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Resonance is a student-run podcast aimed at showcasing the science at Baylor through the eyes of young professionals. Each episode is written and recorded by students who have a passion for research and the medical community. Guests on the show include both clinical and basic science research faculty who are experts in their fields.

Dr. Mary Brandt tells us about her career journey, the unique challenges and rewards of treating children and adolescents, as well as her experience teaching at Baylor College of Medicine

Small but Mighty: Pediatric Surgery | Transcript

Roundtable Discussion

Brandon: We are here.

Erik: And we are here.

Erik: This is the Baylor College of Medicine Resonance Podcast. I am one of your hosts, Erik Anderson.

Brandon: I am another host, Brandon Garcia.

Jennifer: I was one of the writers for this episode, Jennifer Deger.

Erin: And I’m another writer, Erin Yang.

Erik: Yeah, and so today we’re going to be talking with Dr. Mary Brandt about some of her work with bariatric surgery in adolescents, children, as well as her experience teaching at Baylor for many years and also how she sees medical education change and many other things. And so today yeah we have Jennifer and Erin who were the writers for this episode are gonna give us a little bit of background about Dr. Brandt.

Jennifer: I think pediatric surgery is kind of unique because your patient population is so vulnerable I mean if you’re any kind of doctor you’re going to have human patients and humans themselves are vulnerable. We’re like, you know, hairless and soft and we don’t have class. We don’t have big teeth. We’re basically just like sitting ducks on this planet waiting for an alien to come and eat us alive. You know?

All: (Laughing uncomfortably).

Jennifer: No exoskeleton!

Brandon: Wow, somebody’s been watching some Sigourney Weaver movies haven’t they?

Jennifer: Yeah. But uh and that’s one of the things that drew me to medicine I think is just the vulnerability—

Brandon: Sigourney Weaver?

Jennifer: Yeah yeah, Sigourney Weaver.

Brandon: Haha, yeah okay.

Erin: I definitely agree with you. I think um just hearing Dr. Brandt talk to us during lecture when she came, she would always talk about um, these like tiny little babies that she’s like holding in her hands.

Jennifer: I know, yeah.

Erin: I mean they’re literally the size of your hand or smaller and she’s working on premature babies and babies with like, I think she focuses on anorectal malformation like when the spinal cord doesn’t develop properly, all kinds of things that she does. And it’s just crazy to see how small they are and how fragile they are.

Jennifer: Yeah ,that would be terrifying in its own way to do surgery on like a premee baby.

Erin. Yeah, yeah. But you said she also does a lot of work with like bariatric surgery too, right, with teenagers and adolescents?

Jennifer: Yeah she was actually on Oprah talking about these teenagers that she helped with their bariatric surgery. I couldn’t find the episode itself but I could find screenshots. And I know she talked about it so I don’t know what the theme was exactly. But I can imagine you know, Oprah was like “we have these teens now who had surgery, but is this a problem?” I’m sure some people would be like you shouldn’t be doing bariatric surgery to teenagers, or some controversy over it or something.

Brandon: Yeah I definitely can understand that being someone who’s been overweight their entire life. Like bariatric surgery scares me but it was something I thought about when I was a teen. It sometimes feels like an options so I’m really interested to see what her take is on that. Because bariatric surgery is life-changing, both in good and in bad ways.

Jennifer: Yeah it’s like a very, um, it kind of cures a lot of other diseases. I actually shadowed a bariatric surgeon when I was in college and all of his patients were so, so grateful to him. Like I’ve never seen patients just worship their doctors the way that they did with him because they had lost you know like, 300 pounds or something ridiculous and their diabetes had gone away, their hypertension had gone away. But he was very on them about taking their vitamins because that’s a big risk because you can get vitamin deficiency and he was like “if you lose your sight because of vitamin deficiency you won’t get it back”, so you have to be proactive and take your vitamins.

Brandon: Everyone should take their vitamins.

Everyone: Yeah.

Brandon: I do want to make one comment though, that if we’re having a guest that was on Oprah does that put us on the same level?

Jennifer: As Oprah?

Erin: I’d like to think so.

Erik: We’re about to open our own network too.

All: (Laughing).

Jennifer: You get a humpback whale!

Brandon: I was going to ask, what is my gift today?

Jennifer: You get a school!

All: (Laughing).

Brandon: You get some schooling, you get a lecture.

