Introduction

In the fourth episode, we have a conversation with Dr. John Spollen, a psychiatrist at the VA and the Clinical Co-Course Director of the M1 Brain and Behavior module. We talk about his educational journey to medicine, the highlights of his career, and his work with ECT and Ketamine. Dr. Spollen is enthusiastic about his work with students, so we can’t wait for you to meet him.

Listen to Episode Four

Transcript 

Weijia: Welcome to the next episode of Mentor Spotlight, your very own UAMS-led podcast to help connect students to faculty mentors. We are Weijia

Hannah: I’m Hannah 

Jasmin: and I’m Jasmin

Weijia: Your hosts for this episode. Today we have Dr. Spollen. He has been clinical co-director of the M1 Brain and Behavior module since 2015 and has held several other leadership roles, such as co-chair of the evaluation and quality improvement subcommittee. He previously was interim chair of the UAMS Department of Psychiatry and the Junior Clerkship Director for Psychiatry. He is a professor and the vice-chair for education in the Department of Psychiatry since 2004. 

Hannah: Dr. Spollen has received many honors for his work in education including the educational innovation award, the master teacher award from the College of Medicine and the 2019 UAMS Chancellor’s award for teaching excellence. He’s been active in several national psychiatry education organizations. Dr. Spollen is the past President of the Association of Directors of Medical Student Education in Psychiatry and currently serves on the American Psychiatric Association’s Council on Medical Education. 

Jasmin: He practices at the Central Arkansas Veterans Health Care System, where he has held several clinical and administrative roles including his current post as Director of the Psychiatric Consultation Liaison Service and the Electroconvulsive Therapy and Ketamine Program for treatment resistant depression. He’s board certified in general psychiatry, consultation liaison psychiatry, and addiction medicine. It is an honor to have such an accomplished and distinguished faculty member interview with us today, so without further ado let’s get started. Hi Dr. Spollen!

Dr. Spollen: Hi, how are y’all?

Hannah: We’re doing great!

Weijia: We’re doing well!

Jasmin: We’re good!

Weijia: As we’ve introduced, you hold a lot of important positions here at UAMS and at the VA. Do you mind telling us a little bit about what your typical day looks like and how do you balance all these different responsibilities?

Dr. Spollen: So… so it changes a little bit depending what day the week it is but say Monday, Wednesday, and Friday we do ECT in the morning so it’s the first thing. I’ll try to get in about 7:30 and we usually do ECT until around 10. Then we have ketamine infusions from 10-12 so I oversee that. I don’t necessarily stay for the entire thing but I have to go interview the patients, make sure they’re doing OK, make any adjustments. Then I usually will try to go see a consult if we have a new consult. So we have a resident who goes to see the patient first and then they contact me and say you know “meet me on the Sixth floor we’re gonna go see Mr so and so” and I’ll go see that patient with them and then afternoon it’s either continue to see consults or some days we also cover the emergency room. So Tuesday and Wednesday we cover the ER, so we were down at ER before I came here today and then I also have to go to a bunch of meetings for my admin job at the VA, which luckily is on Teams so I just go to the office and log in and there I am. So yeah, it’s usually clinical work early and then afternoon tends to be meetings and stuff like this.

Weijia: OK that’s cool

Hannah: And so going into your background just a little bit, as a lot of students probably know there are multiple ways to kinda get into medicine. So would you tell us a little bit about your path to medicine and what led you to either pursuing psychiatry or just medicine in general?

Dr. Spollen: Well my mother made it very easy for me. She told me that I was going to be a lawyer, doctor, engineer or if all that failed, president. I had a limited option so I didn’t want to go to school forever so I originally started in engineering and I was in my second year of engineering and I worked summers at engineering firms before I decided I hate this and I hate everything these guys do for a living. So then I didn’t like the idea of becoming a lawyer, I thought president was totally unrealistic, so then I was down to medical school my mother actually knew somebody in the Department of Psychiatry. So I got a job working in the summer being a lab assistant and kind of got interested in the science of it got to go on rounds a few times with some of the psychiatrists there as a medical student, I mean as a college student, they don’t allow that kind of stuff anymore, but before HIPAA people could show up and go on rounds and I just really thought it was interesting. So I… I went to medical school thinking I would do psychiatry but not sure. Then during the clinical rotations I had peds first and I really like pediatrics and I thought oh maybe I’ll be a pediatrician but then I did psychiatry again in January after the… after the fall break and it just seemed kind of like a natural to me.

Hannah: I hope mine… I hope my processes is a “ahhh this is the one”

Jasmin: That’s really interesting since the last person we interviewed was Dr. Spond and he also went to school for engineering and then I guess he didn’t like hate it but he knew that medicine was more of his calling and went into medicine. So we were just talking about in the last podcast we did, how interesting it was how a lot of people don’t start off in medicine and kind of just find their way to it…so 

Dr. Spollen: Yeah I mean as I said…limited options

Everyone: laughing

Jasmin: hahaha you didn’t find your way… you kind of had the path already foged.

Dr. Spollen: Luckily it worked out. You know because I… I might have gotten to medical school and decided I hated doing that too. Luckily I was like oh this is actually kind of interesting and kinda fun…so yeah it’s worked out.

Jasmin: Could you tell us more about your educational background, meaning like where you went to medical school and where you did residency?

Dr. Spollen: Sure, so I grew up in Birmingham, Alabama and I well…I went to school at Auburn for a couple of years for engineering, three years actually, and then I transferred to Birmingham Southern which is kind of like Hendrix. It was like the pre Med school. I didn’t have good grades when I was in engineering and so when I met with people about trying to go to medical school they said you’re gonna have transfer to Birmingham Southern and make straight A’s and I did that and borrowed some money and then I went school at UAB which is the state school in Birmingham and… and that was a great deal. UAB was an excellent medical school and was very affordable back then. My tuition was $6000 a year.

Hannah: Oh my gosh 

Jasmin: Aaaahhh the dream!

Dr. Spollen: So actually Birmingham Southern was way more expensive for me than medical schools the two years I had to pay for private school was more than medical school and then I decided to do psychiatry and I did my residency in Charleston at the Medical University in South Carolina, where I lived on the beach my third year.

Hannah: That sounds like a dream!

Jasmin: We are landlocked currently so

Dr. Spollen: Charleston is a nice place so you’ll have to check it out. 

Hannah: I will, I am writing it down. 

Jasmin: Yes yes, so how did you end up here at UAMS for residency?

Dr. Spollen: Yeah well so in my training in the third year in residency, we worked in an outpatient clinic and so do the PharmD’s that are doing their psychiatry residency. We don’t have a residency here for PharmD’s but at USC, they had a big one. So I met this nice woman who was from Little Rock and I ended up marrying her and we ended up moving back here because her family was here.

Jasmin: oh that’s really cute. That’s usually how it works out right like a lot of people like during that time of your life right you meet up with someone that’s where you end up settling but yeah. 

Hannah: So we kind of know a little bit about how you got into medicine. Would you mind telling us a little bit of what your thought process or what led you to academic medicine and like in the academic field versus just being a clinician only. 

Dr. Spollen: So I…I won a teaching award as a first year resident and I was like wow, I never thought this would be something that I would be any good at. Then I won it the next three years too, and so I thought, well I interviewed for other jobs. I considered a job in the public health service for a loan repayment job because I thought academics would pay like nothing, this would help pay off my loans faster. But then it turned out to be not that different and I liked the people that I’ve met in academics and I like the idea of being a teacher and a clinician and maybe even doing some research. At that point, I was still doing some regular biomedical research clinical trial stuff like that. So it just sounded a lot more interesting than just… And actually a couple of those public health service jobs kind of scared me. One job I interviewed for I was gonna be the only psychiatrist for 3,000 people in Alabama…

Hannah: that would scare me too 

Jasmin: the epitome of rural health

Dr. Spollen: I was like this is an important job and somebody needs to take it but I don’t think it’s gonna be me. 

Hannah: yes well I can attest I think we all can attest to the excellence of his teaching. He taught my favorite lectures in the Brain and Behavior module but maybe that’s just because I like psychiatry.

Weijia: As someone with minimal psych background I will say I definitely enjoyed your lectures a lot too. 

Hannah: Very very digestible which is not always the case for every medical school lecture you’ll listen to so we appreciated that. 

Weijia: So how does a psychiatry differ from other fields and what kind of qualities do you think would make a person a better a student for psychiatry>

Dr. Spollen: No, I don’t know that there are any absolutes. We spend a lot more time just talking with people and having a relationship with people ’cause you have to make people feel comfortable for them to be allowed to talk to you about their mental health problems. I would say you have to have at least pretty good social skills. You have to like liking people and wanting to work with people. But I guess you could also say that about every doctor right yeah 

Hannah: At least the ones that have a lot of patient interactions 

Dr. Spollen: Not all of our patients are easy to work with and so you have to be OK dealing with some difficult people and I think sometimes actually that’s like in my role doing consults at the Little Rock VA. A lot of there…sometimes it’s just people that are acting badly because they’re super stressed out or you know, they’re uncomfortable. They don’t like people sticking needles in them but they’ll end up saying some dramatic thing like “Oh Lord! we should call psychiatry!” and really it’s just about how do you work effectively with difficult people. That’s kind of our specialty I think.

Hannah: So I was once told by a psychiatrist, it was like an off candid comment. They’re like you know, psychiatrists are really suited for hospital administration work because they are so used to dealing with so many different types of personalities and making a cohesive team that they’re really suited for hospital admin kind of work. Would you say that that is an accurate statement?

Dr. Spollen: Well certainly not all psychiatrists. We have some people who are bad at that sort of stuff. But I do think you’re right in that people who are very tuned into subtle non-verbal things will pick up on “this is not going well. I need to change my tactics for the better.” It does seem that we have a disproportionate number of people from psychiatry who are in these kind of leadership roles so yeah there’s probably something to that.

Jasmin: I think it’s interesting ’cause I feel like obviously most specialties have some aspect of psych in it. I shadowed palliative care and I was so shocked to see how much psych was like a component of that practice of building rapport with the patient and like a lot of these patients are dealing with things like PTSD. The same thing with family medicine or internal medicine… especially if you’re like a PCP,  you’re seeing the patient for the first time, and you’re having to recognize these multiple like psychiatric..  You know, if the patient is experiencing generalized anxiety which a lot of us are experiencing, like just post-pandemic or intra-pandemic so I feel like basically all aspects of medicine have a huge component of psych.

Dr. Spollen: yeah certainly, any direct patient care you’re gonna run into. Even the surgeons, you’re gonna run into people with PTSD. “We’re gonna put you to sleep…and then we’re gonna do this” and then the “Oh my God! Oh my God! Oh my God!” So yes, yeah everybody is going to end up with some mental health as long as you work with patients, you’re gonna eventually somebody with mental health problems.

Jasmin: With that in mind, I know we mentioned in our introduction that you work with ECT and the ketamine program. So that along with other research, why did you choose to specialize or do that kind of research? 

