in this episode we hear a neonatologist’s perspective on healthcare from Susan Landers. Susan has been serving patients and their families for many years in Austin, Texas. A member of the baby Boomer generation, she is an author, speaker and physician.
Here are 3 things that stood out as Susan Landers shared a neonatologist’s perspective on healthcare on this episode of the Perspectives on Healthcare with Rob Oliver:
· Only 10% of births are premature in any way and not all premature babies get sick
· Babies born before 28 weeks gestation face more complications
· Every single medical procedure carries a certain amount of risk
· BONUS 1: We need to take care of our healthcare workers! (Mental health included.)
· BONUS 2: Medical professionals need to be able to talk about their negative feelings
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Here is the transcript of Susan Landers: A Neonatologist’s Perspective on Healthcare
Rob Oliver: Thank you. And I appreciate you being with me today. My guest today joins us from Austin, Texas. Her name is Susan Landers. She is a neonatologist. She is an attending physician as well as an author and a speaker. She is a member of the Baby Boomer Generation. And Susan, welcome to the show.
Susan Landers: Oh, thank you, Rob. It’s a pleasure to be here. I had a wonderful career in neonatology. I practiced medicine in the NICU, the neonatal intensive care unit. For over 34 years. I took care of small premature babies, full term babies who got sick babies who were born with birth defects. It was a very rewarding career, and I loved working with the families.
Rob Oliver: So I will just let you know. First of all, you’ve already answered my first question in some way, but the NICU is near and dear to my heart. I am the father of 19 year old triplets who spent a week and a half in the NICU after they were born. And so there’s a soft spot in my heart there for any of the folks that work in that particular unit, just from my personal experience, how much of that is a good news situation and how much of that are you sharing bad news with family?
Susan Landers: Well, the good news is that 90% of births produce normal newborn term babies. It’s only 10% of births where there is a pre term baby. Of course, that rate is higher if mom has twins or triplets because of infertility or reproductive assistive techniques, premature babies don’t all get sick. Some of them are big and strong, and they’re just really loud and breathing. They don’t need a ventilator, but they do need a week or two in the NICU. Some are very sick. Some babies are born all as five and 600 grams at 22 and 23 weeks gestation and they stay in the hospital for five, six months or longer. The majority of premature babies that are more than 28 weeks just survive. Most thrive and go on to be perfectly normal children. It’s only under 28 weeks gestation and in babies who have major complications in which we see poor outcomes, higher mortality rates. The tiniest babies, those born at 22, 23, 24 weeks are the ones who tend to survive less often older, so to speak, gestational age counterparts. So it’s not all bad news. It really depends a lot on the reason the baby was born prematurely, how sick they were when they were born. The birth defect, whether or not it can be fixed surgically, whether or not it just needs medical management. There are just lots of factors that contribute, but it’s not a field. You can do without having some heartbreak along the way. We do have some cases that don’t go well, and we lose some babies, and we’re still struggling with the technology for those smallest, premature babies.
Rob Oliver: I would imagine that there is, in some ways it’s a bit of a roller coaster, that there are some very joyful moments, and there are some very painful moments as well. What does quality health care mean to you?
Susan Landers: Quality health care means to me therapy starts appropriately, it’s effective, it produces good results, and no mistakes are made in the giving of that therapy. Whether it’s starting a baby on a ventilator, whether it’s starting an IV antibiotic, whether it’s putting in a central line for nutrition, for a tiny premium, everything we do has risk, and everything we do needs to be done in a certain way. So quality health care means that the things we do are done correctly, timely and effectively. Now, having said that, things still go wrong from time to time. And so we do see complications. A good example of that is the use of vacuum extractors or forceps to assist vaginal deliveries. There’s a way to do those things correctly, to do those procedures. And you can talk with an obstetrician about that. And those procedures can be life saving when an obstetrician has to get a baby delivered in a timely manner. But both of those procedures have low risk of complications attendant with them. Quality health care minimizes potential for complications, and it maximizes therapeutic benefit.
