mind.

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Okay, we are back. All right, so in May of 2020, now some of you may know this story. A lot of you are familiar with this story already, but I had my cardiac arrest. It's interesting because social media has such a short memory. Honestly, I don't talk about the cardiac arrest on social media. I don't make skits about it. That's not really the focus of my content.

Uh, and so maybe there are a lot of you who have never seen me talk in person. Uh, I do talk about a lot more when I give keynotes. That's a big topic is, uh, cause there's a lot that I've learned over the years about things like using humor and medicine as a coping mechanism. Um,

you know, uh, uh, communication and things I've learned about, about patients and, and talking with them about health insurance and so many things, um, that, uh, so I talk about all this during when I'd give keynotes, but not as much on social media. And so it's kind of surprising me still when I hear, when I do give a talk in person and people come up to me afterwards, like I had no idea that this happened to you.

So I figured, you know, for those of you who don't really know the story in detail, I thought maybe I'd just tell you because it's been five years. I broke the four-year curse.

The four-year glaucoma curse. Now, I practice evidence-based medicine, but that doesn't keep physicians from being ridiculously superstitious. So I haven't talked about it until we pass this mark. But for a while, I had my first testicular cancer. Then four years later, I had my second testicular cancer. And then four years after that, I had a cardiac arrest. And so I've now passed the test.

The threshold. I feel like I'm more comfortable talking about this. Stupid. I know it doesn't make any sense, but what is happening in our brain? Where's the superstitious part of our brain? What is that? That's got to be somewhere in the brainstem. That can't be. That's not cerebral cortex. That's not higher order functioning. That's not executive functioning because it doesn't make any sense.

Um, but nevertheless, uh, I've, uh, five years now, five years ago, um, Kristen woke up at four 30 in the morning and I was gasping for breath. She recognized that something was wrong cause it didn't say I snore, but I, uh, but I, I, this didn't sound like snoring. This was much worse. And my color wasn't right. She's turning like gray. I was turning different colors. So, um, she called nine one one.

And they instructed her based on what she was telling them to do chest compressions, to start CPR. And she did it right there on the bed, which first thing, if you're ever doing chest compressions on someone, you want that person on a hard surface.

to be able to resist the compressive. You can better compress the chest if you're pushing against a hard surface. That makes sense, right? Our bet is soft, but fortunately not too soft, I suppose, because she was able to do 10 consecutive minutes of chest compressions. You guys know how long that is? That's an eternity. When you're learning two-person CPR sessions

you know they tell you you don't do it for longer than two minutes at a time because you'll you'll get tired uh fatigue and then you'll you'll do chest compressions less effectively but somehow she was able to just to do it get it done and we when we when we talk together in person doing keynotes or or even some in our live shows we will play some of the 911 call

which I think is really important to do, especially for medical audiences, because as physicians, we are, so we see the aftermath for the most part, right? What it's like after the initial trauma. So playing this call, it gives people an idea of what that trauma is like, not even just the physical trauma, but the emotional trauma of listening to

to someone try to save their loved one's life and it just drives home the the uh the traumatic aspect of it and how this whole experience because i went to bed and i woke up in the icu two days later i didn't have any underwear on i didn't know what the hell was going on kristen

Kristen, she lived through every single second of that cardiac arrest, right? The resuscitation, the talking to the dispatcher, making phone calls while I was sedated and intubated in the ICU, you know, talking to family, calling my office to tell them I wasn't coming in and why.

Figuring out what to do with the kids. Like just there's so much. So the ripple effects of this, it affects, you know, definitely beyond, you know, far beyond just the patient. And so playing that call for people, it helps to, and we don't make it public just because it's a very personal thing. And so I want to be able to control the narrative around that 911 call.

um and so we do it in a controlled setting or we can talk about it and and you know discuss the takeaways of it and i always make sure kristin's there too because this is her thing she she was there during the 911 call the only one there because i was gone um and so the

Something we don't talk a lot about, or at least I don't. Kristen, I think she does a little bit more whenever she does advocacy work around the idea of co-survivorship is the effect that the healthcare system had on her right after EMS took me away to the hospital. Whenever she showed up to the hospital, she was at first turned away

Because this is COVID. This is the height of COVID. We had no vaccines. We had a lot of people couldn't get PPE. People were in garbage bags. It was scary and it was chaos. People were dying. We had no idea what was going on.