Jennifer: Everyone look under their seats.

Erin: Yeah one of the things that Dr. Brandt was really good about when she talked to us was always stressing wellness, you know speaking of vitamins and stuff, just making time to like take care of yourself before thinking about taking care of other people. I think she always encouraged us to have a stop point for studying and go out and exercise and gave us all these recipe ideas, like going to snap kitchen or something. I always found it such a breath of fresh air actually after talking about these crazy surgeries. Just keeping it real, you know

Jennifer: She would like stop ten minutes early and be like wait, but take care of yourself first.

Barndon: she was one of the people that um, when we started medical school last year, that really impressed me to consider the idea of getting help when I needed it which was super helpful this past year when I really was struggling and I got the courage to reach out and ask for help both from professionals and from friends and stuff like that. And I’m really grateful for the wellness course and stuff that she did because it kinda was inspiring to me to get that help that I needed.

Erik: Yeah, I know, so she’s had a big impact on all of us. We’re extremely excited to talk to her.

Erin: So just a little bit of an introduction before we have her on. She is professor of lots of different things. Lots of different departments. But she’s specialized in bariatric surgery and also her surgical focus on younger patients is on biliary atresia, anorectal malformations, gut disorders, and again, bariatric surgery. So she is a PI also, at Texas Children’s Hospital, so she’d definitely got her hand in a lots of jars doing all kinds of stuff from the TMC. And she’s an amazing lecturer at Baylor College of Medicine and we’re super lucky to be able to interact with her.

Erik: Yeah and just a quick note about her background, she did her BA at UT Austin and hook em’, if you will.

Jennifer: What do we hook? Em’.

Erik: So she got her MD at Baylor College of Medicine, did her residency in general surgery at Baylor College of Medicine, and her residency at St. Justine Hospital at the University of Montreal. So yeah we’re very excited to talk to her as Erin said and here’s our interview with Dr. Brandt.

Interview

Jennifer: Hi Dr. Brandt, thanks so much for being here!

Dr. Brandt: I’m happy to be here. Just fresh from the OR. So we were talking a minute ago about Baylor and how people who aren’t here don’t quite understand where it is. And you were saying…

Jennifer: They think Baylor University in Waco.

Dr. Brandt: Periodically when I tell people I work at Baylor, they’ll say “Oh, you guys have a great football team!”

Erin: Yikes

Dr. Brandt: No offense to Baylor in Waco.

All: (Laughing).

Jennifer: I remember when I first got here I had some trouble logging in to some online portal and I found like a tech, and online IT number, but it was for Baylor University so I was on the phone with Baylor University’s tech people for like thirty minutes before we figured out oh you’re at Baylor College of Medicine, not Baylor University.

Dr. Brandt: So you guys know the history, right, about why it’s Baylor?

Erin: They like, got divorced in like the sixties?

Dr. Brandt: Well they wanted to build a medical school And I don’t know all the political issues, I’m sure there were some, but Waco is not the ideal place to build a medical school and so they built it in Dallas. And that’s why the Baylor University Medical Center is there, that’s the other part of that, and then it migrated to Houston. So yeah we're kind of connected by name to a lot of different people.

Jennifer: We are, yeah. So you went to Baylor for medical school?

Dr. Brandt: I did, I absolutely did.

Jennifer: Do you want to tell us where did you go after that in your career journey?

Dr. Brandt: Sure so I went to the University of Texas first of all. What did you guys major in?

Erin: Biochem.

Jennifer: Neuroscience.

Dr. Brandt: I was a Plan II major.

Jennifer: Ooh okay, the real intellectuals.

Dr. Brandt: Hah! I don’t know about that, but it’s a great education and I'm a big proponent of liberal arts for people that are applying to medical school and I do think one of the interesting things about failure and it's always been true is there's a little more diversity in the backgrounds than in a lot of schools. So it wasn't a big deal that I was a liberal arts major. We had a guy that was a merchant marine that had sailed around the world eight times, we had a woman who was a PhD chemist who had worked for McDonald’s. I mean it just went on.

Jennifer: Did you do any gap years?

