The Interview with Dr. Ken Milne
Bat Doc, ER Doc, Educational Visionary and Humanitarian
The Creator & Host of the Skeptics' Guide to Emergency Medicine Podcast-SGEM.
Batdoc video on the Flushot: Well worth watching: https://www.youtube.com/watch?v=x6If9fatNms
The link to The Skeptics Guide to Emergency Medicine: http://thesgem.com
To Contact Ken: sgem@gmail.com
Dr. Ken Milne, who has been honoured with many accolades for his contribution to medical education and helping doctors provide the best evidence care, recently he received:
Judith E. Tintinalli Award for Outstanding Contribution in Education (2019) from The American College of Emergency Physicians (ACEP) (remember he's a Canadian Physician)
&
The FOAMed Excellence in Education Award by the Society for Academic Emergency Medicine (SAEM).
On a Personal Note:
On the day I interviewed Ken, his family was trying to get a hold of his younger brother and he felt something was wrong. They were in a period where they were waiting for information on his whereabouts as he wasn't answering his phone. Tragically, his younger brother (age 45) had died from a stroke. When Ken called me later to tell me this, he wanted to let me know if he was not present or attentive in any way during the interview, he was sorry. I told him I would have gladly rescheduled the interview. He said I made a commitment to you and I wanted to honour that. "Wow, that's commitment at a whole new level" I thought. He said they were in a state of waiting and his wife also suggested that doing the interview would get his mind off of the search.
I have to tell you, he was a gracious host as he had welcomed me and Cameron, (my friendly Cameraman), into his home. Ken is always looking at how can he make people's lives better. He's been a real advocate to help physicians and has made many contributions in that way. I know that he also contributes to many charity events and causes, but you'll never hear him boasting about that.
I must say, I was saddened to hear the loss of his younger brother Scott Milne, who is a national Canadian Bodybuilding Champion. He's huge! He's bigger than Arnold Schwarzenegger. (you can google him and see for yourself). I never met him, but you can tell he is indeed a gentle giant. Please enjoy the lessons and kindness of Ken Milne.
Lalit Chawla
The Interview
This interview was dictated to close as possible to the actual conversation, however, there may be errors in the dictated process. Capturing the intentions and emotions through words to reflect the conversation can be incomplete).
In this sit down interview, we cover a few keys areas:
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Why Ken had to leave his Orthopedic Residency
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How SGEM podcast came to be and it has 40,000 + subscribers; and why I love it
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How EMR (Electronic Medical Records is burning physicians) and the many thoughts around that.
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The Vaccination Debate and how eloquently and humorously Ken handles this
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How Bat Doc came to be
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The Disparities for women physicians
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Surprising studies about women's health that used men as subjects?!
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What his favourite three books are
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Why he is a nerd (the coolest nerd I've ever met)
Lalit:
Ken, I want to thank you for having me here and taking the time out to do the interview. I want to talk about all the contributions and success that you've had. And especially the contributions you've made to all the ER physician -so many ER physicians in the world, but you just about didn't become an ER physician? You just about died in your orthopedic residency. Can we talk about that?
Ken:
Oh, absolutely. We can talk about that. I was dying to be an orthopedic surgeon. I mean I was ready to live and die to be an orthopedic surgeon, but I want to thank you for coming to the bat cave here and doing the interview.
I really didn't sort of clue in that it was going to be videotaped. So I would like to apologize to anybody who's watching this. I worked the long week up in Northern Ontario, got back off the plane to do this and I haven't had time to shave; but I do love C.A.P.E, which is the Canadian Association of Emergency Physicians. So I've got my C.A.P.E tee shirt on, I haven't shaved, so I apologize. All those people who are just listening, you can just fast forward through that part. But I'd be happy to talk to you about my orthopedic experience because that's what I wanted to do. I wanted to be what's called a pedia-pod, a pediatric orthopedic surgeon. That was my career trajectory. Unfortunately, as you know, life can be strange sometimes and my strangeness was I became very sensitive. And what I mean by sensitive is I became anaphylactic to latex; which sort of has a little bit of challenge when you're trying to be an orthopedic surgeon. And so I experienced a few, anaphylactic reactions. And because of that, I had to transfer to something else. And so I transferred into family medicine.
Lalit:
And that's good for us. And you do a lot of emergency room work too.