And so she turned away at the hospital until, well, you know, one of the criteria that to allow people to come in was if the patient was an end of life case. So they told her that I was an end of life case. So it was okay for her to come in. That's what she was told. And various other things. She was, you know, put in radiology.

That's where they told her to wait because it was relatively empty. But the problem is that radiology department is lined with lead, and so she could not get any cell service. So she was not only told that I was basically dead, wasn't coming back, end of life case, but also she was cut off from her support system, unable to get calls in and out. Just a really very, very traumatic experience.

But guess what? It turned out okay. It did. It turned out okay because I'm alive. I'm alive. But that doesn't mean that we're still not feeling the effects of all of this. And so now five years later, you know, I, I, I've been kind of reflecting on where we're at now. And, and,

the things in our life that we're doing that we wouldn't have been able to do and the same places that we're still struggling. And, you know, as a family where it's, it's, it's always there, you know, there's, there's still anxiety going on in our world. Um, and, and that's been something we try to work through together in conversations. And slowly as the kids have gotten older, because our kids were, were five and eight, um,

at the time that this happened we we have slow tried to not not like shield them from it because it's an important part of our lives and our history um but

Give them just a little bit more information as they've grown up and can understand it a little bit more. Anytime they've asked us questions about it, we've been very truthful with them. And they've expressed a little bit more curiosity about it over the years and have learned a little bit more about the event as time has gone by, which I think has been a really great approach to something like this.

You don't want to give them something that they're just not going to understand, that it might just scare them without them being able to understand the context around certain things. And so you give them age-appropriate information without lying to them. And so I think it's been good. It's been good to just process a little bit over time.

And so from like an emotional standpoint, like our family, we're doing okay. We're hanging in there. But what's been really helpful, what's been really great is doing all the glockenfleck and stuff.

Because from a family standpoint, Kristen and I, we do a lot of talks. I mentioned we do a lot of keynotes together where we talk about this and we use it to do advocacy work, both around like chest compressions, cardiac arrest, but also Kristen's work with co-survivorship. And because of her experience, that whole idea of trauma affecting people around the patient

It's something that people don't realize. People don't think about that because we're so focused on the person who had the cardiac arrest for good reason, right? Because the thing happened to that person. But guess what? That thing also happened to the person that is surrounding that patient, that loves that patient, the family members, especially the people that actually responded and had to be tasked with assisting and saving that person's life.

co-survivors they're also survived that event and so uh helping to people through advocacy work and recognizing that part of of this type of medical event has been really helpful i think on an individual and family level but also just helpful it's it's like a purpose-driven thing right it really um

We got a lot of feedback on the impact that this type of advocacy work has done. And honestly, I give all credit to Kristen because the idea of co-survivorship wasn't even on my radar. I've been practicing at that point for a few years. And so she is just phenomenal, which is why I really prefer to tell this story together with her.

In part because of the incredible advocacy work and the way, I mean, it's her story, you know, just hearing her describe it. It's just, it's powerful. It's so powerful. But also my memory is like Swiss cheese around this event. As you can imagine, I still have like massive gaps in my memory. There's a lot I don't, I don't, I just, I probably, I might not ever get back.

Um, uh, I re I have like flashbulb memories of, uh, you know, but my hippocampus was, was definitely, Ooh, it was out to lunch. It was on vacation. Uh, and, um, even like the, the, the weeks leading up to it, I'll tell you one, one thing that I did a couple of days, it might've been a week. I don't know when it was, but it was after the cardiac arrest. I wasn't back to work yet. So it was definitely within that first month is that, um, I, I called my best friend to tell him I had a cardiac arrest.