Dr. Brandt: I didn’t, I went straight in and then after that you know I did my surgery rotation first, and I've told a lot of people this story, to get it out of the way because I was sure I would never be a surgeon, a psychiatrist, or pathologist. And when I trained in surgery there were a lot of reasons to not want to go into a surgery residency but anyway I did my rotation first and day three I thought “Ooooh darn (that's not exactly what I thought), I think I'm supposed to do this.” And then I spent a whole lot of time in medical school trying to find anything else and didn't, so I ended up in surgery. And I stayed at Baylor to do general surgery here. That was with Michael DeBakey as the chief so that was still that era and I was the only woman in the residency for all five years and the third woman who ever finished it.

Erin: How many people were there total in the residency?

Dr. Brandt: We started with 11 in my class and ended with five. It was a pyramidal system, which doesn’t exist anymore.

Erin: Goodness. Okay, so you did residency here?

Dr. Brandt: I did and I did my pediatric surgery training in Montreal. So I speak French because my father was an exchange professor when I was in Middle School and then I went back to France for my freshman year in college to a French University and so I applied to the French speaking Hospital in Montreal because I spoke French. I didn't realize I didn't speak québécois and I also didn't know I didn't speak medical French. But I was working in the French-speaking Hospital St. Justine in Montreal as a fellow for two years. Then I came back here and I've been at Baylor ever since.

Erin: How, I guess besides everything you just talked about, how has Baylor changed since you were here as a med student versus now?

Dr. Brandt: Well I think medicine in general has changed and education and has changed in a lot of aspects. I think there's no question there's a lot more oversight of a lot of things which is good. It does add a different layer of work and I'm gonna say bureaucracy, I don't mean that sound negative, but there's a lot of checks and balances now on what gets done in medicine and in medical education. I'm not going to say it was more freeform because it was incredibly strict when I went, it was just a different kind of strict.

Jennifer: What's it like to teach at the same medical school you attended?

Dr. Brandt: Yeah so I didn't actually start teaching embryology until I'd been back here several years. But you know the first year I walked in and I'm in front of the auditorium that I used to sit in, it was pretty amazing.

Jennifer: Yes that’s really unique! So if you don't mind if we switch to talking a little bit about your specialty in pediatric surgery, what are some of the unique rewards and challenges of operating on such small patients?

Dr. Brandt: Wow. There's a spectrum of things that are really different. I think particularly in a center like Texas Children's where we were really a quaternary center so we get the rarest of the rare things that come in. So we have incredibly complex patients along with the kids in the community we're taking care of. On any given day I and my colleagues can be reconstructing a child that was born without an anus and without an esophagus and then doing a hernia and draining an abscess you know so it's this great balance of really healthy kids and really complex things. To me that reward is extraordinary, to be able to take care of people's lifetimes, instead of just their lives. And to have really long-term relationships. Most of the complex patients you end up staying with and they stay with you over years and years. I actually just had a young lady that came to clinic yesterday to find me who's going to college and she was born with biliary atresia, so without her bile ducts, and I did her original operation when she was a newborn and so I've kept up with her through the years but she and her mom made a special trip to come see me because she's going off to college.

Jennifer: Wow, that’s amazing.

Dr. Brandt: Yeah so I meant, what’s that worth? There’s not a column in the spreadsheet for that.

Jennifer: Do any of your patients want to be a surgeon like you?

Dr. Brandt: Yeah you know there's fair number that end up wanting to go into medicine but I think—I don't know if it's because of me or what they went through. I think a lot of people who will go to medical school have had childhood events where someone helped them. But I think the bigger motivation for people is just to want to help. And so, unlike going into business, which is very noble in and of itself, but the mission of medicine is very different than the mission of business. And there's just a certain group of people who choose that kind of altruistic profession. A calling, for a lot of people, that you don't see in the business world and in some other spheres.

Erik: You mentioned that there was something about surgery that kind of spoke to you when you were talking about doing your rotation in it. What was that?

Dr. Brandt: You know I still look back, you know I don't know. I mean I’ve counseled a lot of students on how to pick your specialty.

Erik: Yeah, that’s why I’m asking

All: (Laughing).

