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Dana Cowles: An Osteopathic Emergency Physician’s Perspective on Healthcare

Dana Cowles shares an osteopathic emergency physician’s perspective on healthcare on this episode of the Perspectives on Healthcare Podcast with Rob Oliver. He currently practices in Florida. A member of Generation X, Dana is an osteopathic doctor.

Here are 3 things that stood out as Dana Cowles shared an osteopathic emergency physician’s perspective on healthcare:

· Traumatic accidents and injuries are more likely in warm weather environments
· New technology does not need to be the first line of testing
· Tolerance and patience for staff that is handling multiple facets of care

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Here is the transcript of Dana Cowles: An Osteopathic Emergency Physician’s Perspective on Healthcare:

Rob Oliver: Thank you. And welcome to another Perspectives on Healthcare Podcast. My guest today is Dana Cowles. He is a member of Generation X. He is an emergency medicine physician down in Florida. Dana, welcome to the podcast.

Dana Cowles: Thank you, Rob. Thanks for having me.

Rob Oliver: You bet. I’m glad to have you here, and I’ll be very interested to hear your perspective. So here we go. Tell me a little bit about yourself and your role in healthcare, please.

Dana Cowles: Well, I’m board certified in emergency medicine. I was trained as an Osteopathic physician. I’ve been working for 15 years now and started around the market in Syracuse, New York, where I did my residency training and then came down to Jacksonville, Florida. So I’ve worked in Jacksonville. I’ve worked in the Greater Orlando area afterwards, and that’s where I am now.

Rob Oliver: Okay. So as far as Osteopathic doctors go, do you have any inclination as to what the ratio is of Osteopaths to more traditional MDS? Do you have any knowledge about that at all?

Dana Cowles: Well, I would say that it’s risen quite a bit in historical times. They used to be in the far minority and not so much anymore. There’s an equivalence in training between the two practices. For me. I like the philosophical difference in Osteopathic medicine and really focusing on the holistic care, where they incorporate mind, body and spirit altogether and the understanding that one part of the body might affect others. And that’s what really drew me to the Osteopathic principles. The teachings, though, have melded over time. And this is once a foreign concept to a lot of medical practitioners, has not been for quite a while now, and with a lot of the equivalents in training and a lot of equivalents and certification. Often times you might have an Osteopathic or an allopathic physician and not even know it got it.

Rob Oliver: So practicing emergency medicine in the Greater Orlando area, I’m assuming that you see things that are relatively typical. Are there things that are unique to that area that you are seeing in the emergency Department?

Dana Cowles: Well, we’ve had quite a few different things that have happened. We have less regional things than what I saw in New York. So different things like Lyme disease isn’t as prevalent, things that we might have a lot more traumatic things, but different avenues. So I’ve worked in some places around Orlando that have had the knife and gun clubs. I’ve had some that were more trauma related. But a lot of people think that if you’re in an area where there’s a lot of snow, things like that, that you’re going to have more trauma, let’s say, from car accidents. But in actuality, people are going to be driving a lot more careful and they’re going to be a little bit slower. So when you have things like wide open roads and open lanes and stuff like that, now you get people that are doing 90 with the radio on, roll out and convertible down.

Rob Oliver: Sure. And I would imagine that you also have people who are less familiar with the roads because a lot of the lot of the folks that are there are transient coming in for vacation or something along those lines. What does quality health care mean to you?

Dana Cowles: For me, the best quality in health care is the relationships. The more relationship that somebody has with their patients, the better they’re going to be able to conduct a lot of the medical care there’s pros and cons for emergency practice style. The one thing that doesn’t happen as much is the patient relationships because they’re generally very brief interactions. And a lot of times we have to come up with answers to very problematic issues, and we have to do it in a very short time frame. And one of the things in emergency medicine that a lot of people might not understand is that it’s not just a problem in front of you. There’s also aspects of what are their social interactions. What are the social dilemmas? What are the contributors that are coming in for a lot of different aspects, different things like in recent years looking for tattoos on teens or things that might indicate that there’s human trafficking going on when all of a sudden some people come into the emergency Department with the exact same complaints. Let’s say all of a sudden you have 1012 people show up with a headache. That’s a little bit different than they’ve had before. Is that because you just had a gas leak in the local area that people weren’t aware of? So there’s all these things that you have to pay attention to and understand the patient relationship suffers for that, especially with the brief interactions. And I’ve become a little discouraged. I guess lately that a lot of the primary care has been Eroding, where I think that’s where primarily people can have those relationships and should to be able to provide the best health care for people.

Rob Oliver: Okay. You’ve kind of done this already, but can you give me an example of quality health care?