Ken:
Yeah, I transferred to family medicine. I, completed my C.C.F.P (Certification in the College of Family Physicians) and then went off and became a rural family physician, which I'm very proud of. My traditional training and background and spent the first four or five years of my career in family practice; but as part of that rural family practice, as you may know, we do emergency medicine in the small towns and communities. And I found that I really enjoyed the emergency medicine aspect and I went back and was able to challenge the emergency medicine exam and get that certification or that designation, to C.C.F.P E.M at the time. And since then I've been doing primarily emergency medicine for the last 20 years.
Lalit:
And one of your best contributions and the reason you've been acknowledged, for some of the awards that you've won is your podcast on The Skeptics Guides to Emergency Medicine (SGEM). And you have about 40,000 plus subscribers.
Ken:
Well, you might call them subscribers. I go, people get a life, Oh my goodness. 40,000 people listening to me. It just seems a bit surreal, but I guess I've connected with the audience in some way.
Lalit:
Yeah. How did that come about? How did you get that? What made you think about doing this podcast?
Ken:
Frustration
Lalit:
Yeah. In what?
Ken: Knowledge translation. So I was working with an outstanding group called the best evidence in emergency medicine group (BEEM). They're out of McMaster. And my mentor there was Dr. Andrew Worster. He had this critical appraisal group that he had put together as a knowledge translation project and they would do the most outstanding, and they still do, the most outstanding critical appraisals of recent publications in emergency medicine. And they would host these conferences.
And they did one in a ski resort and one in a beach resort. So they had Sun BEEM, they had Ski BEEM and they would deliver this really amazing high-quality critical appraisal. But only about, 50 to a hundred people could afford to take off time, go to the resort and attend the course. And this was in the about 2010-ish when this was sort of percolating, and podcasts were becoming more and more a popular medium. And I thought, 'well, wait a minute if everybody can't come and consume this amazing information, what if we actually podcasted it out to them and they could consume it on their time. They could turn their car into a classroom and listen to a 20 minute podcast on a critical appraisal when they're on their way to work when they're in the gym?' And that sort of how it all came to "aha" (moment).
Lalit:
Well, that's what I love about your podcast because it takes the best evidence and you critique what is the best way to look at medical information, whether it's an ultrasound at the bedside or whatever it is. And because there's so much information out there, you know, right? One of the biggest things is the anti-vaccination campaign where people have misinformation about not vaccinating their children, - measles is coming back. Uh, all that kind of thing. So that podcast looks at best evidence- you ask many key questions, is it randomized controlled trial etc? And I love that about that podcast is because with so much information out there, because it can be a challenge to find out what is good,
Ken:
Right it is. And you know, the best evidence sometimes isn't very good evidence, right? So what we look for is the highest quality information to inform our care. And then we do a structured critical appraisal of a recent publication in a standardized way to probe the literature for its validity. But we do it in a fun way, I think an Uber nerdy way. I try to, I'm not saying I can, but I try to sing the introduction because I choose 80s theme music, usually for the introduction to each podcast. People think I pick the music first. I don't.
Lalit:
Well, that's what makes it fun. You know, for people who may not know, about the Batdoc where you wear the mask and you're [inaudible]
Ken:
Did you just out me? Did you just out me? Did you just give away my secret? He has no idea who I am. Yes, I am bat doc on. Yeah. And,
Lalit:
Well, I love the one...my favourite one is the bat doc talking about the flu shot. I mean that's just a fun way to demystify and de-myth some of the myths that are around flu shots
Ken:
Well, there's a great story behind that. I'm chief of staff at my hospital and that's South Huron Hospital, the little hospital that does. And they challenged me as the Chief of staff to come up with a, somehow, to increase our immunization rate against influenza. And you know, some places we're talking about making things mandatory. And I thought that was a little heavy-handed. And they gave me the typical administrative budget to do this, a nice round number. That's right. $0 million. And at the same time when they were challenging me to increase our staff immunization rate. A person had come out with Bat Dad and Bat Dad would put on a Batman mask and talk to his family and make these little short videos and he would talk like Christian Bale. And so I thought, Oh I could do that. Put on a mask, because there's things you can do with a mask on that you can't do with a mask off.
Ken:
Put the mask on and talk like Christian Bale and demystify or talk about some of the myths of the flu shot. And when I did that and we just made these little videos. we combine them together with a software program, made it look very comic bookish, put it out there, spread through social media, through our hospitals, nurses, physicians, all the other staff.