Dr. Spollen:  I’m at the Little Rock VA. That’s where medicine and surgery are. I do inpatient consults to medical and surgical patients. Well that’s why they do ECT as well because that’s where the anesthesia is. The person who was supposed to do it works at the North Little Rock VA and they would have to drive over here and do ECT and then drive back. So they just asked me if I would do it and I said sure. You would need me to get me trained on how to do it, because I have not done it in 20 years. So originally I just did it because they asked me to do it but it turns out, it’s actually been a lot of fun. When I took over ECT, ketamine was not a thing. I mean it was done in research but when I saw that it was likely to get the nasal spray version FDA-approved, I thought well, we’re probably going to have to start doing this. So I went to Yale where they had done all the early research with ketamine and learned about how relatively simple it is to do it. The one thing that is really nice about the VA is that we don’t have to worry about insurance. If you’re ineligible veteran, I can do anything for you. And so the thing in the community is that ketamine is very expensive. It costs you $500-$600 an infusion. You have to have get these over and over again ’cause they only work for a few weeks. So I was able to get a little training up there which the VA also paid for and come back and start it. Luckily since I knew anesthesia really well from doing ECT for several years, they were OK with me doing it, because anesthesia has to sign off on doing something with ketamine since it’s really their drug. The timing kind of worked out because we started doing the Ketamine program in December 2019, and originally it was just for people that ECT didn’t work for. But then if you remember, the pandemic kicked in a few months after that so I had a lot of people who were coming from maintenance ECT that would come like once a month or every other month to stay well who we couldn’t do ECT with because it’s an aerosol-generating procedure. So a couple of months of not doing any of those, I had people calling me saying “I’m really feeling a lot worse, when can I come in and get ECT?” and I said well we can’t do ECT but I have this ketamine stuff that you can try. I think we had six people who are coming for monthly or every other month for ECT. All of them did ketamine and none of them went back. They’re still seeing us for ketamine infusions every two to four weeks. So basically just took over a lot of the ECT business. 

Hannah: That’s pretty cool. I remember so one of my majors and undergrad was psychology and I took a psycho pharm class, and one of my professors was really into ketamine being like treatments for depression and everything, so I remember learning about this. But then I remember them saying this isn’t commonplace, so I’m seeing something in practice. They talk a lot in medical school about how different the curriculum is and just like new information they have every year and so I was like Oh my God, this is cool. Change happened in front of me.

Weijia: yeah I really just thought ketamine was for anesthesia. I didn’t know it could treat depression and all these other conditions. 

Dr. Spollen: And chronic pain. We have a ketamine program for pain infusion at the VA too. 

Weijia: oh OK 

Dr. Spollen: Yeah, it has several uses. For psychiatry, the interesting thing about ketamine is that it is a completely different mechanism. So up until now, every antidepressant that we have (other than ECT which is used for depression) everything else basically increases norepinephrine, endorphins, dopamine, and/or serotonin. So it’s all catecholamines. So every pill that you know of for depression essentially works the same way. Ketamine doesn’t do anything directly to those. So it works on completely new mechanism and so the pharmaceutical companies have realized this and they have now done a lot of trials trying to find things that work like ketamine in a pill so within a few years and actually one if public, would get FDA approved in the next quarter, so in the next three to six months, we will have something that is supposed to work like ketamine. I don’t know how well it worked, but it’s definitely spurred a lot of new things coming out and so my guess is probably in five to ten years, all those antidepressants that we taught you about in medical school, hardly anybody will be using. 

Hannah: Won’t have to learn all those SSRI’s. 

Dr. Spollen: That’s right. All new stuff. 

Jasmin: That’s usually how boards material works. Especially with cancer drugs now. Essentially everything that is in that book is essentially not used. 

Dr. Spollen: Right.

Jasmin: So I guess we can transition a bit topersonality outside of medicine. 

Hannah: Yeah so we talked about your background academically outside of work. What do you like to do for fun or hobbies to unwind just from a busy day or just in general?

Dr. Spollen: I’m pretty social. I like getting together with people and going out. I like traveling. I usually try to do one trip to Europe and one trip to the Caribbean every year. So my wife is a big beach person so we have to go somewhere with a beach at least once a year. Then I kind of prefer to go cities and travel like that. Although the beach is not bad either. Couple of big trips like that. Then work, I get to travel for work a lot which is really fun so those…some place where there’s a meeting. And of course, you know, I go to the meeting for a few hours a day but you have a lot of extra time that you can go travel around the city and see what’s going on so I like traveling a lot. I do like cycling but I mostly do it for recreation and exercise. And so I try to ride a bike a lot to try to keep myself healthy. 

Weijia: what’s your favorite city for travel?

Hannah: That you’ve been to.

Dr. Spollen:  yeah I feel like this is really hard…

Hannah: You can give us like top three.

Dr. Spollen: well I would say anywhere in Italy. At this point, I would say I actually don’t like any of the big cities. I prefer those smaller places in Italy where there’s less crowds. Lake Garda…San Giulio in Italy was amazing! Marina Del Cantone was a little fishing village on the Amalfi Coast was amazing. As far as bigger cities, Amsterdam was really amazing. I really like Amsterdam a lot. 

Hannah: I’ve had several people recommend that I visit Amsterdam. They’re  like, the city is beautiful.

Dr. Spollen: Yeah, and you can bike everywhere. 

Jasmin: Two hobbies in one. 

Hannah: yes yes! More affordable than gas. OK so, we’ve talked a little bit like outside of medicine. Kind of transitioning back a little bit into the healthcare field. Sorry, this might be like a tough one. What are some of your current frustrations that you have either within the field of medicine so like healthcare in general or just specifically within your specialty of psychiatry?

Dr. Spollen: So I think the payment mechanisms lead to a bunch of unintended consequences both in psychiatry and medicine in general. So we pay people for being sick. So we don’t pay people to prevent people from getting sick. So instead of paying primary care doctors a lot of money to help people quit smoking, we pay them to treat COPD and cancer. It doesn’t make a lot of sense. And for psychiatry, pills are cheap and therapy is expensive. So they generally want to pay for pills and they don’t want to pay for psychotherapy which tends to be like 12 weeks of seeing a psychologist or social worker so that’s a lot more expensive than you know, give you Prozac. I think the finances unfortunately lead healthcare to be more about illness care than healthcare

Jasmin: Yeah I feel like especially with our current healthcare system, specifically to the United States, there’s a huge hole for preventative medicine and just even preventative medicine like counseling on preventive medicine.  I feel like we’re not often like…it’s not really super emphasized in our current curriculum. 

Dr. Spollen: Right, there’s so many people who should basically have a health coach that they meet with a lot to help get their life back, to help  get them eating better, moving more, drinking less, and smoking less. Yet instead, you see a primary care doctor and they prescribe medicines for these things that really should have been preventable a long time ago. That’s one thing that’s really nice about the VA. We are kind of one of the few systems in the United States, the biggest system that’s basically it, kind of socialized medicine system, where we care for most of the veterans from the time they start coming to VA until they die. So there’s a little bit more of a focus on whole health and trying to prevent illness rather than just treating it. It lets us be a little more flexible about how we set things up because we’re not necessarily paid by a certain service. We have to justify our workload by showing people CPT codes and all that kind of stuff that everybody in the rest of medicine does, but it’s really just so that the VA can say yes but the people are working. But as far as providing care for people, insurance has nothing to do with it, and reimbursement has nothing to do with it. Hence the ketamine program, which nobody in the community can do a ketamine program like we can in the VA because they have to worry about paying for it and I don’t. I think I can just say this is really good, people seem to be getting better. Let’s see if we can do it as long as I can get through the bureaucracy, you can eventually do right. 

Hannah: Gotta cut all the red tape first. 

Jasmin: That’s why I loved seeing or shadowing at the VA. I saw that a visit was 30 to 45 minutes where we could really sit down and talk with the patient. Especially with veterans who have long histories of PTSD. You have to do the suicide screening. You have to really get into the nitty gritty. So yeah I think the VA system it’s like kind of a model that we can have hopefully for like the greater…but that’s a huge wish. 

Dr. Spollen: Yeah, but it works too!

Hannah: Room for improvement but also some commendable advantages. 

Dr.Spollen: I’d agree.

Weijia: So do you think there are any implementable changes that we can put within our healthcare system?

Hannah: big or small.

Dr. Spollen: Yeah I think what they were moving that direction with unfortunately kind of got slowed down but some of the Obamacare stuff about paying. In fact, the day before y’all’s time, there was a move to manage care which basically put insurance companies in charge of deciding what they’re going to do or not. I thought what Obamacare did was really put healthcare systems in charge of it so instead the insurance company basically became UAMS and Baptist or some other large care system, like Kaiser. And then it was up to them decide what we’re gonna do and so you would have to make strategic decisions about things that are medically appropriate and necessary and make some things that are reimbursed for in the community but maybe aren’t that important and maybe we should be doing less of that so we can do more of this. But I think that the decisions in those cases are made by the healthcare system rather than just an insurance company.

Jasmin: a lot of policy making that even involves people outside of health care too so it can get pretty controversial pretty fast.

Hannah: the downfall of a capitalistic society. 

Everyone: *laughing*

Dr. Spollen: Capitalism also has its benefits and its problems

Jasmin: I feel like I think it’s really interesting to even study like other healthcare systems in other countries and how they set up you know payments and everything. You’ll have like the United states as like one extreme and then you have like European I guess…

Weijia: Yeah, universal healthcare. 

Jasmin: Yeah on another extreme and I think it’s all about finding a healthy medium but even that’s really difficult.

Hannah: No system is perfect. It’s just trying to maximize, I guess, what’s working for you. Alright so kind of just another broad question but just, what is one piece of advice that you would give to any medical student regardless of what kind of…what specialty they wanna go into or like whatever they want to do…just a broad piece of advice.

Dr. Spollen: I think you have to pick a field of medicine that you’re going to be intellectually interested in so that you will read because you need to read a lot if you’re gonna keep up. So you don’t wanna be one of those doctors that practice is just like they learned in residency 20 years later. So you have to, you know, they’re gonna send you journals to your house, and if you don’t really like it, if you’re not really interested in some of that, you’re gonna put it in recycling. And then you’ll become a dinosaur. You’ll be a bad practitioner. So you’re gonna stay up to date and you’re really gonna like your field, you gotta be intellectually interested in it because there’s a lot of work to be done to stay up to date. That’s like a big one. I would say when you’re going through the third year, look for what you feel most comfortable in, what you go home and feel excited about, what do you talk to your significant other about, and you know, try to see if you can find something that seems like a good personal fit. You know, most of these jobs pay a lot more than what your parents may. A lot more than what you really have to have to live, so you know, pick something that you’re excited about ’cause then you can still be excited about it 24 years from now. 

Hannah: So just out of curiosity, I know like different licensed professionals have different numbers of continuing education hours they have to receive. What is like the standard for most medical clinicians for how many hours of continuing education do they technically have to have?

Dr. Spollen: So I think it is state by state. It’s 30 hours for our state.

Hannah: OK 

Dr. Spollen: So it’s not not bad you go to a couple of meetings and you can easily get it. I think it’s harder for people who are in private practice, who don’t need to go to these meetings that I get to go to and get 20 hours one weekend. 

Hannah: Right 

Dr. Spollen: But you know one thing you can do is…you could actually get hours by just reading articles on like Medscape and so you can sign up for those things and just every time you read an article you know… sometimes they ask you to go answer a couple of questions but it’s basically rewarding you for like on the fly learning like “oh I’ve got somebody with hypothyroidism, let me make sure I still know what the heck I’m talking about.” Go read UptoDate, boom, got an hour of CE right there.

Jasmin: I have heard that from multiple people like multiple mentors we’ve interviewed or like even some attendings that I’ve talked to you like in my other program about how a lot of them have the habit of like reading one article a night or something. They make it a habit or something to… to like keep up with the current literature.