Dr. Brandt: And I think that it's rare to have that moment where you go, “Oh man this is what I'm supposed to do!” Especially when you went into it thinking, “No way!”, right? So you kind of pay more attention to it when you give that hundred and eighty degree flip. I think choosing your specialty in general—you know there's so many factors that do go into it, but I think we sometimes have a mistaken idea that you are always going to have that flash or that recognition and I saw so many students through the years that just put themselves in a corner going, “I’m making the wrong decision,” “what if it's something else,” “I needed to do one more rotation,” “I need to do this.” And I used to tell them that it's really more like dating and getting married emotionally, okay, so all of us recognize that no matter who we end up with for our significant other there's probably hundreds out there that would be just as good for the rest of our life right? So this idea that there's just “the one” is not true in who we date and who we marry and it's also not true in how we pick our specialties. So I've come to believe that, just like a good marriage, it's after you make the commitment that the work starts. And I've often said after I get to know you a little bit, because there's a little bit of a personality difference, assign you something.

Jennifer: You want to assign us?

All: (Laughing).

Dr. Brandt: And you accept it and say that's what I'm gonna do the rest of my life. What you would do is start working to master it and as you master it, you fall in love with it!

Erin: That’s actually so refreshing to hear. I feel like, I don't know about you guys, but I always hear people saying like “oh if you're like this and this, this will be good for you,” or like “if you're like this you definitely shouldn't consider this.”

Dr. Brandt: When people say that it's like okay, and I don't know if you guys are married or not, but all of us when we start dating we’re thinking about who we're gonna spend our lives with, we have a list of in mind right? Sometimes it's our parents’ lists and we're modifying it a little bit but we all have a list. And I will tell you, and you guys can correct me if I'm wrong, I have never met anyone who married the person who had everything on the list.

Jennifer: Yeah have you ever read the book The Course of Love by Alain de Botton?

Dr. Brandt: No.

Jennifer: It’s kind of about that whole concept. Society tells us we're supposed to meet a soulmate and they're gonna be perfect and we're not gonna have problems. But he talks about how it's all about compromise and being okay with being average, otherwise no one would be happy.

Dr. Brandt: Well, I don't think “okay with being average” is the right idea but I think you have to have this craftsman mentality I’ll remember the name of the book in a minute, I have a blog post about, which is this mentality that “I'm gonna take what I'm given…” You know you guide yourself into what's the most likely thing but then you're gonna take what you're given and work at it like a craftsman so that you end up becoming the best spouse or the best pathologist or whatever you know whatever it is because you're just working at it.

Erik: She pointed at me!

All: (Laughing).

Dr. Brandt: Really? You’re thinking about pathology? Cool! Listen but pathology and radiology and PMNR, which have always been sort of underappreciated, undervalued, I don’t know, in the crazy hierarchy that people make about specialties, which I do believe is crazy because I think we have to have that jigsaw puzzle all of them take care human beings, but they're about ready to explode! You know PMNR and radiology when we start doing all of the microchip technology and the incredible computing, and pathology as well, and then it's going to enter an entirely different..it's gonna be an entirely different field!

Erik: Yeah, well what you spoke about also is making me think of how you had your background in the liberal arts. I also had it in the liberal arts and I went through that sort of decision-making of like “what am I meant to do?” When deciding to get into medicine and you're right I mean it's you can maybe make yourself go crazy but you just have to make a decision at some point

Dr. Brandt: Well the other thing is you also have to realize is there are no bad choices. There are no bad choices in medicine. You are not fixing roofs in Houston in the summer. Everything you're doing is making other human beings better.

Jennifer: So I have a more technical question that actually came up in conversation yesterday with my mom. We were talking about you know like omphalocele where a baby is born with its intestines outside of its body. And with other defects also like you said if a baby's born without an esophagus and an anus. How much can you prepare for that by doing ultrasound or other imaging techniques before?

Dr. Brandt: Oh, most of our congenital anomalies can be diagnosed by ultrasound. Prenatal ultrasound or MRI. So it's very rare these days that we have sort of the surprise diagnosis

Jennifer: In what scenario would that happen—if the mother just had no prenatal care?

Dr. Brandt: Poor prenatal care, yeah. And there's a few that are a little harder to diagnose. They're just a little stealthier when it comes through the ultrasound probe. But the big heart defects, things like I'm omphalocele and gastroschisis, the abdominal wall defects, which those two are part of, those you can usually diagnose.

Jennifer: And then is everyone ready in the delivery room to just whisk the baby away to the OR?

Dr. Brandt: Well a lot of them don't get whisked.

Jennifer: Really?

Dr. Brandt: Well there’s maybe a few cardiac things that they really have to do immediately but most of the time when you're transitioning from I kind of believe I'm a fish and now I have to breathe air, right? We don't want to disrupt that thing that happens in those first 24 hours so a lot of these things we just are very deliberate about the timing. It's really only on the TV shows that you run down to the operating room with the baby in your arms.