And our immunization rate went well above 90% just because it was fun. It was engaging, it was entertaining. And it, you know, I don't like confrontation. And so, to try to force someone to have a flu shot, I want them to have the flu shot. I want them too because I want them to be healthy. They want to be healthy, but they're concerned and they're hesitant. And so, I don't like to confront them and say, "thou shalt have a flu shot." I'd rather talk to them in an engaging way that isn't threatening that they go, "I want to have a flu shot." I was misinformed. So, I kind of, I steer away from the anti-vaccine sort of label more to the hesitant or concerned because when it comes to parents and their children, I'm sure they love their children too and want the best for their children. So do I, and we can meet in the middle somehow to find some common ground so they can be more informed about it.
I pick the paper first and then I turn to that large cannon of wonderful music from the 1980s and just because I can't sing doesn't mean I won't sing. And I think that even makes it better because if I was a really good singer, okay, it would be good if I was like somebody who thought I could sing, it would be really bad. But I'm not someone who thinks I can sing it all. I can't sing. And so I just put myself out there very vulnerable and I try to sing the intro to the song, to the podcast. It reminds me of Marshall McLuhan's famous quote, "anyone who tries to make a distinction between education and entertainment doesn't know the first thing about either." And so I'm trying to combine, you know, the education, the entertainment into a very consumable, product that people can have and learn from.
Lalit:
Yeah. It's such a fun way. And I like when some of the staff gets startled in the video
Ken:
Oh, that's Joy. That's my favourite- "Joy, wash your hands for disease." Yeah, she didn't know I was going to do that, but I caught her off guard. Yeah, it was great. It was a great moment. That wasn't it? Yeah. Great. Spontaneous moment.
Lalit:
Well, you know, that's the thing. Know that's probably the best way to say it because it's not that they're against it, but they're hesitant, Because I've heard so many people say, I heard you get the flu if you get it (the flu shot).
Ken:
Sure. They're anxious, they're concerned. And I'm there as a resource. I work for the patient. And in this case, it was the staff. I wasn't their physician, but I look at it as I work for them, right. And they're an expert in their own body. I'm an expert at the medicine and we should talk about it and I can be their expert, they can consult me, but I need to consult them because they're the expert at them and we all want them to be healthy and well. So we have the same goal.
Lalit:
Well, I'll put a little link in the show notes to that video cause it's, it's a blast. Now, I heard you speak at the physician wellness, conference there. You were the keynote there and one of the things you really conveyed exceptionally well was, and it's a growing concern, is about physician burnout and the consequences of that. Do you have some statistics on that.
Ken:
Well, the statistics keep changing, but unfortunately, they're going in the wrong direction. When they were talking about burnout and some of the numbers that I was talking about of burnout at that conference was from a survey of American physicians. But I think we can generalize it to some extent. It was different specialties and saying that using the Maslach Burnout Inventory, TM there were a majority of physicians; so more than 50% of physicians were expressing some symptoms of burnout. and at the highest level was emergency physicians and I believe it was north of 70% were expressing signs of burnout.
Lalit:
Yeah. And I know one of the things, with you being a family physician, and I've known I've talked about with colleagues, and it's well documented, is how E.M.R (Electronic Medical Record) plays a role in that. And E.M.R was a great panacea that was supposed to make our lives better. In some ways it has, but that is also affecting us and is the big cause of burnout.
Ken:
Yeah. When they survey physicians and say, you know, what are the causes? What's contributing? What would you put as number one? By enlarge, the E.M.R and the struggles that we have interacting or interfacing with an E.M.R and how it gets in the way of the, you know, the therapeutic alliance, they put that down as "this is really sucking the joy out of practicing medicine."
Lalit:
Well, there's so much data entry. I mean I feel like I'm not doing medicine .
Ken:
They've done studies where they've looked at how much time the physician stares at the computer screen and it's less or sorry. And it's more than how much they actually look at the patient and look at the patient's eyes and, and, and have that kind of interaction with the, and so if you're sitting in the room as the patient who, who do you think is more important in the room? Is it the patient or is it that computer screen the physician spending all the time interacting with and so yeah, it's really made us into expensive data entry clerks.
Lalit:
Yeah, that's a good way to put it. We are expensive,
Ken:
expensive data entry clerks and because there are people that can type faster than I can, and they can navigate through these complex (pathways).They were set up I believe as billing systems and to capture data and not necessarily enhance the patient experience or the therapeutic experience.
Lalit:
I've worked on a few different E.M.R. I just don't think they've developed a real good one and it just, it takes the joy out.