Dr. Spollen: I tend to maybe be more case based like we get patients who come in who have X problem and it’s been a few years since I’ve seen X problem. So I’ll spend a little bit of time that afternoon when I get in between things just downloading a bunch of articles. Then I may go home and read them that night if I haven’t been able to read them. But to me it makes better sense to.. I do like further journals I get at home, I will scan them if there’s an article that’s pertinent to me, I will go ahead and read that sometimes there are not that many, like one thing out of entire journal but… but I find that at least in my job because there are certain things that I see a lot of that I tend to keep up naturally because we see a lot and then there’s some things that you don’t see very often and so I have to go back and kind of relearn that to make sure that I’m up to date on what it is that we’re recommending. As a consult psychiatrist, I get called to basically see someone and then explain to medicine and surgery what’s going on and what the plan is. So I kinda have to keep up to date ’cause a lot of people are reading my notes so I don’t want to say anything stupid.  Unlike in private practice where the only people reading my notes is me, at the VA I it’s it’s totally secure as people can read anything so I’m always kind of feeling like “eeehh, I’m gonna make sure that I stay here is right” so if I start typing something I’m like not sure about then I’ll stop and I’ll go look it up online or even article or two and just make sure that what I’m saying is accurate ‘cause you never want to lose face and say something foolish in the medical record where it stays forever. 

Jasmin: PCP’s will read that, that will just be like in there forever yeah 

Dr. Spollen: I use voice dictation and so you gotta… you gotta worry about what it’s gonna say ’cause it’s always English, it just may not be what you said. So one time I had this really nice lady and back then they were really begging for us to take a social history that included hobbies, so I was going down- “what’s your hobby” and she said cooking. Later on I went there and dictated it, the computer misinterpreted me and thought I said cocaine and that was still in her note when she came back a few months later.

Hannah: They were probably like “Oh my gosh…umm”

Dr. Spollen: I put a little addendum- by the way, above incorrect, it should say cooking not cocaine. So yeah, but that’s still in the medical record 20 years later.

Hannah: Gotta work on getting rid of some of my… my country accent.

Jasmin: That’s really funny. So my aunt in the Philippines, you know they… they allocate a lot of these jobs or medical like medical transcriptionists to other countries, other English speaking foreign countries ’cause of cheaper labor. So my aunt used to like, they would send her the voice recordings and a lot of times it was for like surgeries and sometimes while I’m there during the summer should be like “hey Jasmin, can you come here. Do you understand what they’re saying?” and I was like, noooo. I even have some medical knowledge but I’m still like “I think they’re just really tired” ’cause you know like when, especially when like physicians, surgeons are so tired they’re like mumbling. So I was like oh this is all mumbling and she’s like “OK”. So I… I think computers are a lot smarter now so probably they’re phasing that out but jobs like that very well still exist. 

Hannah: Need to work on my enunciation

Jasmin: Yeah and I think less… this is kind of an off track but as future doctors we need to make sure that we enunciate really well because there could be situations like that where you get cooking and cocaine mixed up.

Dr. Spollen: Whoops

Jasmin: It can very well be a part of patient care.  

Hannah: Yeah one is definitely more of an eye blinker than the other one. Okay, so if you wouldn’t mind, what is your most memorable experience either from medical school, residency, as an attending, like in your just general practice, either most like memorable or 

Jasmin: life changing kind of just changing your perspective

Hannah: you thought it was like really cool that you would like to share slash can share 

Dr. Spollen: Yeah, I can probably share most things. Yeah, I don’t know that there’s one thing. I mean you get these things all the time. I had somebody give me a present today. I had a guy who made a pen and brought it in for me and was like “I want you to have this. You have really been helpful and I am really appreciative of what you have done”. I was like I think I can take this, I figured theres a government rule that says I can’t do that. When people get better and… and are… are really happy that whatever we’ve done has really been helpful, which is surprisingly common in my job, maybe it’s ’cause I’m giving people ketamine all the time and this actually was an ECT patient so you know maybe some of the things I do tend to be pretty helpful for people who felt pretty miserable so you know I think those are the kind of things that are kind of fun. There’ve been a few kind of like cool moments when I figured something out like when other people hadn’t and I was like FINALLY… I got to you know… I’m the consult psychiatrist and I was actually able to figure out what was going on. We had a guy who’s having visual hallucinations and we have no idea, his labs looked fine and I just started going through every drug he was on, looking for a drug interaction ’cause I knew it had something to do with the medicines he was on and I figured out it was vortioxetine, this drug, not vortioxetine, voriconazole. He was on vorioxantonizol and was taking inhibitor of that so he was getting really high levels from it and you get hallucinations with toxicity with voriconazole. Had the same thing with somebody who had encephalomyopathy from…oh what was it… they had balance no, acyclovir. So they.. they came in, they’re getting treated for some kind of herpes thing with acyclovir but they had renal failure and so they haven’t renally dosed it and so this guy was completely and encephalopathic and acting wild and tearing up the emergency room and it’s just ’cause I went back there and kind of went through methodically through all the things. You know, I narrowed it down to: medicine hasn’t figured this out, which means it’s probably nothing in their domain. It’s probably one of these pills that he’s taking and so I went there and kind of investigated, figured it out. Then went back out to the ER and was like “I know what it is! Here’s what we do!” So sometimes that’s kind of fun, which in my field you don’t have a lot of gotcha’s in psychiatry. So it’s nice when you… when you get it right. There’s so many things in medicine when they call us and it’s like this guy is delirious and I’m like “yeah I totally agree, I have no idea why” and we just don’t even figure it out but that’s a third of the people that we have are delirious between all those consultants, medicine, and neurology, psychiatry we never figure it out. When you get into clinical stuff, the first few years there’s a diagnosis and there’s a treatment and you know what it is and you know what to do. Then you start doing like wards and it’s like “we don’t exactly know what’s going on with this guy.”

Hannah: Right you learn there’s an answer ’cause there has to be an answer on the test but in real life not so much.

Dr. Spollen: If you want to learn, Nick Gowen from the VA writes amazing notes, where he will go through exactly what the thought processes are and you get down to the bottom you’re like… he just says it in such a matter of fact way like “we have considered many things but we still have absolutely no idea what this is.”

Jasmin: I’m sure you don’t really figure or like you figure things out more as the disease progresses, you know with time right ’cause like more symptoms show up right? 

Dr. Spollen: Yeah … yeah I had…

Jasmin: It’s a waiting game.

Dr. Spollen: I had sort of an unusual gotcha thing when I was in medical school on my Peds rotation, probaably one of the reasons why I liked it so much. I had this kid that got admitted with you know vague kind of fever but he had a platelet count of like 700,000. I was like that seems odd. Maybe it was a million, it was like seriously seriously high. So I was like I wonder if that’s a clue and so I started going through the book of everything that had thrombocytosis as an option and I just went through and kind of like ended up saying well it can’t be that, can’t be that, and then I got to Kawasaki’s Disease and I was like well what else we looking for? It’s like desimation of the fingertips. I went back there and looked didn’t have it, six hours later he had it and it’s sort of played out… like overtime you could see these other things show up and it’s like I think this might be Kawasaki’s Disease and the next morning I presented it as that and the resident was like yeah kind of doubtfully and the attendant was like you know could be but it’s so rare but you know four or five days later it turns out that’s what it was. We had you know he had cardiology and they’re saying “Oh yeah that’s what it is” so it’s you know kind of one of those things that kind of played out and it played out over my night on call so like you know presented it like you know 6:00 PM and by 10:00 PM I’ve got a list of six things it could be and by you know three of three o’clock this morning I’m like “Oh my Lord I think that’s what it is”

Hannah: It’s just like hmmm it just keeps getting more similar

Jasmin: So the beauty is just like all those Eureka moments that you have in medicine. It really is just like…

Hannah: Very satisfying 

Weijia: Yeah sounds like stuff you see on TV, it’s kinda cool

Dr. Spollen: Most days are not like that 

Hannah: If they teach you anything in med school, it is that medicine is not like you see on TV Weijia: Yeah, no, no only certain moments 

Jasmin: So as we’re wrapping up, how can a student contact you if they wish to ask you a question, shadow you, or just in general want you as a mentor someone to ask questions?

Dr. Spollen: They can just email me! I’m the only Spollen in the global.

Hannah: Okay, perfect and then is there anything that we haven’t kind of touched on in this interview that you wanna add in? Anything you think is like vital to it or just any lasting thoughts? It’s okay if you don’t have any, we just wanna make sure that we’ve covered everything that you know should be covered.

Dr. Spollen: Yeah I should prepare for that, to have one last thing.

Jasmin: No is a good answer too

Hannah: It’s okay, I think you would probably be like.. if you actually had something I think you probably feel like the first one.

Dr. Spollen: Yeah…no…no I can’t think of anything, sorry.

Hannah: That’s okay!

Jasmin: This was a great interview in itself!

Hannah: Well thank you so much for being available for this podcast and for your dedication to student education… so … and listeners as always reach out to us and let us know your thoughts, concerns, questions and we’ll see you in the next episode!

Introduction

In this episode, we have a conversation with Dr. Matthew Spond, an anesthesiologist here at UAMS. We discuss his journey to and through medicine to date, his advice for students, the field of anesthesiology, etc. Dr. Spond is a great advisor for students and always cheers them on – we cannot wait for you to learn more about him!

Listen to Episode Three

Transcript

Jasmin: Welcome to the next episode of Mentor Spotlight, your very own student led podcast to help connect students to faculty mentors. I’m Jasmin Cotoco, and I’m Weijia Shi, your hosts for this episode. Today we have Dr. Matthew Spond, an associate professor in the department of anesthesiology. Dr. Spond completed his medical training right here at UAMS for both medical school and residency. He’s a diplomat of the American Board of Anesthesiology, which means that he has met the highest standards first practice in anesthesiology.

Weijia: He coordinates the M3 selective for anesthesiology as well as the M4 elective course. In addition, he is a faculty advisor for the Anesthesiology Interest Group, and he is a house advisor. He loves to help students truly cares for them and is always available to help us in any possible way. You will hear him say, “always hearing for you” whenever you become his mentee, and he truly means it. So without further delay, let’s get started. Hi Doctor Spond!

Dr. Spond: Hi, how are y’all? Thank you for having me.

Jasmin: Thank you for joining us today.

Weijia: Yes, can we start off with you telling us a little bit about yourself?

Dr. Spond: Absolutely. So, native of Arkansas, I was born and raised in North Little Rock. I went to high school here in Little Rock Catholic High School for boys. I went to college at the University of Arkansas at Fayetteville. I got a degree in civil engineering. I did not have medicine on my horizons whatsoever, thankfully, took more pressure off. And then I worked as an engineer for about four and a half years, and in 2004 I began medical school here at UAMS. I’ve been here ever since.

Jasmin: Awesome. So we know that you’re in anesthesiologist, of course. But how else would you describe your job title? What other positions do you hold?

Dr. Spond: I guess technically, and I’m not real big on job titles. But technically I am an associate professor, and tentatively, as of July one of this year, I’ll be the vice Chair for education for our department of anesthesiology here. And I’m a house faculty advisor for academic house Lowe.

Jasmin: Go Lowe. Yeah, we’re both part of Lowe.

Weijia: yes we are.

Jasmin: So you mentioned that you made that transition from engineering to medicine. I’ve heard like some people make that transition. And whenever I hear it, I’m like, wow, that’s really drastic. So could you talk about more of what made you transition to medicine?

Dr. Spond: Absolutely. I like technical topics of all sorts. And I thought I was gonna get a Ph.D. in structural engineering. I thought that was going to be the rest of my life and then sort of life happened and I ended up in medical school. So how does that happen? Well, I found when I was working most productively as an engineer, I wasn’t really interacting with many people. I was interacting with the computer and calculator and pencil and paper. And I like to talk. And so did my mind sort of searched around what I wanted to do. I thought about law school, and then I, you know, for better or worse, I thought, you know what, I’ve always heard medical schools hard. I like technical topics. I like to help people. I like to interact with people. Let me give it a shot. And I looked into it, and I didn’t have that many prerequisites that I hadn’t already had. And so I took the four prerequisites that I didn’t have over the course of about a year and a half. And I applied, and I got in, and it’s been one of the best thing that’s ever happened to me, to say the least.