Dana Cowles: Yeah. If we have all factors that are put together where you have a collaborative team effort and people can utilize a lot of the interactions and relationships like, let’s say, from primary care if we have communication and access to them, if we can have the ability to minimize the amount of tests that have to be done and lower the cost by actually getting back to histories, physical exams and pertinent positives that are there so that people can understand the differences of what’s happening today, because a lot of those differences are telltale of where you need to be looking okay.

Rob Oliver: So what I’m hearing you say is sometimes we have a bunch of new technology and new testing that’s available, and we are quick to use that. Whereas there may be some old fashioned, so to speak, ways of examining the patient, that could be a start, the testing wouldn’t be the first step. There would be some other steps that could be taken first. Is that what I’m hearing you say correct?

Dana Cowles: Correct, and from our perspective, in emergency Department, a lot of times people will use it as a convenience factor, or they’ll use it as a modality. One thing that discourages me is if health care costs come into it where they tell me I need to come in and get a certain study because it’s actually going to cost me more if I do it on an outpatient basis or it has to come out of pocket or these kind of things. It’s a little disheartening because it should go the other way around. They should be getting a price break for doing it on their own and not running to the emergency room to do it, so to speak.

Rob Oliver: Yeah, I’ve mentioned this before, but it is very difficult and problematic to me as well that in healthcare, when someone is prescribed a certain test or whether a certain piece of equipment, whatever it is that the first question that’s asked is, what kind of insurance do they have? And in that way, their medical professional, their treatment team is not the one that’s actually determining the course of treatment, but the treatment is determined by the type of insurance they have. But that’s a side note. What do you wish people understood about your role in health care?

Dana Cowles: The number one thing that would be helpful for people to understand is how multifactorial it is and that there would need to be a factor of tolerance in that we try to utilize the services as quickly as we can to be able to help people get their efficient care. And while we’re doing that, there’s a lot of different factors that are going on. So it is kind of a mental game when there are things that are going on behind the scenes. Or maybe we’re waiting for tests to come back or we’re waiting to have a phone call that we put out on an urgent basis to come back. Or maybe something terrible has just happened where you might have just run a code or pronounced somebody dead or had to facilitate some trauma or some social situation. And then you get to walk into the next room within a minute or two and you have to clear all that out of your system, start over and be able to have the new interaction. And that can make it difficult if the next person and everybody is focused on their issue, their problem. We understand that, and we want to make sure that we treat everybody the best accordingly.

Rob Oliver: This is just curiosity for my part, how do you keep yourself from getting either jaded or like you talked about the importance of relationships. And yet when you have people coming in, you’re dealing with a lot of trauma. You’re dealing with a lot of issues that if you invest heavily in the relationship, it can be emotionally draining or just wipe you out from a psychological perspective. Can you comment on how do you kind of find that balance?

My personal outlook on that is to make sure that the expectations are in the right place. It’s a skill set that emergency providers have to develop, and it’s probably one of the most difficult to develop. And if somebody asked someone who’s been doing it for a couple of weeks versus somebody that has been doing it for years, I can tell you that it doesn’t get any easier. My outlook on it is to be able to figure out what your expectations are in the interactions. One of the things that people have said to me is, oh, you save lives for a living. I really don’t. Sometimes you can’t. Sometimes it’s inappropriate. What I look at it is we provide options, and we provide options for people so that they are able to do things that they wouldn’t be able to do on their own fixes that they wouldn’t necessarily have. Otherwise. Patients are the ones that have to consent. So I will lay out information for them, and I will try to make sure that they’re fully aware of the pros and cons of every side of the situation. And then they can make their consent of what needs to happen. And sometimes you’ll tell people exactly what it is that needs to happen. They’ll tell you no, they don’t want it. I’ve had an issue recently with a veteran, and he had one leg amputated. He was very disabled, and he was living on the street, and we were able to secure him a nursing home to go to. That would facilitate a lot of care for him, help him get his daily living activities done. And he told me not only no, but absolutely no, and started yelling at me in the process. So I think if you get into the perspective of having your expectations in the right place of what you’re able to do for people, what you can offer to them, and then you have to sort of disengage after that. And that doesn’t mean you can’t get invested in some of their stories, because even when there’s the low end stories where it might be emotionally impactful, there’s also the high end stories and the high end stories. The people’s achievements are the ones that really keep you coming back every day, and especially if you can facilitate it. I remember back when I was trying to decide what to do as far as the field, I was sitting and talking to someone, a man who his wife was dying, and we talked long after my shift was over about life and death and the meaning of it all. And he came back in probably four months later for upper respiratory cold. And, you know, I was saying Hello to him and nice to see him again. And he acted like he had never seen me before. He had no idea who I was. And in that same week, this woman came up to me in the grocery store. She said, oh, Dr. Cole, it’s so great to see you. I’ve been seeing you in years. Do you remember when you ran in and you delivered my baby and you were there when my OB couldn’t be there? And we talked a little bit. But she remembered how many kids I had. She remembered exactly where I lived. She remembered everything about me. And I found that a stark contrast and then came to realize it was because I was there for one man’s darkest day of his life that he wanted to just get rid of. And he didn’t ever want to think about it again. And I was also there for another woman’s best day of her life. And she wanted to remember every detail. And so I had to ask myself, which part of that experience, human experience, do you want to be involved in on a day to day basis? And I realized I can’t get people to stop smoking, and I can’t get people to eat properly. But I can tell you’re not going to die today.