Ken:
It does. It's a tool, right? And it's how you use the tool and if the tools implemented without the end user being intimately involved in setting up then you're going to have frustration, difficulties and ultimately failures of implementation. And they've shown, that certainly in the emergency department, when you implement something like this, productivity goes down. In other words, the throughput goes down and the number of people that leave without being seen goes up. The length of stay goes up. All these metrics that they capture, it's a little bit of meta and irony combined. All the things that the E.M.R is capturing shows that it's getting worse. You know there are some definite positives to it, but I think we have to look at, like any intervention- if I'm introducing a new drug, I don't just have to look at the benefits, the potential benefits. And so there are potential benefits (with the E.M.R), you know, not having to pull charts and being able to see lab tests and trending, all very good. Right? But there's also potential harms; then at the end of the day we have to say, is it more beneficial or is it more harm? I think the current technology leads to more harm.
Lalit:
So what do you think, the average person would say, you know, "like, Oh, come on docs, you're just whining" you know, I mean, but do you think the public has a good understanding of how the dynamics of medicine has changed?
Ken:
I don't know. I think it would be a good question to ask patients as opposed to me. my impression would be as a patient, because I been a patient, my impression as a patient, not as a physician, my impression is I want the system to work. I want it to revolve around what's going to achieve my best outcome. And that can be health or that can be a good death. Right? But I want it to achieve, you know, the best outcome possible with wellness. And I want it to respect my autonomy, my agency. But it's Medicine, it's healthcare, it's human contact. I want that human contact. I want to be treated as a person. I don't want to be treated as a data point. I don't want to be treated as a statistic. I don't want to be treated as if I'm on a conveyor belt. I want to be treated as a human being.
Lalit:
With the increasing level of demand and the way physicians work. The CMA, Canadian Medical Association. that's one of their biggest mandate is to work on physician health. We know that, you know, simply doing yoga and all of that, that's not going to be the answer.
Ken:
I am not yogapenic, no, no, that is not the cause of my burnout or the lack of yoga or lack of wellness officers or wellness programs. And this sort of steers it away from the label of burnout where that blames the person. It's like, "well doctor, you're just not resilient enough. Toughen up, suck it up buttercup. You know, like, I mean I've had to do it, you have to do it, just get, you know, get through it." And, so there are some reasonable criticisms to be made about using the term burnout and talking about interventions to prevent burnout and mitigate burnout. And people are, some people are shifting more towards using things like moral injury and the E.M.R is a moral injury in a way. It's preventing me from doing my best job and I want patients to get the best care based on the best evidence.
Ken:
And if that E.M.R is in the way, I am frustrated and that brings or sucks the joy out of medicine and having me do a mandatory online on the same E.M.R, some wellness module is just crazy. Right? And so I think we need to look at what is wrong with the system that is resulting in burnout rather than saying, well the system is what it is. You're burnt out, let's fix you. As opposed to maybe we should fix the system so people don't get chewed up and burnt out or express that. Because you know, I've advocated strongly that it's about patient care. It starts with patient care. It ends with patient care. There's an association and I've used the term association cause I can't, you know, I'm an EBM nerd and you know, cause and effect, there's an association between burnout and poor patient outcome or poor patient care. And so if you have a burnt-out physician that is associated with getting poor medical care and nobody signed up, you know, at the start of their medical career or getting interviewed, because I know we're doing this right around, you know, all the med school interviews have gone out. Um, jeez, I want to get burnt out and give crappy care. Nobody says that. Yeah. Nobody, they want to help people.
Lalit:
Yeah. People are genuine, vast majority of doctors, they go in medical school because they go in with that. They want to help people.
Ken:
Yeah. Nobody says I want to make oodles of money and I want to be an extensive data entry clerk and get burnt out, be frustrated and get angry at the next patient. And I'm not really angry at them. I'm angry at the system.
Lalit:
Yep. So, let's talk about solutions. Do you have some ideas on that?
Ken:
Yeah. So, whenever I look at a system problem, I think if we're going to implement something, we should do it on evidence-based manner, right? And evidence-based medicine approach. So, you need to look at what is the best literature that informs what's going to happen and then look at the potential outcomes. And so when they rolled out, and we're using the E.M.R as an example, when they rolled it out, did they really think it through and say, ‘will this improve patient oriented outcomes or what are referred to as POOS - patient oriented outcomes.
And so when they tried to roll this out to our facility in our hospital, we, and specifically me, but we as a medical staff said, “well, would this help patient care? Because you know, we're in it for better patient care. And if it can't be demonstrated that it improves patient care, then we shouldn't do it.” So solutions to this would be in the E.M.R world is to implement things at the time that it's going to improve patient care. And so if that means, can I see x-rays on my electronic record, no matter where I am, I'm giving service, then that's a great use of that electronic health record or electronic medical record. But if it's going to make me, you know, do 4,000 clicks, which is one research study, 4,000 clicks in a typical emergency room shift, I'm going to get like click fatigue.