Jasmin: Awesome. I’ve heard a lot of stories of, like, people transitioning from computer science or like engineering from, like, a more technical, less people oriented field, to like computers or like to medicine, and I think it’s just crazy how you’re willing to go back to school again and go through all of that to get to where you are today. So yeah.

Dr. Spond: I was very fortunate. I wasn’t attached to anybody. I had no dependents. I had no debt. And sort of the world was my oyster, and I was willing to put in the time and energy and effort. And I’m very thankful that I did.

Weijia: Okay. And anesthesia is not a field that’s on a lot of people’s radar, especially at the beginning. So we were curious how did you decide on anesthesia?

Dr. Spond: Absolutely. So, it’s interesting cause the very first week of my M1 year I always sat in the back. Everybody came to class, and we had a lot of classes. And I sat next to a classmate of mine whose mother was an anesthesiologist, and I explained to her that, you know, I was an engineer by training already. She said, “oh, you’re gonna go in to anesthesiology”. So that was the first time I’ve ever heard. That was in M1 year, and then a couple times as the as the years progressed, I heard a few more times. And back then, way back in the Dark Ages when I was a med student here, every M3 had to do one week with what was called the surgical subspecialties, which was one week with Anesthesiology, one week with ENT, Urology, and Orthopedics. So we all were exposed for at least one week to anesthesiology, and it was Monday morning at about 9:00 o’clock on my one week of anesthesiology that it finally clicked in my head, that epiphany, Eureka moment. I know what those people were talking about; this is what I want to do. And it’s heart, lung, CNS physiology, and pharmacology. It’s all the real time, good ideas, bad ideas, you’re gonna find out. I have problems and make mistakes all the time. Fortunately, they’re dealt with almost exclusively in real time, so I go home with very, very few problems. And that’s one of the things I really like about it. One of many things I would like.

Weijia: Can you describe what a typical day looks like?

Dr. Spond: Sure! So a typical day, the operating rooms here, the main OR, main operating rooms here at UAMS. We start our cases typically on Mondays, Wednesdays, Thursdays or Fridays at 7:00. On Tuesdays, we started a little bit later at 8:00 because we have didactics. And so on a generic weekday, I get here at about 6:15, plus or minus. It seems really early, and it would have kind of blown me away if I have been told that. laughs I didn’t it’s gonna be getting up at 4:30 for the rest of my life, but you get used to it. I get here and I go see patients in the preoperative holding area for surgical cases that had been pretty well delineated the day before, unless I’m assigned to the add on room, and those are cases that have been added overnight. And you get to meet those patients in real time. And like I said, I really enjoy talking with people and people say, “well, if you like talking with people, why did you go into a field where patients are all asleep?” And that’s a good question too. But I get to deal with patients and talk with patients and interact with patients when they’re at their most vulnerable. They have a major operation ahead of them. There’s no such thing as a minor operation. They’re worried about the diagnosis: is this cancer, is it not? Is it curable? Is it not? What’s gonna happen to me? They’ve had to rearrange their life, arrange for childcare, elder care, pet care, arrange with their work, with your school, etc, etc, etc. So they have a whole bunch of unknowns in the back of their head, just kind of swirling around, and they’re really at their most vulnerable. And you know, I get extreme pleasure of telling them, “you know, we’re gonna work hard to have a boring day for you, unless you’re gonna have a baby here, excitement in the operating room is usually not a good thing. So we’re gonna work hard to have a boring day.”

Jasmin: I hear a lot of surgeons I’ve shadowed in the past say that, and I think that brings extreme comfort to a lot of patients. They laugh at it. It’s a good laugh. And then they’re like, that’s very comforting to hear.

Dr. Spond: Exactly, exactly.

Weijia: Boring day’s our goal.

Jasmin: Yeah and I think a lot of people have that stereotype about. I know we definitely interested in anesthesiology; she’s doing the preceptorship. But anesthesiology isn’t on my radar, but I always poke at Weijia and say, “they just put patients to sleep”. But now that you’re telling me this, like, how much is actually involved with comforting the patient, you know, it’s at their most vulnerable point, I guess I can stop poking at Weijia for that.

Dr. Spond: I have a favorite little Venn diagram. I’ve come to realize like Venn diagrams. Weijia has seen it, where I draw in the middle. I draw small circle, and I say this is anesthesia. This is how much propofol to give a patient, how to put a breathing tube in, and that takes some amount of time, a couple of years. And then I draw much larger circle all the way around, and I said this is anesthesiology. This is a bottomless pit of learning. There’s not many things in all of medicine that I can legitimately say I don’t need to know that. Yes, the answer is I do need to know that because you could have the patient, the procedure, and the time. It could be a healthy patient and normal hours going for routine procedure, or it could be a very sick patient in off hours going for very, you know, high complex, high morbidity procedure. So I need to know everything I possibly can.

Weijia: I’ve heard that a good four or five times now. Can you describe but one of your most memorable experiences, either from Med school or residency or attending?
Dr. Spond: Most memorable experiences. I’ve had some moments; I’ll try to keep these non-scary moments. Probably most memorable experience in medicine was probably, frankly, the birth of our third child, which was here. So it was at work, and it was about six years ago, a little over six years ago. And so it was in an operating room on the fifth floor, labor and delivery where I trained as a resident. I had been a medical student, I trained as a resident. I’ve been attending in this room and now I’m the patient’s significant other, and it is different, even though you’re at your place of work. It’s different to be in sort of this role of the patient. You understand that it’s a big deal.
Jasmin: And I think at that point, since you’re experiencing what a patient might feel like, you realize how much they feel like they don’t have control over the situation they’re in; versus where you’re an actual doctor for a patient, you have all the control.

Dr. Spond: Absolutely, absolutely. That’s one of the silver linings of going into medicine. Unfortunately, I haven’t had to do it much. But when you have a loved one or a family friend who’s in the hospital and is sick, you can go to their physician and say, “tell me what’s going on.” You don’t have to ask for a watered down version. You just say, “just speak to me, and I’ll listen. And I’ll understand what you’re talking about.” You don’t have to get the water down version, so.

Jasmin: So speaking of family, what are just some other things that you like to do outside of your job with your family or just, you know, hobbies that you have?

Dr. Spond: For sure. I’m married. I have three kids. One just turned 15 a week ago. She’s a fantastic ballet dancer. We did that whole last week. I have a 13, almost 13 year old son, and then our youngest is six. My wife’s a nurse, but she’s been staying at home for the past eight or ten years. She’s thinking about going back into the workforce now that our youngest is starting kindergarten. Um, I would like to say I like to do some amount of exercise. I know it doesn’t look like it, but I like some amount of physical exercise. And I love to read so.. and cook.. and eat.

Jasmin: I think we can all relate to that very well. laughs Yeah. So what kind of things do you like to read?

Dr. Spond: Anything that’s nonfiction. I like history. I like biographies. Anything that’s nonfiction: current events, recent history, so on and so forth.

Weijia: What’s your favorite dish?

Dr. Spond: Favorite? Oh my Gosh.

Jasmin: Or something that you can cook with conviction.

Dr. Spond: With conviction that I know I’m gonna do a really good job is steak, brisket. If it was my final meal, it would probably be catfish, coleslaw, and hot sauce. Yeah, so those are some of my favorites.

Jasmin: If you ever retire, just open up the kitchen. Southern cooking kitchen. I feel like there’s not enough of those around here. So yeah, I’d definitely go.

Weijia: So a little shift from personal life into your dreams and beliefs. So are there any goals that you’re currently working towards?

Dr. Spond: Yes. It’s my ongoing goal, which is very nebulous, which is to improve in all directions. I’ve never been very big on setting a grand course and following it. I kind of get distracted too easily. So if my transition from engineering to medicine happened out of luck and chance as opposed to grand plan. So I would say my goal is to continue in all directions wherever that leads me.

Weijia: OK, interesting. In terms of healthcare, is there anything that you would like to see?

Dr. Spond: Oh my gosh. OK, let’s see here. I wish that patients would, and I would probably be just as guilty if I hadn’t gone into medicine, would be a little bit more attuned to their own medical health or overall health. Sometimes it’s puzzling why, I ask patients if they ever had surgery, and they said no. And then they have to think and like, “Oh yeah, I had this” If I ever had surgery, I think I would remember, so from the top of my head, that would be the first thing I would say.

Jasmin: I think that kind of plays into just like health literacy. You know, they don’t know that this is something that’s concerning and should be given attention to their healthcare provider, so they don’t mention it. But yeah. Another question I have, this is actually not necessarily on our script, but I’ve always read about how you know people can or medical students for example considering going into anesthesiology. There’s always this saying or a lot of news going around about “oh CRNAs will eventually replace it”. That’s a hot topic now. So I would like to hear your opinion.

Dr. Spond: Sure, sure. They’re very important part of a team, just like Nurse practitioners are very important, important part of a team and primary care. And so it’s no different. You know, they’re valuable components of a team, but yeah I’m not worried about that, no more than than someone going into family practice, Pediatrics, internal medicine, psychiatry, dermatology, list goes on and on.

Jasmin: For me who doesn’t know a lot about anesthesia, anesthesiology. Can you delineate what are the responsibilities of an anesthesiologist versus the CRNA, the daily works,

Dr. Spond: Yeah, absolutely. So CRNA is advanced practice nursing and other states, it would be the PA version and anesthesiology assistant. They’re gonna be the ones in the room who are monitoring the patient; monitoring, reporting during an anesthetic. The physician’s job is to diagnose and treat. The physician job is at the top of the helm, if you will. Often times, it seems like we’re the only physician that looks at the entire patient when they come to the hospital. And again, that kind of goes back to where, I can’t legitimately say, really anything in medicine, I don’t need to know that. I need to know everything. I need to be the absolute best physician for the patient, for my team members, whether it’s nursing anesthetist, whether its residents, whether it’s in another state, anesthesiology assistants. I need to be the absolute best physician I possibly could be.

Weijia: Awesome. That’s cool. And for people like me who are interested in anesthesia, where do you see the field in the next 10, 20, 30 years?

Dr. Spond: I think it’s only going to expand. Basically, at any hospital anywhere in the country, sort of the economic engine of any given hospital is the procedural arena, whether it’s operating room, interventional procedures, whether GI or cardiac, etc. That’s the economic engine of a hospital, and that was really, kind of brought to light with the COVID Pandemic. A lot of hospital functions shut down; people were sent home; etc etc. But the operating suite just kind of has to keep going, for number reasons, to take care of patients. But it it’s also economic generator, and so anesthesiology services are always going to be required in that interventional arena, whether it’s operating room, what we call off size interventional GI, interventional cardiology, etc, etc.

Jasmin: That makes sense because when COVID was hitting, the question always being asked within healthcare was like, “OK, what preoperative or what preoperative testing must a patient go through before they’re like qualified to get their surgery?” It just seemed like hospitals always emphasized on the pre-OP testing because like you said surgeries are such a huge honestly, like revenue generator, for big hospital systems such as UAMS.

Dr. Spond: Exactly. They are. You know, it has to keep moving. And patients with cancer, they need to have an operation, right. So at some point, you know it’s gonna be too late for surgery. So the whole system has to keep moving, even though the COVID pandemic kind of showed that that we kind of slowed a lot, but we kept moving.