And then I called him the next day to tell him again. He was like, yeah, man, you called me. You told me yesterday. I had no recollection of doing that. And this was all, everything, that had all happened after the arrest. So memory is a weird thing. I don't understand it.

Uh, but it's, so that was, that really threw me for a loop. I was like, whoa, like this is crazy. It's not even just like the event itself. It's like even the, my, it's like my brain was slowly coming back online and it, it, it took some time. Let's take one more break and I'll come back with a few more things.

Hey, Kristen. Yeah. I've been, you know, grossing you out about these Demodex mites, although I'm not sure why they look like adorable. Well, these are cute, but it's the real ones that kind of freak me out a little bit. Yeah, but I have some new facts to share with you about Demodex. Oh, great. All right. These mites have likely lived with us for millions of years. Oh.

Yeah. Does that make you feel better? No. Like they're passed down through close contact, especially between mothers and babies. Oh, wow. Such a special gift for our daughters. They're born, they live, they crawl around, and then they die on your eyelids and in your lash follicles. Their entire life cycle lasts about two to three weeks, all spent on your eyelids. Well, thank you for that. This isn't helping, is it? No. How do I get rid of them? Well, it's

It's fun to gross you out, but we do have all of these. It's really common, but there is a prescription I drop to help with these now. Okay. That probably excites you. That makes me feel better. Any way to get rid of them, right? That's right. All right. Sign me up. Visit MitesLoveLids to learn more about demodex blepharitis, which is the disease that these little guys cause. Sure. Again, that's M-I-T-E-S-

Love Lids, L-O-V-E-L-I-D-S.com to learn more about Demodex and Demodex blepharitis and how you can get rid of it. Okay, we are back talking five years after the cardiac arrest. Here's one more thing, probably one thing I would have done differently. I think maybe I've mentioned this once before on this podcast, but if not, I would have waited a little bit more time before coming back to work.

I had a lot of empathy fatigue. I didn't really know what that was. I'd heard that term before, but I felt it. Oh man, I felt it. It was like patients, here's an example. A patient would come in with pretty minor complaints, dry eye symptoms, their eyes a little scratchy and just be really bothered by it, which is fine. It's a legitimate problem. But I would feel, and I would never voice this actually in the room with the patient,

In my mind, I'm thinking, how dare you complain about something so trivial when I just had a cardiac arrest? Don't you know, patient coming to see the doctor, what I, the doctor, went through? It's like, and it sounds stupid. It's like, and it sounds wrong. And it is. It's dumb. Like, why? Like, you can't project your own medical problems onto this person who just is meeting you for the first time.

Or is it just there to talk about, you know, to get help from you? And that's what I was doing. I was like projecting my own medical problem that I just had. And as like, I just had found this inability to like, to care, you know, that's empathy fatigue. Like I had no empathy. It's like, this is nothing. I want to, I had a cardiac arrest. How about that? It sounds ridiculous, right?

whenever i say it but that's how i felt and it's that's not it's it kind of scared me honestly as as a physician because like i know this is not the way i'm supposed to be feeling but i feel it and it faded over time which is and pretty quickly so i honestly i i should have taken like an extra couple weeks maybe even a month um just to to just still just get a little further out i'm still processing everything that was happening and and so um

And with the pandemic, with people that are working in the hospital, in the ICUs, without PPE, without vaccinations, you heard a lot about empathy fatigue. And I get it. I absolutely get it. And man, it's a tough thing. And I had the good fortune of having a strong support system. And I could have taken more time off if I needed to or if I requested it.