“You know like my second MCP is going to get a little arthritic from doing all these clicks. Yeah. So, so I think we need to look at solutions as in a system solution and say, will it benefit the patient and how much does it cost? Because once you've decided that it works, because if it doesn't work, why are we doing it? Right? I don't care what the cost is, but if it works, then we take the next step and say, how much does it cost? And could that money be better spent on things like the social determinants of health? How about access to good nutrition? Well paid jobs, affordable housing, public transportation. Could that chunk of money keep our society healthier if we did those things or if we had some fancy electronic record that made me work slower, not see as many patients get burnt out and give worse care.
Lalit:
That's well put. Now the nature of medicine has changed a lot too, I think in a good way, where we have more women entering the workforce. Some physicians have not necessarily endorsed that. You are all for it. I know you were one of the only three male physicians asked to speak at the FIX (Females in Emergency Medicine Ideas Exchange) conference, which was basically 800 women physicians there about ideas, bringing the, you know, the female factor into medicine and their perspective. What were some of the things you talked about or shared there?
Ken:
Yeah, so that was the females in emergency medicine or FemInEM group, and they run a FIX Conference, and the FIX stands for female idea exchange. And I had the privilege or the honour or the, Oh oh, I'm so scared because I mean, look at me.... I'm a privileged white male. I have everything right. And so to put me into a position where I'm the minority, it was very good for me. And it was a great learning experience; to understand like even the washrooms. Even the washrooms there, they changed. There's a men's washroom and a female's washroom at the conference center. They changed it just to a woman's in a woman's and I had to go somewhere else to another floor to find where, where I could get rid of my nervous bladder before I took the stage. But it was a great learning experience and my eyes have been opened. It was a real thrill to be there and experience that.
And what I talked about at that female idea exchange was from evidence-based medicine to feminist-based medicine. And I use the model of evidence-based medicine on how it is failed or the research that has shown- the gender disparities that we have in society. And I looked at it from the three pillars of evidence-based medicine. The three pillars and evidence-based medicine are the literature, the clinician and the patient. So, the literature informs our care and guides our care, but it shouldn't dictate our care. But evidence-based medicine is not just about the literature.
Then there is the clinician who has to use their clinical judgment- 'in my experience, how do I put this into context?' And then they have to ask the patient what do they value and what are their preferences? And so, I took that evidence-based medicine model and those three pillars and set it - there's this transition that I went from evidence-based medicine to feminist-based medicine talking about- well if you look at the literature, women have been excluded from being research subjects. So, we're being informed by studies that were exclusively done on men.
And the most outrageous example I could find was a study looking at uterine cancer. So, in other words, a uterus and they have inclusion and exclusion criteria in studies and they excluded women. That means you only had men in a uterine cancer study to inform about uterine cancer!? So, you know, and then there are other studies that show women aren't treated as aggressively when it comes to heart attacks or their pain is under-recognized, diagnosed and treated. So that's the research side of things.
Then when you look at the clinician side of things, there seems to be a bias with regards to quantifying how much someone can get paid. Such as a new grad paid in academic medicine, paid in emergency academic medicine etc. And I gave a number of examples of studies that have demonstrated an apparent gender pay gap. And then I looked at the actual patients themselves. And so, I went through those three categories. And so, it was from evidence-based medicine to feminist-based medicine. But actually, it didn't stop there.
I said we should just keep going down the alphabet because it was E for evidence-based medicine, F for feminist-based medicine. Then I recognized that it creates a false dichotomy of men and women or depending on gender, male and female. So, then I said that we should have gender-based medicine to be inclusive of however you want to identify. So I went from E to F to G and then the closure was to H that we should do humanist based medicine, one race, the human race, all inclusive. That was the closer.
Lalit:
That was nice. That's nice, that's clever. That's good. That's
good. Well, you know, one of the things I see women are really more
consistently good, I guess they really connect with patients. I've seen that.
And I guess what I'm trying to get at is ...let's talk about vulnerability and
shame and that part in medicine. Men are not as open about that. And you've
been a big proponent of that and in a very admirable, in the way you talk about
that.
Ken:
Well, I'm thinking about how I want to respond to that.
Lalit:
I didn't set you up right?