Jasmin: So Family Med and internal, I feel like can move to Tele health, but I feel like what you do, can not move to tell telehealth.

Dr. Spond: Exactly. You know, interventional procedures can’t be outsourced. You can’t let a robot do it.

Jasmin: Sounds like some good job security. Now you’re making me think “that’s some really good job.”

Dr. Spond: probably so. I can’t see the future, but probably so.

Jasmin: A good outlook. It would be a good answer to that question.

Weijia: Yeah, that’s good to know. ’cause I’ve heard it being replaced by CRNA; also like modern technology.

Dr. Spond: I had heard that we’re replaced by CRNAs 15 years ago when I was in your seat. And the person I heard on campus, who I have great respect for, he’s 20 years beyond me, and he said he had the same question 35 years ago. Question’s been around forever.

Weijia: Good to know.

Dr. Spond: Yeah. You know, the AI thing. That is probably, frankly, in all of medicine whether it’s certainly about radiology all the time. If you look into radiology, it’s gonna be dominated by AI, I have no idea if that’s true. I got to do a mock interview with an M4 student this past year, and I made-up a question about whether this person was concerned about going into dermatology, whether AI would play a role. And I completely made this up. I didn’t realize that’s a real thing. Google has some sort of app that can diagnose melanomas with great accuracy. So, in all of medicine, I can’t tell you where the future is going to go. It might be. It does take over: AI. That’s something to be aware of, and I don’t think anybody would be sheltered.

Jasmin: It is definitely a thing for pathology. For a bit, I was kind of interested in pathology, and that subject was always brought up. I actually have an app on my phone called Diagnose Us, and it uses AI technology. So medical students or residents or even doctors can join the app, and it will have like pictures of chest X-rays or skin biopsies, and there’s a little practice question or practice session where they’re like train you to look at different diagnosis. So the point of this app is to develop AI to work smarter. You’re not necessarily diagnosing these actual pictures that they’re showing you, but you’re just teaching AI. It’s the manpower of teaching AI, so I definitely think that’s a new forefront, but I think there’s just so many parts of medicine where you just need a pure brain.

Dr. Spond: Yeah, I think you’re right. I mean it’s like there’s been so many things over the last hundred years where we’ve just adapted, from invention of cars, to airplanes, and so on and so forth. We’ve incorporated those things: smartphones, computers, calculators, etc. We’ve benefited. There’s a net benefit. Has it displaced some people from work? Yes, you don’t make horse and buggy carts anymore ‘cause we have cars. But it’s been a huge net benefit to society.

Jasmin: The only thing is, can AI comfort you before surgery? I don’t think so. I think there’s personal aspects that a doctor provides to patients that I don’t think AI can ever really replace so.

Weijia: No AI is gonna tell you “we’re gonna make your day as boring as possible.”

Dr. Spond: I tell patients, you know, I my crystal ball is broken. I try to be a little funny. I said my crystal ball is broken; I can’t see the future. And my magic wand is broken. I can’t metaphorically pull us out of the ditch. So it’s better to stay out of trouble than to get out of trouble. But we’re going to work hard to stay out of trouble.

Jasmin: Um, veering back, I guess, to anesthesia. We went a little tangent about AI. But what advice do you have for medical students, whether they’re pursuing anesthesiology or not pursuing anesthesiology? Like these four years are pretty tough. I know residency gets tougher, but what I advised do you have to set us up for success?

Dr. Spond: Work hard, be bold. Don’t be afraid to make mistakes. Get exposed to as much as you possibly can. Will it all stick the first time you see something? No, but important common stuff. I think Weijia heard me say this morning. If common stuff comes up again and again. And the sooner you can get water, in my mind everything is Cartesian coordinates, right? So on the Y axis we have exposure experience; and the X axis is time. You wanna high arching curve with with as much area under the curve as you possibly can. Will you instantaneously memorize and remember and incorporate everything you hear? No. But will it come up again and again? Then you could scaffold onto what you’ve already heard, yes. So get your hands dirty. Don’t be afraid to make mistakes, safely. Don’t be a wallflower. Read, read, read, read, read. You’re gonna read the rest of your life. I mean, I brought an article that I’m half done with. So I try to read two articles per week. It’s probably grossly under what I need to, but it’s better than nothing.

Jasmin: So I heard that advice from another. I think he was a general surgeon. He reads one article a day before you know, bedtime reading. OK. I feel like I’m backtracking, but I think this popped up. But what made you choose this area of anesthesiology, like academic medicine?

Dr. Spond: You know, I really am, you know, at the root of it all, a big nerd, and I like to learn. And the academic setting really lends itself well to that as you can interact with other learners, and I’m gonna be learning the rest of my life. I say I’m a M18 now I guess, so that just goes to signify that I still consider myself learning. And it’s a environment where I want to be encouraging. Nobody in my family is in medicine. I had an aunt who’s a nurse, but no one in my family is in medicine. And so I just wanted to show other people that if I could do it, they can do it too. Especially coming from a 90 degree turn from engineering.

Weijia: And I just want to say that you packed a lot of good advice all at once. Like with not being a wallflower, and also not being afraid to make mistakes. I think that’s a big thing, especially for us M1. I don’t know how Jasmin feels, but I feel like, for us, we feel like we don’t really know much, I don’t know if I can do that. But really, it’s important to get yourself out there and just start doing things.

Dr. Spond: yeah, exactly

Jasmin: I feel like a lot of times we’re too afraid to be wrong, and that’s the culture that’s cultivated. I wouldn’t even say just with our class. I feel like with a lot of people, a lot of medical students. We’re group of very intelligent people, so we all go through impostor syndrome. But I don’t think we all realize that. And so we’re always so scared to be wrong, And so you think that like, “oh that guy says smartest person in the room,” but really that guys just too afraid to say something that makes his wrong.

Dr. Spond: Exactly, impostor syndrome is very real. I mean, I still have impostor syndrome and maybe I should, I don’t know. But you wanna make mistakes early. What you don’t want to be is a silent wallflower. And then the next thing you know, you’re in M3, and M1 and M2 are looking up to you for the answers, but you just don’t have the answers. You remain quiet. And then you’re a M4 and then more people expect more of you, and you still can kind of keep it hidden. And then you’re an intern. Then you got people above you and below you expecting stuff from me. Then you’re upper level, and people below you and and above you have more have more expectations of you. Rather, stumble and fall and pick yourself up early on. That’s the best thing, so work hard and don’t get a wallflower. Get your hands, metaphorically dirty.

Weijia: And something kind of random, but because I’m on the preceptorship, I was told by one of your residents to ask you about your car. What kind of car do you drive and does it have a seat?

Dr. Spond: I had a car like 20 years ago that did not have air condition and yes my car has air conditioning. I have a 2007 Toyota Camry. And a leopard can’t change his spots. I love my car. And they probably asked you about this because about a month ago and I fixed it, I went forward over a parking bumper in a parking lot, and then I came back over. And it kind of popped this piece of plastic down, so it was kind of dragging for a little bit. I put some tape and the tape fell. So I don’t care. You know, you ever Uncle Buck, the movie? To the to the listeners, if you’ve ever seen Uncle Buck, it’s not quite that bad, but my kids called the Uncle Buck. And I ya’ll should look up Uncle Buck.

Jasmin: My dad has a Toyota Corolla, and something about the plastic… Oh wait, this is not sponsored. laughs No, actually, I remember it kind of came unhinged. And it feels like plastic, and you just got to pop it back in. And my mom drives a 2002 Honda CRV, and she travels for her job. So if it ain’t broke, don’t mean to fix it, don’t replace it.

Dr. Spond: I drive my 2007 Camry and I got it when I was beginning of the M3 and I love my car.

Jasmin: So next one is gonna be a Tesla is what you’re saying.
laughs

Dr. Spond: My wife actually has two nice cars,

Jasmin: OooK

Dr. Spond: One of them is a hand me down the moment I want it, but I don’t want it. So then it’s becoming our 15 year olds; she’s like, “well, I’ll take it.” That’s not gonna happen; you’re gonna get my Camry.

Jasmin: You have a backup?

Dr. Spond: what else did they tell you to ask?

Weijia: That’s the only one. The AC thing was the big one.

Dr. Spond: I’ve got air conditioning. Yeah, I’ve got air conditioning in my car, thankfully. I did in back in 2002. I had two engineering buddies, and we shared a house over in West Little Rock. And we went two full years with no air conditioning in this house. We rented it. It’s a long story, and there’s a lot of hard headedness and stupidity. everyone laughs And who’s gonna crack first? Who’s gonna complain first? And we went to full summers with no air conditioned house.

Jasmin: In Arkansas

Dr. Spond: And we had good jobs, and we could have bought a new air conditioner. We could have bought the house. But who’s gonna flinch? Not me. That might have been what they were talking about my air conditioner.

Weijia: I think she said your old car before you got your new car did not have air conditioning.

Dr. Spond: Oh yeah, my old car didn’t have air conditioning. So my now wife when we were dating, she lived up in Conway. And I would like take off my undershirt, and just wear a shirt that I wasn’t even going to wear to see her. I’d park at her parking lot of her apartment complex. I’d wipe down with some paper towels and go in. So yeah, my old car didn’t. I’m too proud.

Weijia: Alright, as we’re getting near the end, I wanna make sure we hit all these questions just very quickly. How can a student contact you if they have more questions? If they wanna shadow you?

Dr. Spond: I’m the only Spond at UAMS. So Spond Matthew at UAMS.edu.

Weijia: And is there anything else that we have not covered that you would like our listeners slash students to know?

Dr. Spond: Yeah, absolutely. Just have confidence in yourself. It’s a long, hard slug. You hear sometimes, I hear in people when I was in medical school saying “oh med school’s easy.” And so my two questions to them would be: number 1, did you go? Don’t tell me it’s easy if you haven’t been. And what were your grades? Were you AOA or not? And if you weren’t, then don’t tell me it was easy ‘cause it’s tough, it’s hard. Be proud of yourselves. It’s a long, hard slug. It feels like a sprint at times, but it’s really a marathon, and it is hard, it is difficult. But it’s your long term, durable competitive advantages. It’s what sets you apart from physician assistants, nurses, nurse practitioners, and everything else. There’s only one way to do it, and it’s to go through it. And if I can do it, anybody can do it. I only had two Biology classes where I started in M1 year, freshmen level biology, which some of it included: plants have cell walls. Totally worthless when you get to med school. And then I had a pretty good microbiology class, and that’s all I had. And was I studying scared for most of medical school? Yes. But does that work? Yes. So if I can do it, anybody can do it. And like I said, I’m cheering for you. I think that’s what I try to usually tell people who are in my academic house: I’m cheering for you. It’s tough. It is hard. I didn’t know what I was getting into. Nobody in my family has been through med school. It was kind of the great unknown. The fea of the unknown is the biggest fear there is. So yeah, be proud of yourselves. Keep your chin up, keep working, and you’ll get there. Four years goes by really quick. What your real goal is: someday to be board certified in whatever specialty you enjoy. That’s five, 10 years down the road for most folks who are in med school. But you want to be board certified, active and productive physician in whatever specialty you like. Because we need good family practice doctors. We need good psychiatrists. We need good general surgeons. We need good OBGYNs. We need all you folks.. Whatever somebody is has a passion for, go for it.

Jasmin: I’m so happy this is recorded ’cause then I can just listen back when I’m at my low point. laughs On that note, thank you so much for having this interview with us. And he dropped his e-mail earlier, so everyone feel free to contact him.

Dr. Spond: Yeah. Thank you both. This has been fantastic.