i know a lot of people didn't have that luxury around the pandemic you had to work through it because patients were sick and there was nobody else and physicians were getting sick nurses everybody's getting sick so man empathy fatigue's no joke it's a real deal and it's it's scary as a healthcare professional who when you dedicate your career to patient care i'm doing well five years now um

you know, I physically, I'm, I'm great. I'm actually in the best shape I've ever been in because, uh, Kristen got me this tonal thing. I'm, I'm lifting weights regularly. It's awesome. I love it. And, and it's, it, and just the, the, I obviously owe so much to Kristen and, you know, we're, we're, we're doing great. We're, our family's doing well. Um, and then sometimes I just think about everything that's happened in the last five years, um,

that wouldn't have happened if it wasn't for her. Basically all of Glockenflecken, everything, everything we've done, this podcast, the characters, Jonathan wouldn't exist if it wasn't for Kristen. Like I made all those characters after I recovered, after I came back and just telling our story, you know, just using, I'm so proud of both of us

For, for using this platform to try to, to make some small part of the healthcare system a little bit better. And it's just, it's, it's a, it's a, it's been healing honestly for us, I think, you know?

Now it's, we like have a new normal now. It's that life is never going to be exactly like it was before because we have this, you know, and there's always a little bit of fear. Like, you know, what if it happens again? Fortunately, I have my little buddy, I have my defibrillator in place just in case, but it is, it's something kind of, it's kind of sticking around in the back of my head. And I don't know, I do feel like,

Certain parts of my life are just have a little feel a little bit different, you know, both in the patient care. I, I talk more with patients about, um, I have more empathy now for them, especially about around their health issues like cancer around heart problems. You know, I, you know, the, the,

Being face-to-face with mortality, so to speak, really gives you a different perspective on life. And most of my patients are in their 70s and 80s, and they're dealing with things like cancer. They've had deaths in the family, or they themselves are dying. And I feel more comfortable in those situations as a physician, just talking with people and having real conversations if necessary. And so it has made me a better physician. I honestly believe that.

um and um and i don't know i'm i'm i'm less uh i'm more open to like spending money you know there's like a thing about about being a being in health care being a physician is that you you're you're you spend so much time like saving and saving and and and not spending because you're a resident or you're a med student you don't have much money and you have all this loan debt and it's hard to get out of that mindset once you do have money and we're doing

very well now financially. Like it's not an issue, but like there's this like mental hold on like not spending money. Well now it's like I, I die, I almost died. And like what good is, is, is all, you know, saving. And I mean, you'd be still save. It's still important, but like now it's, it's more like, you know, it's okay to live a little, it's okay to live a little, you know, and, and create experiences with your loved ones.

And that doesn't have to be expensive stuff either. It's just being more present about that type of thing. Not trying not to put things off. Really just getting after life. I don't know. I don't know. It sounds cliche, but there's a reason cliches exist is because there's some truth to them. And I do feel that. And I hope that doesn't go away. I hope that doesn't fade with time. Hope some of the other bad things about this experience fade.

And I start paying just more attention just to the good stuff. You know, like being there with my kids, making time for them whenever I can, making time for Kristen, all that stuff I'm getting better at, you know, over time. So five years, hopefully many more. Five years. I did it. I surpassed five years.

All right. Thank you, guys. That's it. That's Knock Knock Iowa. I'll be back next week with some more eyeball stuff. My eyeballs are doing fine, too. I did not get, while I was in the hospital with this cardiac arrest, not a single ophthalmology consult. I'm a little insulted.

Not even a phone call to say, what kind of artificial tears would you recommend for this patient? It would have been nice just to know. Actually, you know what? That is something that I think Kristen actually did mention that to the ICU physician when they called once. It was like, I know this sounds silly, but he's an ophthalmologist. Have you ordered artificial tears? I got to ask her. I'm just now getting a memory that she...

She asked about that. I'm going to make sure and make sure it's not just something I've made up just now. I swear, I think she did that. I think she asked the doctor to order me some artificial tears. Oh, man. Anyway. All right, guys. Thanks for listening. I am your host, Will Flannery, also known as Dr. Glock and Flecken. Thanks to my executive producers, Aaron Courtney, Rob Goldman, and Shanti Brick. Editor, engineers, Jason Portiza. Our music is by Omer Bensfi. We'll see you next time, everyone. Bye. Knock, knock. Goodbye. Bye.

You've been caught, Dent.