Ken:
Well, no, it's okay. It's just; I really think it puts gender stereotypes into the conversation. I'm suggesting that women are better communicators or more empathetic or work-life balance. I've seen a spectrum, right? And there's lots of overlap, and I've seen some very, extreme examples in both female and male physicians. But as a movement, I would agree with you that the feminization of medicine, if I can use that term, has been a great benefit; and gotten back to our humanity and the art of medicine. It's made us recognize what really, I think, drove us all initially of being caring, compassionate, wanting to help people. And so this has been great, but for a long time there had been cultural constructs, and I am not an expert at gender medicine, but I'm certainly an observer that men had traditional roles and were expected to behave a certain way and to show vulnerability was to show weakness.
And I think that's absolutely the opposite. I think to be vulnerable and to express uncertainty is to show great strength and great insight and great knowledge about yourself. And so I'm glad that it's happening. I'm glad that I'm seeing it. I speak out and advocate about, you know, it's okay not to succeed. It's okay to fail at something. It's okay to be vulnerable and to talk about those things openly like I have about my experiences.
Lalit:
Do you want to share a particular example?
Ken:
Well, so the example that I used, and that I've done a podcast on, was being on the edge of burnout. And I was invited to be a keynote speaker in Australia for their national meeting. And shortly before, and so that obviously was set up months and months and months, almost a year in advance. And as the buildup was coming to that wonderful, I'm going to be going to Australia. My wife is going to be travelling with me.
It's going to be a wonderful thing. Just in the lead up to that, my father got diagnosed with a very terrible and ultimately terminal illness that took him within months. And while I was preparing for the conference, this was happening, and I was being a son. Um, but I was also being the family advocate, the physician in the family and going to his medical appointments, going to his medical treatments and ultimately his hospitalization. And so I was on the edge of burnout, trying to keep my head above water. And it was looking pretty grim before I was about to leave. And so I had approached my father and family, and had a good conversation with my dad about, "you know, I don't need to go. I mean, they can invite me back next year. They can get another speaker. It's fine. I'd rather be here with you."
And of course, you know, my dad being, my dad was, "Oh, no, you, you've been invited, you have an obligation. Live up to your obligation, son, and I'm proud of you, and I want you to go." And so we worked on my talk together on burnout from his hospital bed, and he gave me references, books to read, slide ideas. We ran through my slides together, and we put this talk together from his palliative care bed basically. And, again, he encouraged me to go. So, uh, I went, uh, and, uh, got to Australia, uh, climatized as one does when travelling such great distances. And then I gave my talk. We had arranged that I would live stream it to him so he could watch it so he could enjoy it.
So he did. And then, after getting off the stage and getting back to the hotel, I was able to reach out to him and call him and say, "what'd you think? And how did it go?" And told them that it was well received and he was very proud and very happy that it had gone so well, and that had been so well received. And then I got a call later that night that he'd passed away.
Lalit:
That must've been hard.
Ken:
Well, it was another extended travel period, getting home, you know? Yeah, you travel for 30 hours, you're there for, I don't know you know, it's all a blur now. How many actual hours I was in the country and gave the talk and then turned around in 30 hours home. But, Mmm Yeah, it was tough. And, and I, and I had great difficulty and great sadness and grief as it sucks and, uh, I'm still trying to get to a new normal and there's not a day that goes by that I don't think of my dad.
Lalit:
Yeah. Yeah. Any advice that you would give if they're on that path to burn out.
Ken:
Oh, absolutely. I guess my advice would be, that I was given- that worked, and that was helpful and it made me better. I mean, I've come through it, I'm different, I'm still me, but I'm different. And it's a new normal, but it was, it's okay not to be okay. It's okay to break down, cry. Cry in front of people. It's, it's going to end. It will pass. You will get through this. It's temporary. The grief may go on, but it is temporary. Right. Um, and so not to think that you can't reach out. And so I was encouraged to reach out, and I did. And I reached out to some people I knew very well, but also people I didn't know very well, and the support and understanding and encouragement, wrap me like a warm blanket and got me through a difficult time.
It was overwhelming the kindness within the medical community. I think once you come out, I guess in a way to say, "Listen, I'm struggling, I'm having a hard time" it is a weight off your shoulders to some degree because you know, you're not alone. And that many others have experienced that. But we're too ashamed to say anything they felt they had to... and I felt part of that, 'Oh I've got to keep it together.' But you don't, you don't have to keep it together and you will need to take a pause. You will need to take a moment. There is time to breathe and to reflect and to process. And I am so thankful to all those people, uh, that provided that support,
Lalit:
Well, I think that's been one of the positive transitions in medicine is that there is more of that conversation because those conversations would never have occurred.