All: (Laughing)

Erin: I was curious so you do also like bariatric surgery with adolescents?

Dr. Brandt: I started the program here, I've been doing it for 17 years, and really did it as an ethical conundrum as well. So here's kind of the long story: when this first started one of the GI doctors stopped me in the hall and said “Mary you need to learn to do bariatric surgery”. And I responded to him in a way that I can't really repeat on a podcast but the bottom line was you're crazy! And then I started meeting these 500-pound kids that couldn't go to school and were pre-diabetic and having heart failure and just socially miserable and psychologically miserable And you have to start weighing the pros and cons of a big life-changing operation. So I became part of a NIH-funded study with Tom Inge who was at Cincinnati then and is at Denver now, was the head of it. But there were five of us that banded together and these programs started enrolling patients that the NIH paid for us to follow. I think we're now in year 12 and we’re already paid through year 15 for the long-term outcome. Because we didn't completely understand the risks that could happen we assumed that in teenagers it was going to be close to adults, but teenagers are a really special group of human beings, particularly psychologically, but also physiologically. And so we've been able to show that it is safe, that there is a subset of young people that benefit from having this operation early because it has a better chance of reversing the things that have happened like high blood pressure and diabetes and all that, than if you wait till they're adults. And we’re have two New England journal publications out of this and the second one which just came out a month or so ago was the one that really talked about that. So I think it’s such an interesting part of medicine. Bariatric surgery has kind of these two components. There's a part of it that is a little bit like plastic surgery, that is about the way people look. And people paying to look a different way, which is foreign to me I have to be honest. I'm an academic surgeon and I'm a sort of metabolic surgeon so that's not the way I think. But I know it's there. And then there's the other group that really is trying to figure out, so what is causing this obesity epidemic? And what do we do with the really sick patients that need some intervention? And I don't believe and I don't think anyone believes that bariatric surgery is the solution. And I would just assume we figure out socially how to deal with the obesity epidemic that didn't exist thirty years ago, and put bariatric surgeon is almost out of business because it doesn't make sense that in a society where we've gotten this level of obesity, that we’re treating it with surgery. So I certainly feel for myself I have an ethical obligation to also focus on food and nutrition for children and all of the things to do the right thing for their nutrition and prevent the obesity and so I've been very active doing that too.

Erin: Yeah don’t you do the CHEF class?

Dr. Brandt: Yeah so when I was Dean of Student Affairs that was started by a group of students and I was super happy to sponsor it. It's been it's been a real success, it's still ongoing. And actually I'm the faculty advisor for it now.

Jennifer: So I was going to ask—you mentioned it a little bit with the NIH study—does bariatric surgery help the kids long-term and what what's the longest you've followed a patient?

Dr. Brandt: So we’re in twelve years right now, you know if you look at sort of history of the epidemic and the history of the surgery you know it's been interesting. So the lap-band which was the billboard surgery right? Made a lot of money for a lot of people. I predicted when it first came out that it wasn't gonna work because putting a rigid device around the top of the stomach was gonna cause a blockage for the esophagus and cause problems, and guess what? So now nobody's doing bands anymore at all. The bypass has been done, the gastric bypass, for about I think 35 or 40 years, there's probably good data in adults. And we can maybe extrapolate that to adolescence with just some tweaks. The other really big operation that's out there—the gastric sleeve—has only been happening for less than ten years. So we don't know even in adults what happens. And I have some qualms about it just physiologically so it'll be interesting to see what happens what time, whether that pans out to be as effective as the bypass without some major complications.

Jennifer: Right, yeah. I shadowed an adult bariatric surgeon one time and he told me a lot of his patients you know they'll lose the weight very rapidly. They'll lose 300 pounds in like a year but then over time they slowly start to gain it back because they learn how to overeat basically in a way that doesn't overfill their stomach.

Dr. Brandt: Yeah the way the way we set up our program, our kids come in for or came in for about nine months to a year with us, meeting with a psychologist and dietician every month. Because we had to teach them how to eat healthier because these were kids, I mean I still remember having a family that brought a kid into me and I was talking about healthy eating because it was a four year old or something that was really overweight. And the mom said well we eat fruit, he eats Cheetos. And she thought because Cheetos were orange it was a fruit. And there is no parent who wants to do harm to a child. Sometimes it's just an issue of education and an issue of education in our schools for kids that we've been missing out on.