Rob Oliver: Okay. So what I’m hearing you say is that no matter what the procedure is, there is a risk that goes with it, that it’s inherent in the procedure. But sometimes things just don’t go right. Not because of medical error, not because of poor technique, but because there is just we’re dealing with humans. Exactly. We’re not machines. And there are sometimes things that happen outside of our control.
Susan Landers: Right. We put in tiny little pic lines percutaneous Ivy lines that track up the baby’s arm. And we do that for a reason to lower the risk of infection. And they go through a small vein and the veins get bigger and they just enter the heart. And sometimes that catheter punctures the heart covering. Sometimes that catheter punctures the lung, and it’s very rare. And even if the procedure is done perfectly, those two major complications can occur. The
Rob Oliver: Got it. You already did this. But I’ll ask anyway, can you give me an example of quality health care?
Susan Landers: Quality health care is when a mother who is a gestational diabetic who has taken very good care of herself during her pregnancy, she’s monitored her glucose and she’s watched her diet, and she’s taken her insulin and her labs look good, and she comes in for a delivery, and her baby is normal. But her baby might have some low blood sugars. The health care system screens her baby, who is at higher risk for low blood sugars, make sure the baby is fed early, continues to screen. And if feeding doesn’t do the trick, the baby gets an IV, and all of that happens in a timely manner. The mother was informed long before delivery about the risk of having a baby with low blood sugar and the blood sugar responds to therapy and allowed to breastfeed her baby and mom and baby are joined back together, rooming in on the second or third day of life, and they get to go home together on the fourth or fifth day. That’s quality health care. Some people would say, oh, my God, that’s terrible. That’s separating mom and baby. But when you know that problems may occur with a diabetic mother or with a mom who’s pregnant with triplets, and you talk to the patient ahead of time about what to expect. Then when those things and we’re ready to take care of them, we’re ready for pre term triplets, for example. And the care goes smoothly. That’s quality health care.
Rob Oliver: Got it. What do you wish people understood about your role in health care?
Susan Landers: I wish people understood that my role in health care is to explain to parents what is happening with their baby, help them to understand what their baby is capable of, what their child is going to go through, and they will go through and that they understand that we have things to support their child. Modern parents are very anxious about outcomes and want to know how things are going to go and be going to be normal. And what if that and my role as a neonatologist and I’m basically a pediatrician, even though I’m in the ICU is to explain things to parents, to actually explain to them how the treatments work and what risks there are with putting a baby on a ventilator or putting a central line and a baby or putting a baby on ECHMO. I think the Nanatologist is a straight shooter who helps the parents deal with what they’re going through. And I always thought that my role as an intensive care doctor was not totally taking care of the baby, but it was also attending to the parents.
Rob Oliver: That is such an interesting thing that you say. And let me just say this that we went through IVF, and they told us all of the statistics, right? They gave us the likelihood that we would be able to have a child. Then there was the likelihood of twins and the likelihood of triplets and quadruplets. And so on. And I will say that I heard there’s a possibility that you can have a child, and after that, everything kind of stopped. Okay.
Susan Landers: Right. It goes in one ear and out the other.
Rob Oliver: And I’m wondering, do you have that same experience when it comes to parents who have a child who needs some form of therapy and you say we’re going to give them this therapy? It is likely to help them. But there is a risk involved. I’m assuming that it’s very similar that they hear it might help them and the risk they don’t hear.
Susan Landers: Yes. We always want to focus on the possibility, and everyone wants their child to be the exception that will improve and respond to therapy. Human beings can only tolerate so much stress and having a set of triplets and having a sick, premature baby or a baby with a birth defect is extremely overwhelming. And so we are used to telling parents things many times over and answering questions that we answered four days before because you can’t get it all. I like parents to write things down, and if they go home and look things up, I like them to write down their questions and come back. And then the next day we talk about it. So it is a process by which you have to let that the stress and the feeling of overwhelmed die down a little, and then they open up to get more information. That’s true of any family who has a patient in the ICU or in the hospital anywhere. We only hear initially. Oh, my God. We hope they’re going to get better and they’re doing something to help them get better. We don’t hear the outcome. We’re not ready for it. We can’t handle it emotionally.