Ken:
Yeah. You wouldn't have expected them to have occurred it's unfortunate. I think it drives some, a lot of pain - and it would be, it would be nice. I don't, I don't think we're there yet, where everybody can walk around and you walk up to someone in the hallway and say, "how are you doing today?”
And they don't go "fine" and keep walking past you. I think we're still in that stage.
But I think the door has been cracked open for them to say, "yeah, I'm not feeling that well today."
Lalit:
Well, it's admirable, because someone with your level of success and…
Ken:
and failure,
Lalit:
Do you have a favourite failure?
Ken:
Oh, geez, I've failed so many times. I mean, the standard joke is grade one was the longest two years of my training. I just wasn't finger painting with the rest of them, but I was held back a year because of the learning disability, and you know, people throw it ... 'Oh, you had a learning....' No, I mean it was tough going through school. So people, and it's hard to recognize myself, you know, as a successful individual, but I have to take a step back and say, Hey, I've got it pretty great. I mean, this is a pretty good life. I'm living; I'm really happy. Right. But people see a really happy individual and they don't realize that. Yeah, you repeated grades, grade one. Yeah. You, um, you took five years instead of four years to get through your undergrad.
Ken:
You know, you didn't, you weren't that person that got into medical school after two years. I did five years, and then I applied to medical school, and I still didn't get into medical school. And I had, well, I didn't have to, but I did a master's degree, and then I didn't get into Western (University) where I wanted to go. And so I went out to Calgary, which was a fantastic experience. And then I wanted to be an orthopedic surgeon, and then life throws you a curveball, and you end up anaphylactic to latex. I mean, I might as well want it to be a beekeeper and be allergic to bees. So you know, and then I ended up in family medicine, and then I end up in a rural community, and I'm like, 'ah, I love rural medicine. This is fantastic!' And then I'm really about doing emergency medicine, and I go back and get my emergency medicine papers. And then you know, the internet comes along where, you know, technology combines that podcast can happen and then boom; wow, I've got this like amazing platform! This Skeptics Guide to Emergency Medicine, 40,000 subscribers, translated into four other languages. And people see, wow, what a lucky guy. And what they don't realize is it's boom, boom, boom, boom, and life bounces you around and it turns out okay.
Lalit:
It's true, isn't it? You talk to successful people who outwardly look successful. It's the journey.
You just don't know.
Ken:
And again, it's not where you end up as long as you end up happy, I guess. But the journey is really important. And when I talk to people applying to medical school or medical students applying to residency or residents now applying for staff positions, and now I'm at the stage where, you know, staff physicians are coming to me for advice. It's like, you know, I still feel like that 'wet behind the ears' guy. Um, they come to me for advice, and you think about it, and you go, "you know what, it's not all the eggs in one basket" but don't get so set on 'I have to get into this medical school' because you know what? You don't. I have to get this residency position. You don't. I have to get this staff job. You don't. And I know that comes with time and perspective. And I didn't have that insight. I was devastated at various points along the (way) (exasperatingly) "Ugggh I'm not going to be an orthopedic surgeon," right? But you know what? It's turned out great. I've got a great life. I'm happy. You know, it's okay, and I think that's a really good, at least perspective, that can be provided to people that are coming up that I can share with them. That, you know what? It'll all be okay. It'll turn out fine in the end.
We can't change what's going to happen to us, right? This control idea is an illusion, right? So, don't try to control everything, but what we can have agency over is our reaction to it. How we deal with it. I can't control, 'Oh my God, I became allergic to latex.' But what I can deal with is how am I going to handle that? What am I going to do with that? How am I going to turn that into an opportunity and make it into something? And so that's what we have control over. Not the crap that happens to us, but how we respond to the crap that happens to us. Because I don't want to lose your iTunes rating by using other words.
Lalit:
(Laughing)that's, that's very well put. What hobbies do you have to keep yourself, you know, relaxed?
Ken:
Oh, I'm an Uber nerd. I don't think people would be saying it's a hobby to be stuck in the 1980s and obsessed with eighties music and eighties movies, but I am. I will be having a Top Gun party. So when, when Top Gun II Maverick comes out... Are going to be oiling up. We're going to be playing beach volleyball. It's going to be all in with a Maverick and Goose. So I also really like working out and I think a lot of people would share that, where they use exercise as a positive stress reliever. So, I really enjoy having that opportunity to for an hour a day or so to clear my mind. Work on my workout, get my heart rate going up, take care of the engine, make sure the engines running.
Ken (42:23):
And that's sort of my hobby, I guess, is working out.
Lalit:
Do you have a mentor?