Jennifer: So you appeared on Oprah, we have to ask. What was that like?

Dr. Brandt: Oh you know it was so interesting. She was interviewing three people who had had bariatric surgery as teenagers and I just was along for the ride kind of in there as a possible expert. At one point, I can't remember who was saying what, but it was so outrageous and there were some people from TCH and some of my people that were with me and they started elbowing me like “You’ve got  to say something!” so I did. It was quite an experience it was you know people have said jokingly but maybe not so much in the past when she had this show that there were two ways to change medicine the United States: one was with a New England Journal article and the other was by going on Oprah.

Erin: Did you get to meet her in person?

Dr. Brandt: Just briefly at the end, I got a picture with her.

Jennifer: Did you meet Dr. Oz?

Dr. Brandt: He was in the audience.

Erin: So I wanted to ask more about your talking about being the only female resident in your program. Even now I think surgery is pretty male dominated. Can you comment on how that’s changed or how you feel about that or what it’s been like to be in a male-dominated field?

Dr. Brandt: Well I think Baylor has done a really good job of becoming much more diverse—gender diverse and ethnically diverse in our surgery program. And I think you can tell the difference in how the residents are treated and how they treat each other. I hope socially there's been a change. I'm very worried right now that we're backsliding in the United States on a lot of issues of equality and diversity. And I think it's really very important for those who are in medicine to speak up about that. I certainly use Twitter a lot as a platform. We all hear all this negativity about social media but especially if you get to be a senior person who has a voice and has a reputation and a standing, I almost view it as important for me to speak out. And I encourage people to speak out. I think we've got to all band together to keep from backsliding. And keep it moving forward.

Jennifer: Any advice for female medical students who are thinking about going into surgery?

Dr. Brandt: No different than any other field, I mean honestly I think you know we have issues across the board in our country with pockets of people who express or believe one of the “-isms”. And sometimes I really think they don't see it and I also just did a blog post recently on social location. It's a very important kinds of that we don't talk about very much. But every one of us has a social location. So it's your gender, it's your race, it's your educational background, it's whether you're able or disabled, it's whether you're cis-gendered or not, it's whether you're gay or straight, all of those things make up your social location. And in the United States, in what is a constructed reality, so this isn't saying that this is true—but there's a hierarchy of social location. And in social location in the United States hierarchically at the top is: white, male, cis-gendered, straight, Christian. And here's the thing if you're in those groups you literally can't see the other ones. So my favorite story about this is David Foster Wallace's commencement address called “This is Water.” I don’t know if you guys have ever read it or seen it, you really have to. But in it he tells this little parable of these two young fish that are swimming along and the old fish is coming toward them and swims by them and goes “hey boys how's the water?” and they swim on a little bit and one of them finally says “what's water?” because in the United States if you're in one of the dominant social locations, it’s water right? You don't have a desire to be a sexist if you're male or be a racist if you're white, some people do want but that's a totally different thing. But most the time it's inadvertent because it's the water. And until someone points it out to you, you can't see it. So I think part of our job is to keep pointing it out, you know “did you realize the way I interpreted that?” Or “I heard you say this, did you really mean that?” I talk to men all the time and you know I have several colleagues who are Latinx and if a Latina walks into Grand Rounds she is always aware that she is of Latin descent and she's a woman. If a white guy walks into Grand Rounds that thought’s never in their head, right? So I think we just need to keep talking about it and so my advice to all women going in or anyone who's not in the super dominant social location, is most of the time people are not doing this intentionally. But there are -isms. And so it's our job to call them out when they happen. And if you are able, if you're one of the people that is in a senior level that, you know I feel very strongly as a white senior person at Baylor, if I see any discrimination towards a student of color, it is my job call it out because it should not be the students of color who are having to raise the issue themselves. It should be me and my colleagues so I think that's real important too.

Jennifer: How do you see medical education changing in the next, say 20 to 25 years? And medicine, as well.

Dr. Brandt: Oh my gosh!

Jennifer: It’s a very broad question. This was actually suggested by Dr. Poythress, so thanks Dr. Poythress. He wanted us to ask you that.