Weijia: Thank you. And listeners, as always, please reach out if you to let us know about your thoughts, concerns, or questions. We’ll see you in the next episode!

Introduction

Our second episode highlights Dr. Joseph Margolick, a general and trauma surgeon as well as Assistant Professor within the Division of Trauma and Surgical Critical Care in the Department of Surgery. In this podcast, we cover topics related to his career pathway and his interests, including research, global health, differences between healthcare systems, etc. Listen to learn about his passions both inside and outside the hospital!  

Listen to Episode Two.

Information about the article mentioned regarding the six pillars that indicate sustainability of global surgery partnerships:

Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986.

Episode Transcript

Hannah: Welcome to the second episode of mentor spotlight, a podcast designed to help connect UAMS medical students to faculty mentors. We are Hannah, Manasa and Weijia, your host for this episode. Today we have Dr. Margolick, a general and trauma surgeon as well as a surgical critical care specialist in the surgery department at UAMS and he is excited to be a mentor for students.

Manasa: Dr. Margolick is originally from Canada, he first moved to Texas where he completed his fellowship in trauma and critical care surgery then he came to Arkansas. His past experiences include working with the Canadian Red Cross global emergency response unit as well as working as a research assistant and Tel Aviv Israel. He has done research on numerous topics from trauma care to global surgery initiatives he has helped to develop institutional guidelines within UAMS here.

Weijia: If you ever work with him during rotations you will see that he is very passionate about teaching students and is an advocate for student involvement. He is the epitome of Canadian kindness we can not wait for you to meet him so without further ado let’s get started! Alright Mr. Margolick…

Everyone: *laughing*

Dr. Margolick: That’s alright, yeah it’s MarGoLick, yeah and it’s just it’s kilogram backwards if you ever forget.

Weijia: kilogram 

Dr. Margolick: Yeah, not that it makes it that much easier to remember.

Weijia: OK OK hi Dr. Margolick

Dr. Margolick: Hi

Weijia: Can we start off with you telling us a little bit about yourself?

Dr. Margolick: Yeah sure so first of all I think this is a great podcast and I really commend you all on this initiative. It’s great to see medical students taking interest in mentorship and helping other medical students find mentors so… so good on you all. Yeah so as you mentioned, I’m from Canada. I was born and raised in Vancouver BC. I did my undergrad near Toronto and I did my med school near Toronto and took a couple years off kind of in between. and you know I… I came down to… to Dallas to do a residency or sorry fellowship in trauma and… and actually haven’t been back to Canada since, which is odd. It’s been like almost three years since I’ve stepped foot on Canadian soil and you know I… I really like it here and my passions are really just trauma care, critical care, emergency surgery and just making sick and dying people people better.

Hannah: Nice, alrightly, so for us and M1s who’re new to everything, could you just tell us a little bit about what your job entails, what you do kind of on a daily basis.

Dr. Margolick: Absolutely! I mean I… I really… one of the things I love about working here is that my… my job is quite varied. You know I…I mainly do clinical work and that’s divided between trauma surgery so take trauma call, an emergency general surgery, and those are both pretty full on and then I also do surgical critical care, so that usually is like a week or so of critical care every six weeks and then on top of that I have a you know a modest elective practice that I try to squeeze in and I do endoscopies, colonoscopies, and EGD and then when I’m not you know doing clinical things I… I try to get some research done, so I’ve got a few projects on the go with medical students like yourselves and I’m interested in divisional initiatives like trauma guidelines and then we’ve recently started doing trauma simulations, which has been a lot of fun. We’ve partnered up with the metropolitan EMS service and they had these really cool mannequins that are that are like these, I think they’re called, trauma FX mannequins and they’re extremely lifelike and you can pump them up full of blood and create pulsatile bleeding and have them mimic lots of trauma physiology like tension pneumothorax or airway emergencies, so just like a airliner might simulate various cockpit emergencies we’ve been simulating trauma situations with the residents, so that’s been that’s been a lot of fun. So yeah every day is different and… and then on top of all that you know teaching medical students and residents.

Manasa:  It’s really cool you get a wide variety of like differences in day-to-day I guess too.

Dr. Margolick: Yeah absolutely and I mean for someone like me I knew that that was going to be important and that’s one of the reasons why I like trauma. You know we get to operate in different body cavities. You never really know what to expect when one is coming through the door.

Manasa: So we know a little bit about where you trained for medical education, but can you tell us a little bit more about your background in education as far as the undergrad or like even what you wanted to do when you were growing up versus how that changed with time.

Dr. Margolick: Oh yeah, well you know I… I don’t have a formal background in education, you know I haven’t actually done any university training. I don’t have a masters in education or anything like that. I… I got my undergrad degree in… in psychology and biology and I originally wanted to be a clinical psychologist and I actually was gearing up to do a Ph.D. program in psychology, but I don’t know. You know sometimes you don’t even necessarily make decisions or make plans things just kind of happen and I kind of just had a change of heart and a bit of an awakening that I thought medicine was gonna be the right career choice and so kind of near the end of my fourth year of university or sorry college, I pivoted to to medicine and haven’t looked back since. As far as my educational interest, I guess I don’t really have any formal training I think a lot of it is, at least in my opinion, kind of intuitive and a lot of it is based on trying to emulate what my mentors and what my educators helped me with and how they were most effective. So that’s sort of what I try to do. I… I would say that I don’t have any, like I said, formal background or… or formulaic approach to… to teaching or education. It’s just sort of you know what interests me and hopefully my passion kind of seeps through.

Weijia: I see and you said that you changed your interest in undergrad. I was wondering what made you change your interest, made you become interested in *implied trauma surgery and critical care*

Dr. Margolick: You know there was really no defining, I would say no defining moment. It was just sort of a set of various circumstances and you know when you go into something, you know with a preconceived idea of what you think is going to be the end result, it can sometimes take a long time to… to change directions. It’s kind of like turning a big ship and so I think there was just a bunch of different experiences and… and circumstances that just caused me to… to change my mind you know. I realize that I didn’t want, you know, for one thing I wanted to be active. You know psychology is really interesting but I kind of thought I might be a bit bored sitting, you know in an office all day or I just kind of wanted to explore other options and so it’s… it’s really hard to say. There was no defining moment. 

Hannah: Was there any defining moment for like, this is I want to do, surgery, trauma surgery, critical care? Or was it like the same, I kinda just ended up here?

Dr. Margolick: Yeah, I mean I’ve never been one to really make a whole lot of plans. You know, I’m not a 20, I’m not someone who, *pager beep*  scuse me, I’m not someone who thinks you know twenty steps ahead you know. But it is funny because, you know, psychology is… is very different than trauma surgery. But I think there are some kind of parallels, you know, there’s a real exploratory element of both fields and… and as soon as I started general surgery residency, I just knew that that trauma was gonna be it was gonna be where I… I ended up and… and… and as a Med student I knew that general surgery was where I wanted to be, to end up and I mean I… I enjoyed being in the operating room but I just, I enjoyed the idea of being able to be that doctor that could identify a problem and then fix it. You know I didn’t like handing things off necessarily, and so yeah. It’s funny because as soon as I entered Med school, I mean within like two months, I was like yeah I wanna be a general surgeon and then as soon as I, *pager beep* excuse me and as soon as I started general surgery resident, I was like yeah trauma emergency general surgery that that’s the field for me and I think it just has a lot to do with my with my personality and just yeah I… I like kind of like the unknown and the excitement of not knowing what you’re going to find.

Hannah: Something new everyday. 

Dr. Margolick: Yeah!

Manasa: So I guess along with that, do you have, I know we kind of talked a little bit about your research interests but a little bit more about your passions within the field like any specific things that you haven’t already mentioned and I know you mentioned that you do trauma guidelines and trauma simulations and anything else that students could potentially get involved with working with you with or anything like that.

Dr. Margolick: Oh yeah, absolutely! I mean I have quite a few research projects on the go. You know at the research is hard because as a Med student, you know, which you don’t have a lot of is time and you also don’t have a lot of money and research requires a lot of time for no money. So you know it’s tough but it you know I would say that I am really interested in getting Med students involved in… in research not because I feel like I’m the greatest mentor for… for research I’m… I’m not the world’s greatest researcher, but I do think that it is important to be invested in in the future of ones field and it and it just shows a commitment to growth and… and learning within the field of medicine and so I… I think getting involved in research for medical students is… is a really good investment in… in one future and it’s also just something too that, you know, you get to know people and department or the division of the field that you’re interested in. You know for example just like the three… three of you I mean,  you know, I know that you’re interested in surgery *indicating Manasa*. I’m not sure about you all yet. If you’re still deciding but now you know me and you know now you’re getting to my other colleagues like that kind of stuff is important for building connections in the future so yeah I think just getting getting those students involved in research I think is… is a good interest.

Weijia: And is there, what are your passions outside of medicine?

Manasa: We are taking a big shift. Yeah like you’re inside the outside *the hospital*

Hannah: Like a complete 180

Dr. Margolick: I think that’s about tapped out on research stuff but you know I… I would say probably like a lot of you have a lot of interest and some of some of them had to take a backseat to training you know. So you know I used to do a lot of hiking. I used to work as a hiking guide and used to run quite a bit. My… my wife, whenever I got too chunky would just sign me up for marathons and I’d participate. 

Hannah: That’s something I think my mother would do.

Everyone: *laughing*

Dr. Margolick: Yeah… yeah like you gotta be kidding me. But you know I just like being outside you know fishing or hiking is probably my favorite thing to do now but I haven’t… I have a baby at home and so she’s been taking up just about every ounce of my free time.

Hannah: As kids do. So I know you said that you don’t really plan 20 steps ahead, but are you… do you have any current goals that you’re working towards in the future whether they be long term, short term, inside medicine, outside medicine?

Dr. Margolick: Yeah, you know I… I think at this point you know I’m… I’m still early in my career as a faculty so my short term goal is just continue to progress and continue to get better continue to improve as a surgeon as a clinician and as an educator and there’s really just no substitute for… for experience you know and so that… that’s sort of my… my short term objective is just to kind of come in as someone who’s open to new experiences and willing to take on new tasks to help the department, help the division and… and help myself grow, just kind of like how you are all doing that today. You know my long term goals, you know, I… I… I love UAMS. I think this is such a great institution. I think you know I… I never planned to be in Arkansas, you know but I came here and I immediately fell in love with this place and I think that we have a phenomenal department and a phenomenal division and so, you know my long term goal’s just help continue to grow and develop this department and… and… and turn it into and well continue to… to help it grow and really turn into one of the premier trauma centers in… in the country, which I think it is.

Manasa: So I guess this is more of like your ideals of goals of what you see in healthcare but like what changes would you wanna see in healthcare and what are the main concerns you have with it right now?

Dr. Margolick: Well…

Hannah: A complex question…

Dr. Margolick: Yeah, well you know, I tried a different train a different system as you know the Canadian system is you know universal health care so you know physician and hospital services are… are completely free for… for residents and citizens and so yeah that’s what I was used to you know so dealing with insurance issues and having you know patients without insurance not be able to pay for their services and you know that… that part to me took some getting used to. I don’t have to deal with that stuff on the day-to-day basis but occasionally you know we have to cross paths with the insurance companies and you know it… it… it does sort of bother me that… that access to Healthcare is a challenge for… for millions of people in this country and so I don’t know what the right answer is. You know there were there are downsides of you know universal healthcare system. I mean are… my wait time for a lap Kohli is maybe three weeks you know whereas in Canada might be six months so there is upside to… to certainly to this system I think one of the challenges I’ve seen coming to Arkansas though is that patients come in and they’re not healthy you know.. they don’t see primary care physicians necessarily very often they have untreated disease you know untreated cardiac disease and… and that impacts only my practice but you know any surgeon that comes into contact these patients will have to optimize them and so that becomes that becomes a real challenge so I guess if I could make one change it would be just better access to primary care. You know I think family doctors have such a critical role to play in patients lives and in their overall well-being and long term health so I would love to see patients engage with their family doctors more and be able to access them or more easily.