Ken:
A mentor? (laughs) I have so many mentors that I feel not beholden to, but thankful for. Absolutely, Yeah. Oh, so many. My first one would be my parents because that's, you know, my dad was a physician, and so, I wanted to be a physician. My mom was a teacher, so I wanted to be a teacher, and so here I am. I get to be a teacher of medicine. I mean, it's just great how that worked out. But I had a fantastic high school teacher-English teacher. Yeah, Even though I was a science nerd who thought, you know what, I was quirky and weird, and that was good. And promoted me to use that and embrace that and get me involved in theatre and get me involved in those types of aspects.
So I still remember when I got into medical school, I went by Mrs. Pearce's house and brought her a bouquet of flowers. She had long since retired, but to thank her and she was like, "Kenny Milne, is that you? Kenny Milne, little Kenny Milne and little skinny little Kenny Milne." And coming to say thanks for being my English teacher. But yeah. And then I've had an EBM mentor. I mentioned him earlier, Andrew Worster, but I've had some fantastic when it comes to understanding gender equity, Dara Kass, Dr. Dara Kass, I don't want to decredential her. She is just a wow, like opened my eyes. I can't close my eyes anymore. I can't unsee gender inequity. And really showed me what advocacy looks like. So from that standpoint. Then teaching there's an emergency doctor, Dr. Rick Vukada, who has really shown me how a community doctor, I'm a community doc.
I'm a front line. I'm a grunt. I'm a grunt. I'm not, you know I don't want to get tribal, but I'm not working in a tertiary care center. I refer to the hospital, I work at the little hospital that does, but I refer to it as a rural ACE. We are rural academic centers of excellence. It's high thought, low tech. So we spent a lot of time thinking about patient care and how are we going to do patient care and how will that benefit. What are the potential harms because we don't have a lot of tech surrounding us to scan them and make up our minds for us. So Dr. Rick Vukada was a fantastic community doc who showed me that you could actually teach and influence and, and change practice for the better. So patients are getting the best care.
Lalit:
Nice. Nice. Do you read anything outside of medicine? Are you a big reader?
Ken:
Yeah, I really like philosophy. I'm an epistemology. I read a lot about religion. So all nonfiction. I'm a nonfiction guy. Yeah.
Lalit:
Is there a particular book that you've gifted more than any other?
Ken:
Lately, there's been two books that have been gifted, well I should say three. The book on kindness (The Power of Kindness) by Brian Goldman.
Lalit:
I've read that.
Ken:
He has added a layer to my practice with the emphasis on kindness and the joy that I get back in being kind in my practice. So that book that Dr. Brian Goldman put out. The Vagina Bible by Dr. Jen Gunter, she is a Western grad actually. And she's quite outspoken when it comes to explaining women's health, a very, very, strong voice in that regard.
Ken:
And so, I've given a lot of those books out recently. And then the final one is The Skeptic's Guide to the Universe. And you'll pick up on that, that my knowledge translation project is called the Skeptic's Guide to Emergency Medicine. That's a little homage to them. That's a podcast that I've been listening to for ten years, I guess or so. And they came out with a book last year, and it's how to be skeptical, how to critically appraise the literature, how to critically appraise any claim and an approach to life, a philosophical approach from scientific skepticism. And that's by Dr. Steven novella and his rogues. And so those would be the three books: The Skeptic's Guide to the Universe, The vagina Bible, and The Power of Kindness.
Lalit:
Well, those are fantastic. I've read the Book on Kindness, and I do think that's a fantastic book
Ken:
It really is, yeah. Brian Goldman is fantastic.
Lalit:
He's an amazing fellow.
Ken:
And have you seen he shaved for the N95 mask? He's got a babyface now. He hasn't been beardless for something like 15 years or something. Oh, yeah, yeah, yeah.
Lalit:
I did not know that. Okay. That's good. That's good. I'm going to ask you a final question. If you were to put a message on the billboard for people to see or even if you wanted doctors to see it, what would that message be?
Ken:
The message will be, don't panic, stay skeptical and be kind. Nice. Nice.
Lalit:
Ken, thank you for taking the time. What's the best way people can get ahold of you if you're open to that?
Ken:
Oh, absolutely. Yeah. The podcast is called the Skeptic's Guide to Emergency Medicine. Its URL is www.sgem.com http://thesgem.com/ and if they need to email me, it's the sgem@gmail.com.
Lalit:
I'll put a link in the show notes and thank you so much for having me in your bat cave this has been great. Thank you for taking the time.
Ken:
My pleasure.