Dr. Brandt: (Laughing). Oh, he and I should go out for a cup of coffee. So I think we're in a very big transition right now in the United States more than other countries, where we're gonna have to make some decisions about the business of medicine versus the calling of medicine. And that transition that we're in right now is a hard one. And I think there's potential repercussions if we make the wrong choices as to who's gonna want to go into medicine, who's gonna stay in medicine, what's gonna happen with our burnout rates which are sky-high. I am believing more and more that burnout is not about doing more yoga and eating right. It almost is a moral distress of being in an environment where as a physician who is called to this profession you want to do what's right for your patients. And the institutions we work in absolutely believe that too but there's just different ways of looking at it that sometimes are in conflict. And I think particularly if you look in the private sector in smaller communities, we have a huge number of young adults who are uninsured or underinsured, who are not seeking medical care. And if you're the physician when they walk into your office and you know you can make them better but you can't find a way financially to do it, that creates moral distress. And when that happens over and over and over again I think that's one of the things we need to talk about in terms of burnout.

Erik: We hear about burnout all the time now, do you think burnout was around 30, 40 years ago and it wasn’t talked about as much or do you think fundamentally something, maybe the presence of insurance companies more and more in your daily like prescribing and everything has affected it?

Dr. Brandt: I think there were always some people. I do not think what we have now existed then. I don't. A lot of it was, physicians had much more agency and autonomy. We were much less likely to be part of big, big organizations. And there's something in there, I haven't even sorted out myself, so I don't want that to be misinterpreted, but how medicine is practiced on a day to day basis by physicians has changed. And part of that change I think has definitely contributed to burnout.

Jennifer: Do you think technology at all has played a role in it?

Dr. Brandt. Oh you're gonna get me in the EMR. So if you're on Twitter you have to follow EMR, you have to check out Epic Parody. So when we talk about the electronic medical record which has contributed to burn out—the data is really clear right—we have to remember that it's not in its infancy but we are still very early in the evolution of this EMR. We went from like 12% to 80% of physicians on EMR ten years ago. And that’s when Obama passed the legislation that allowed for the money to be used for, you know that whole thing—I can’t remember the name of the act but I should, there was a sudden burst right. And so we went to the blue screen of dos, which you guys don't even know what that is, but basically if you imagine the very first computers and the interface is off, but it just kept evolving and the latest rendition we have of epic here is much more user-friendly and much better. But there's still a huge burden of clerical work now that physicians are having to do that was not true previously. And that has to be looked at because it's kind of a waste of a lot of education if there's things—that could be offloaded to people who need the jobs and have the skills—but they’re keeping physicians from doing what they're actually trained to do and seeing patients.

Jennifer: I remember that movie Code Black, it was a documentary showing an emergency room in LA, I think the big LA hospital that sees more car accidents than anywhere in the world. But they were showing this waiting room full of people who are super sick, like throwing up into bags, and the physicians are just like having to fill out all this paperwork. It was ridiculous and they were like “oh I got to finish this before I see my next patient.” Like you said a waste of a lot of education.

Dr. Brandt: Well I think you know, big changes that happen this fast create unintended consequences and I think that's where we are is trying to figure out what those unintended consequences are and how to deal with them.

Jennifer: Well if y'all don't have any questions I have one last question for you: why is there no fifth for pharyngeal arch, or is there?

Dr. Brandt: (Laughing). There was in fishes!

Jennifer: There was in fish, fishes.

Dr. Brandt: Yeah, so we have, I don’t know. I don’t know.

All: (Laughing)

Erin: Don’t know where it went.

Dr. Brandt: There's a lot of symmetry that gets to asymmetry as things get developed. That  could be a new t-shirt.

Jennifer: “What happened to the fifth pharyngeal arch?” Well thank you so much for your time, you can go back to saving the world.

Erin: We won’t keep you any longer.

Dr. Brandt: Alright well thanks the opportunity to talk to you guys.

Jennifer: Yeah, of course.

Outro

Brandon: All right, that is it for now, we would like to thank everyone who took the time to listen to this episode of the podcast. Special thanks to Karl for writing the episode. Thank you to our faculty advisor Dr. Poythress for helping us put everything together. Thank you to the Baylor communications department for help with the production and website and thank you again to Drs. Pillow and Agrawal for taking the time to be interviewed by us. We hope everyone enjoyed it and hope you tune in again soon. Goodbye for now.