Rob Oliver: Yeah. And I will say that as a parent, when things happen to my kids, I’d rather be sick for a week than have my kids sick for a day or even just a couple of hours. That kind of thing. So what you said earlier about taking care of the parents being part of the job of caring for the new infants is very telling and very interesting. What excites you about the future of health care?
Susan Landers I’m excited that the future of health care has not been tarnished by the Codet pandemic. We still have lots of kids premed applying to Med schools. We still have lots of young people wanting to go into nursing. That being said, I am really worried about burnout in health care. I am really worried about physicians and nurses and respiratory therapists and others who have been through the wringer with this pandemic. If we do not start talking about mental wellness for health care providers, we will lose our doctors lose our nurses. We’re already losing nurses. They leave, they quit or they go work for a traveling nurse agency. We have to take care of our caregivers. They’re so stressed right now that they cannot do more than they’re already doing. And when we finally figure out in health care that mental wellness for the caregiver is crucial, health care will really be capable of thriving for the long term. So I’m really big on a champion of wellness and every practice and every hospital service surveys of givers to see how they’re doing, talking together, peer support counseling, if necessary, paid leave if people are burned out, time off to figure out what’s going on. If we don’t do those things, our best workers, our most compassionate people, experienced doctors and nurses will continue to drop out of the system. And then we’ll have nothing but young, inexperienced doctors and nurses. Not that that’s bad, but they’re less experienced. And so I don’t want that to continue. As this pandemic rolls along.
Rob Oliver: I had Justin Ayers on who started Equalitymd. Com, which services the LGBTQ community. And Interestingly enough, they’re doing education for medical professionals and the area that they decided to start with was mental health, because in a survey, 70% of the community said mental health is their biggest concern. And I think that’s not particular to that community. Mental health is something that it’s really affecting all of us, especially the way it’s been exacerbated by COVID. Right. What is one thing medical professionals can start doing today to improve the quality of health care?
Susan Landers: They can talk to each other when something bad happens, they can go, oh, my God, that really sucks. Let’s talk about that. Let’s sit down as a team and dissect it. They can prop each other up. They can go to the guy next to him or the girl that’s crying, and they can say, look, that was a really bad case. It’s okay to be sad. It’s hard to your patient die. They can talk. They have to talk to each other. And hospital administrators are going to have to listen when doctors and nurses talk, whether it’s peer support, whether it’s psychotherapy, whether it’s a social worker on the unit, they’ve got to talk about what they’re seeing and what they’re feeling. And if they don’t, we won’t be able to get better. So that’s my wish that we would learn how to make it okay to talk about our bad feelings.
Rob Oliver: So let me just see. Did I hear you suggest that the social worker can be a support, not just for the patients, but for the staff as well. Is that what you said?
Susan Landers: Absolutely. The perinatal social worker in the NICU propped me up some days. If she saw that I was sad about a baby doing poorly, she wasn’t just propping up the parents who had their family and their chaplain there she was propping me up and getting me to talk about my feelings. And so maybe it’s a long career with a lot of experience. But if we do not talk about our feelings in health care and how we’re having compassion, fatigue or how we’re mad at antivaxxers or whatever it is we’re feeling. If we don’t talk about those things and we stuff them down, we won’t get better. We’ll all get sicker.
Rob Oliver: I think my analogy on that is it’s kind of like the Red Sea, the Dead Sea, where there’s no outlet for it. So all of the toxicity flows in. And if there’s no outlet for the toxicity, you end up with a place that can no longer sustain life and that would be a huge concern, especially in an industry where people are providing such important care. Listen, Susan, you’ve been fantastic. I appreciate you being on the show and thank you for sharing 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.