Weijia: that would be a good change for sure. You said that you’ve worked in the Canadian system too and I was just curious would you recommend students to maybe go out of the country for some medical experience?

Dr. Margolick: I think that’s beneficial yeah I… I mean I… I think so it… it… it… I mean I went to you know if you’re… if someone kind of like you know there’s… there is an adventure element to it you know I… and I think that that’s important to recognize. You know I… I don’t think that two week rotation in another country is gonna, you know you’ll learn some things but it’s not gonna make a huge difference in your medical knowledge. I don’t think, I mean it kind of depends on where you go at least that was my experience so I… I mean I went to Haiti as a Med student and I just I… I met this doctor who was an anesthesiologist at my Med school who was from Haiti and I just chatting with him one day I said you know I really like to go and he was really cool and he just hooked me up with this doc in rural Haiti you know and I just kind of went there on my own for a month and… it was really cool yeah few hiccups you know like I knew it wasn’t a particularly safe country there was a lot of kidnappings at the time and they actually forgot to pick me up at the airport which was you know.. where you are.. scary and you know I learned a lot on that rotation mainly about just healthcare disparities and how difficult it is for you know people to get the care that they need and a lot of other countries but…so from that perspective it was really beneficial and it also kind of plugged me in with a bit of the global health scene which I continue to sort of be involved into this day. So, yeah, think it’s a very I think …I think… it’s exciting and a useful opportunity if one goes into it with the knowledge that you know.. you know maybe the medical knowledge is not the prime objective is to make connections learn about another country, learn about another culture,  and… and with the idea that you know it’s best also to to take something away that’s going to be a bit of a…a long term collaboration or.. or commitment with…with…with people from other. *pager beeps* I’m so sorry.

Manasa: so for our listeners that don’t know much about global surgery since we’re on this topic now. I know coming in I didn’t know much about it but I was curious so I guess for a student that’s wanting to know more about it what are some resources or where some places or people that can talk to you about just getting like their toes dipped into the sea of it.

Dr. Margolick: yeah yeah absolutely so a lot of universities are big into the global surgery field so for example, Duke University, UCLA they have large branches and divisions dedicated to global surgery. It…it is a bit of a convoluted field because there are you know NGOs involved there are you know academic institutions there are faith-based institutions all sorts of different fields and specialties so I’ll tell you it is I think it is a difficult thing to…to even start to wrap one’s head around you know because it can just be kind of… all this overwhelming. You know, Operation Smile, Doctors Without Borders, various universities…it’s difficult I think the best way to start is to make a personal connection you know with someone who is actively engaged in the field of global surgery. So for example, here at UAMS Dr Lori is… he’s a colorectal surgeon and really great guy and he’s involved in actually doing trips to abroad. I think he goes to Liberia every few months or so and other various other trips as well that other various surgeons have taken. I personally started out through the Canadian Red Cross and my… it was just just like that was personal just like my trip to Haiti was a personal connection as a trauma surgeon at my Vancouver General Hospital who did some work for the Red Cross and I… you know… we… we were you know friends basically and so she got me involved in the Canadian Red Cross and I was able to go down to Mexico City for a month and just do a trauma rotation there. And that was really interesting because I just went down there to just to get you know to…to learn a lot about trauma surgery. Mexico City is only one trauma hospital in like a city of like 30 million people and so they don’t have a trauma system necessarily like we have here but… And I got to be at it which was really eye opening and very cool and then my last week that we actually had a 7.5 Richter scale earthquake that was you know… tumble a whole bunch of buildings and sadly hundreds of people lost their lives and thousands more injured but… I was just happened to be you know moment zero at Ground Zero of the Red Cross hospital in the middle of Mexico City when this happened so that was so that was quite a wild experience and amazing learning opportunity. So I digress though. I think just developing personal connections is the best way to do it. The field of global surgery has changed so much to where really people are focusing on professional relationship development and sustainable collaboration over many years and that’s changed from a traditional mission style trip where a group of surgeons from you know let’s say United States or Canada or Australia parachutes into a country, operates for two weeks, and then you know leaves. That still happens and…and that’s fine but really the the focus has changed you know there are you know several pillars of sustainability: ongoing funding, bilateral collaboration research, and authorship, ongoing training, and ongoing discourse and you know bilateral binational exchange of ideas and…and that I think is the most important thing for global surgery these days.

Manasa: So Doctor Margolick actually wrote a paper about these pillars as well so y’all can check that out.

Dr. Margolick: Yeah that was my shameless plug. The Margolick Pillars.

Hannah: I know you briefly mentioned the being in the Red Cross. Mexico. Ground Zero. And you had a very unique learning opportunity there. So while it wouldn’t be, I think, coolest would be the best word to describe that experience. What is the coolest surgery that you have gotten to see or do in your experience as a physician?

Dr. Margolick: oh boy!

Hannah: Or some unique cases you have seen?

Dr. Margolick: well well I’ll tell you what a case from yesterday. How about that?

Hannah: The recency effect. 

Dr. Margolick: What was that?

Hannah: The recency effect. 

Dr. Margolick: Yeah… so… a young guy was shot. Cruiser. Just happened to be cruising by. And somebody flagged down this cop and deputy just loaded this guy into the back of a cruiser and just dropped him off at UAMS ER and which was… that move saved his life which is I think is very cool in and of itself. You know had that deputy maybe stay called an ambulance then you know waited 10 minutes for the ambulance or five minutes for the ambulance and then like he was just wouldn’t have survived. So that…that decision to just load him up in the back of the truck and drive him to the UAMS was that in of itself is a cool…cool feature of the story. So yeah this gentleman showed up with the blood pressure in the 60s. Obviously bleeding from a gunshot wound and I took him immediately up to the operating room where he had bullet had gone from his abdominal wall through the left lobe of his liver and shattered that lobe. It had gone through and through his stomach, nailed his spleen, bounced off of something else, nailed the mesentery of his colon, and then went through his kidney. So yeah that was a situation where there’s almost an overwhelming number of priorities. I mean this guy is bleeding to death from numerous locations and time is really critical in these patients. The longer you operate on them, the more hypothermic, they more coagulopathic, the more acidemic. They get a lethal triad. So once i get into this state, this physiologic state of dying, they just start to circle the drain, so you really need to mobilize quickly and get all this bleeding under control. So I actually, I called my colleague Dr. Matt Roberts, who…another trauma surgeon here. So we work on him together and took out you know a lot of this left lobe of his liver, spleen, kidney, left colon, the left kidney, half of his stomach to get the bleeding under control. So yeah that was my late afternoon yesterday. 

Hannah: Sounds like a busy afternoon…

Weijia: just a typical day… for sure 

Weijia: So you’ve had a lot of you know international experience and you know you’ve been to Canada you’ve been to Texas. Now you’re here what’s one piece of advice that you give to medical students in general?

Dr. Margolick: One piece of advice?

Weijia: Mhm. 

Dr. Margolick: That’s a tough question. You know I think um what’s really important to recognize. You all have decided to become doctors. You could have taken the easy, an easier path in life but you decided to to push yourselves, challenge yourselves, and go into a field that is really important and really challenging and I think that’s really commendable you know. Med school is hard. Residency is very hard. Being a faculty is hard. And so, but the more that you invest in your future, the more that you invest in your career, the more that you invest in your education, the better it’ll be for everybody. And most importantly, the better it will be for your patient. So I would say, you don’t, you only get one Med school. You don’t get redo’s. You don’t get to do it twice. You get one. You have four years to become as good of a doctor as you possibly can be, and so I would say take advantage of every opportunity you can you know. Read 5 pages of a textbook every night you know. Try and do some research if you can. Review anatomy regularly. Get to know faculty. Do things like just as you all are doing. I mean this is a perfect example of…of the kind of things that I would advise medical students to do you know. Create your own opportunities you know. Medical school is not spoon fed to you. You have to seek out those opportunities and take advantage as much as possible because ultimately we have a contract. It’s an unwritten contract with society that you get these enormous privileges of being a doctor and prescribing medications or even doing surgery on patients but in exchange, you have a duty to be as good of a doctor as you possibly can be. So..so keep that focus in mind. Enjoy the moments of training and because if…if you’re constantly looking at the next step you know you’re not happy in university ’cause you’re too focused about getting into med school, you’re not happy in med school cause all you wanna do is get into residency. You’re not happy in residency ’cause all you care about is a prestigious fellowship and so on and it’s like, you know, it doesn’t end you know. Then there’s divisional promotions and department heads and all that kind of stuff to get to ultimately where you’re just in the retirement home of your choice. So it is important to enjoy the moment but also stay focused on the momentous task at hand. 

Hannah: On the flip side, what was the best advice you were given? Both either as a med student or just in life in general. You have some if you’re given some very sage words. 

Dr. Margolick: Oh man. I’ve had a lot of great mentors and I think I…I mean I’m kind of regurgitating that advice like what I just told you is advice that I got from mentor I really trusted and…and… and he’s a great guy. He’s a trauma surgeon in Vancouver. But you know he…he basically told me you know to be the best surgeon as possible you have to kind of pick the more challenging things. You have to seek out opportunities and challenge yourselves whenever you can you know. The easy…the easier path is… won’t make you better. If you’re always comfortable, you’re not learning and…and that’s true in surgery you know. If…if you’re a resident doing an operation and you’re too comfortable, you’re not…not really learning. You’re not pushing yourself. 

Weijia: So what’s trauma residency like? You know we always hear surgery super busy, you don’t get to have a life. How…how much of that is true?

Dr. Margolick: You mean general surgery residency? 

Weijia: Even trauma, yeah.

Dr. Margolick: Well the trauma fellowship is…is quite different. You know, it’s… it’s one year, it’s a lot of critical care. It really depends on where you do your…your…your fellowship and so I think there’s probably not a big ubiquitous lifestyle associated with trauma fellowship. It’s busy. You know and just like what’s true for residency, you need to apply yourself every moment of every day when you’re in the hospital. Yeah, I did general surgery residency and I mean I did in Canada. It’s…it’s different you know. We don’t have the 80 hour work. We shouldn’t have to log hours. It was different. I..I think it is a little bit more old school you know. It’s…it’s tough I mean it is you know. There’s…there’s going to be sacrifices. But there’s like most like everything in the human body there’s gotta be some hemostasis or homeostasis where there’s no substitute for experience. You have to recognize that. But you also if you burnout, you’re not gonna be a very effective physician, wife, mother, son, whatever. So you gotta try and find some balance and way to enjoy yourself outside of medicine. But yes, no, residency is busy and it’s hard and you should go into that knowing that it’s going to be hard. In fact, that should be a motivating factor you know. If you’re gonna be a surgeon you have to I think enjoy pushing yourselves and enjoy challenging yourselves and…and…and really feel like you want to rise to that occasion because if you’re constantly…if you’re constantly thinking of the you know the pillow or wanting to take a nap, it’s just gonna make everything so much more challenging. If you’re gonna do a night of call as a resident, if you accept the fact that you’re just gonna be up all night working all night then you know if you do get an hour or two of sleep, that’s a bonus you know. If you go into it thinking “Oh my gosh I just want to sleep!” and it’s just going to be so painful. So you have to go into it with that mindset. So yeah, I…I would say that there’s…there’s no it’s a very busy and challenging five years but the challenges are offset by the thrill of learning to do something that’s so unique. I mean there aren’t a lot of people on this planet who know how to do a surgery you know and…and as you progress in residency, you start to develop more knowledge, more…more skills, more and more confidence, and so that is really exciting.