Rob Oliver: Well said, what excites you about the future of health care?

Dana Coles: I think one of the things that I saw over the last year, because the last two years obviously have been very difficult in the healthcare. But there was a massive collaboration. And I honestly believe that to fix our medical system, that’s what needs to happen. There’s no person that’s going to fix it. No doctor is going to fix it. No politician is going to fix it. It’s going to have to be a collaboration among everybody. And what I saw is again, we talked about when people put down a cigarette, or would they eat differently? But over the past two years now, people have put on masks and they’ve worked together, and they even put themselves in significant financial peril as they were isolating and locking down. They did this for the betterment of themselves and for other people. Healthcare does its part. But it can only carry so far. And the fact that everybody was able and willing to do that shows that this collaboration is absolutely possible. And one of the little known things, and I’ll give a quick plug to an unsung hero is Dr. Bruce Franklin. You might want to have him on the show. Okay. We talk about if somebody is saving lives. This is one of the guys who saved the world, and he’s a very unsung hero for doing it. One of the things that you may or may not know is we have one of the local testing sites for the vaccines. Excel Clinical research is out in the land here, and they were tasked in studying the vaccine, studying the effects and then the benefits. Now, what happens over time and people might say, well, it wasn’t very well researched. We didn’t research it for years like we used to. And the fact of the matter is that to develop a vaccine appropriately, you do a pilot study with, like, 3000 people in it, and then you do a main study with 30,000 people in it. And it takes years to get 30,000 people together to study a vaccine that’s unproven for a virus that nobody cares about, right? Nobody wants to run out and get the Zika virus vaccine. And this collaboration among people and healthcare. There was five different companies, and each of the companies got 60,000 volunteers, and they were able to process them just as quickly as they could. They were coming out of everywhere. And so Dr. Rankin is leading the Excel clinical research site, and that was able to process quite a number of these and get the vaccines out in record time.

Rob Oliver: Yes, I would definitely love to have him on the show. Last question for you, what is one thing medical professionals can start doing today to improve the quality of health care?

Dana Cowles: I think the main thing that they could do across the realm is to have the understanding for people of the challenges that are out there in regards to finances, in regards to accessibility, to care, things like that and to try to open up where we can, whether it be a small amount of off time. One of the things that I think people in general have to understand is what a scam medical insurance has been and what it was put out there. One thing that I came across somebody had told me about is like when Medicare and Social Security were set up, they set up 65 is the age to use. And the reason for that was and you can Google this what was the life expectancy of males because they didn’t care as much about the women in 1963, when they were writing the bill and the answer is right there at 66. So the idea is we collect money throughout the entire time while people are working, and then we don’t have to pay it back much because it won’t be alive for much longer. But that was a poorly skewed statistic. So anybody that is in the statistics, you need to get rid of the outliers. And if your life expectancy is calculated by just taking all the birth dates and all the death dates, well, there’s a lot of people who were dying at birth or within the first year. And if you took out for those, then people were actually living a lot longer than you think. And when I have scribes working for me, one of the things that we did was a little exercise where you look up your favorite historical figure and what age they were when they died. And the vast majority were well over 65. A lot of those things. Now the life expectancy has changed because of the development of vaccines and the fact that SIDS rates are very low now, so it’s very rare to have a child die. And so a lot of this. Social Security and Medicare were almost insolvent from the day they were started. And insurance is. Their main job is to not pay the bill. They have board meetings and strategies of how to minimize the amount that’s going out. And this collaborative effort to make things better is going to have to go beyond that as far as a financial approach. And I like your outlook on what does it take to make a patient centered approach, and that’s what’s most appropriate. That’s what we need to get back to and we have to I know it’s callous to say take finances aside from that, but it cannot be the primary motivator if we want to have anything quality.

Rob Oliver: Again, well said Dana Cowles. Thank you for joining me. I appreciate you sharing. I appreciate you giving us your perspective on healthcare.

Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.

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