Weijia: Mindset and passion. 

Dr. Margolick: yeah!

Weijia: ..and success.

Dr. Margolick: Yes, exactly! That…that’ll keep you going.

Manasa: Well if a student is interested in working with you, either shadowing you or having you as a mentor, has… just has a question they want to reach out to you about, how can they contact you?

Dr. Margolick: Yes! Email me. Yeah, no problem. I’m always happy to get emails from students. We’ve had. I’ve had a couple yeah actually a few M1s you know shadow me and I’m you know happy to arrange something and more than happy to have them scrub into the OR. So yeah just… just e-mail me: JMargolick@uams.edu. You know if I don’t get back to yo,  just e-mail me again. I’m not the best at responding. But yeah just get in touch with that way. I’m happy to do it. 

Hannah: Alright is there anything that we haven’t covered so far that you want the listeners, students to know about?

Dr. Margolick: *laughs*

Hannah: It’s OK if there’s not. It’s not a trick question.

Manasa: It’s probably also a lot that you would want to let us know about.

Dr. Margolick: Yeah, well, you know, I I think I’ve probably rambled enough on your podcast but I will say, I really do you know commend you all for doing this and I think like I said is if…if your med student that’s serious about being the best doctor possible and getting the most out of your educational experience then then doing stuff like this not necessarily this exact thing is…is…is the way forward. So congratulations y’all. 

Weijia: thank you.

Hannah: Well thank you so much for talking with us today. We really appreciate you taking the time to participate in this podcast and help out the student.

Dr. Margolick: Great, you’re so welcome. Thanks guys. 

Weijia: And as always, please reach out with any comments, concerns, or suggestions to let us know your thoughts.

Introduction

Our first mentor we cannot wait to introduce you to is Dr. Hakan Paydak of the Cardiology Division of the Department of Internal Medicine. He is well known to our medical students as he teaches an amazing EKG course for M4s! Listen to this first episode of Mentor Spotlight to learn more about Dr. Paydak’s journey through medicine and to UAMS, his interests, as well as his advice for students.

Listen to Episode One

Episode Transcript

Manasa: Welcome to the first episode of Mentor Spotlight, a podcast designed to help connect UAMS medical students to faculty mentors. We are Manasa, Hannah, and Weijia, your hosts for this episode. Today, we have Dr. Hakan Paydak, an Electrophysiologist in the cardiology department at UAMS.

Hannah: Originally from Turkey, Dr. Paydak was an Assistant Professor of Medicine at the Medical College of Wisconsin before he joined the UAMS COM in 2009. He started the cardiac electrophysiology program as well as Device Clinic here. He is also highly active in research, publishing over 80 pieces to date and has presented at over 105 conferences.

Weijia: He also teaches the fourth year class “ECG Reading and Arrhythmias”, highly recommended by those who take it. He has won over 10 teaching awards nominated by medical students, residents, and fellows.

Manasa: Without further delay, let’s talk to Dr. Paydak. Hi Dr. Paydak, we are excited to have you here being our first faculty mentor being spotlighted!

Dr. Paydak: Thank you

Manasa: Everyone that knows you has wonders to say about you, so it is high time everyone learns about you and how you want to get involved with students!

Dr. Paydak: Sure

Manasa: Can we start off with you telling us a little bit about yourself?

Dr. Paydak: Sure. I was born and raised in Turkey. I was born in St. Paul’s City of Tarsus and I lost my dad at five years of age so it was a hardship for me. But I think it made me stronger in life later on. At 11 years of age, I went to a boarding school in Istanbul, which is the biggest city in Turkey and had all of my classes in English and some in German by American teachers and English teachers. It was a private school designed specifically for the kids who had lost their fathers in the wars. I became a part of the school and I still keep my relationship with the school. We are actually going to be celebrating our 40th graduation anniversary this June and I’ll be staying at the school for one night. It is one of the top schools in the country and after graduating that school as the valedictorian, I had a brief stint in the United States as an exchange student before I graduated. When I was a Junior in my own high school, I came to the United States as a Senior high school student and stayed with an American family, whom I call mom and dad, Mr. and Mrs. George and Karen Marshall, who I’m gonna visit this weekend in Phoenix, Arizona. They hosted me for a year and that was one of the best years I have spent in my life because I came from a boarding school and then saw that people were coming to school by driving which was a big big change for me. I had a wonderful year and I still call my mom and my dad. They are gonna put me on their will. They said they saw my home here and they said “We are taking you off the will,” but that’s okay. My dad was a hall of famer in basketball in Indiana, so he told me he is gonna give me his trophies.

Everyone: *laughing*

Hannah: That’s a pretty good inheritance, if I do say so myself. Alright, if you wouldn’t mind, you told us about your upbringing, what made you specifically decide through your medical journey that you wanted to specialize in cardiology and then even more specifically in electrophysiology.

Dr. Paydak: So that’s a great question. So my uncle was an internist and my other uncle was a dentist, so they were both in the medical field. My uncle who was an internist was a great physician in my opinion and I worked with him in middle school years during summer time. I helped him register his patients and there were about 65 of them a day. And he was very caring, he didn’t even go to lunch. He started early in the morning and stayed very late. He took care of the patients. Some patients couldn’t pay him, but they would bring him some chickens or some other gifts, etc. So he was my role model. He was also very interested in cardiology but then during the second year of medical school, I went to Hacettepe University School of Medicine in Ankara, Turkey, which was a top medical school in the country and I am one of the first graduates from the English group. During my second year of medical school, I got sick during summer time. I was doing translations, I was trying to become a tourist guide to make money and I was interested in tourism and could use my english. But then I think I over worked, I was also doing some research in biochemistry and I think I overworked and I had a viral pericarditis, myocarditis involvement and I almost died. But they did a cut down and they took me emergently to the hospital and I survived, thank God. But this made me more interested in cardiology. And then after finishing medical school, I went to study internal medicine in residency, but I wasn’t always determined to go into cardiology. What happened was, I got lucky. In the middle of my residency after the second year or so they said cardiology is now going to be a different department and the ones who wish to go into cardiology can apply and if they are chosen then we are automatically going to let them finish, do three years of cardiology fellowship and that was a great opportunity for me. So I didn’t need to take any extra exams or anything like that to go into cardiology. And then I was reading a lot, I was reading a pamphlet on the wall one day during my residency and I saw that there was a scholarship from the Netherland’s government to do research in the Netherlands at one of the top centers. And I applied for it and I got chosen and I spent a year in the Netherlands and worked on cardiac electrophysiology and I didn’t know anything about cardiac electrophysiology until I went to the Netherlands. It was a virgin field in Turkey and this is happening in 1992, so this is about 30 years ago. I chose to go into clinical cardiac electrophysiology or heart rhythm disorders because mentor said this is the only virgin field in Turkey, and I know you want to stay in academic medicine, so if you chose this field, he said, then your chance of staying in academic medicine will be higher. So I did a proposal for research and it was accepted and I went to the Netherlands for a year and worked at Utrecht University Hospital for a year and was clinical cardiac electrophysiology fellow. I worked with one of the top cardiac electrophysiologist in Europe at that time. The physicist that worked in the group at the time, actually invented the mapping systems that we are using today and had 40 patents. And my boss there, he later died, Professor Robles de Medina was so kind, he told me that if they liked me they would give me the second six months of scholarship and they paid me actually three times the scholarship that I received in the first six months from the Netherland’s government and they gave me an extra 500 euros to go on vacation. So it was a great year there and that expanded my chance of coming to the United States because, had I not had one year of training in cardiac electrophysiology at one of the top centers in Europe, I don’t think that I would’ve been able to come to the United States by phone interview. So after I finished my cardiology fellowship, I was offered to stay as chief of cardiology at a smaller university hospital in Turkey, but I decided to pursue electrophysiology, because at that time electrophysiology, and still is, very expensive, so it isn’t one of the fields that is actively pursued by people in Turkey. So I thought that I should come to the United States for further training. So I applied to positions and Dr. Richard Kehoe from Illinois Masonic Medical Center in Chicago asked me for an interview and I said I don’t have enough money to come and visit you but can we do it over the phone? He said yes. Because of my prior training in the Netherlands he thought that I would be a good candidate and he offered me the job, I accepted it. When I came I told him, I have not been to the United States over the last 16 years, I was there as an exchange student but I don’t know anything about Chicago. And when I came to the airport, I might be the only fellow, who… there was a limo waiting for me, at the airport for me. He was so kind, he provided the limo, he provided a furnished apartment for me until I got my stuff and I started working as an electrophysiology fellow with him and his group. On the third day, he invited me to his home and said “look we want you to stay for another year, if you want you want to do another year” and I said “look let me apply to ten best places in the country and if I get in, I’ll do a year there, if I don’t then I’ll do another year here with you.” He wrote me very nice letters and I ended up working for his rival, University of Chicago, in Chicago. So that was that was the best training that I’ve had at one of the top schools in the country and I worked with one of the best electrophysiologists in the world, Dr. David Wilbur and I published a circulation paper in 1989 and I want to go back to Turkey and work as an electrophysiologist, but the opportunities were still not there at the time, so I decided to go to Kuwait. Because it was closer and there was an electrophysiology opportunity. But then they told me that I need to be board certified in the United States in order to work in Kuwait, so I said “I am getting board certified.” In addition, I interviewed at the University of Illinois, but I couldn’t get the job because I don’t have a license, I don’t have any board certifications, none of those things so they couldn’t offer me the job unfortunately. So I said “I am going back to training.” That was the moment difficult year of my career in the United States because I went from PGY-8 at the University of Chicago to PGY-1 at Illinois Masonic Medical Center. When I was a fellow there, the interns who worked with me became my residents, the residents became my attendings. But still, I had a great year. They made me run the EKG courses there for the morning report because of my EKG knowledge and cardiology knowledge. And I did research with Dr. Kehoe and the group. I did my clinic with him and the board gave me a year of credit because of my prior training in Turkey, so in two years I became an internist. I then decided to apply for a cardiology fellowship. I couldn’t convince Northwestern University that I would get a year of credit, but Case Western was convinced that I would get it. Case Western offered me a position out of match and I accepted it. There I worked with Dr. Waldo and the group over there. Dr. Waldo is one of the most pioneers of electrophysiology. So I have been lucky to have great mentors in my life and I think this helped me to become a good teacher, because I learned from all these wonderful mentors.

Weijia: That’s a great story, thank you Dr. Paydak. So I’m gonna take us back a little. When I first heard the word ‘electrophysiology,’ I was like ‘something fancy to do with the heart’ right. So could you explain to us maybe what you do on a daily basis.

Dr. Paydak: Sure. So electrophysiology means studying the electrical components of the heart. The heart composed of two parts, one of them the plumbing that supplies the blood supply to the heart. The other one is electrical system that helps the heart contract 72 beats per minute most of the time. Electrical problems can be due to slow rhythm problems or rapid rhythm problems. For the slow rhythm problems, we will implant pacemakers, like I did on Wednesday, to a patient who needed a pacemaker. For the rapid rhythm problems that can potentially kill you, then we can implant a defibrillator. Which can detect the rhythm problem and pace you out of it or shock you out of it and that’s what I did today at the VA medical center. We implanted a defibrillator with two leads. So there were two reasons I went into this field, one of them is: it is very rare in medicine to be able to cure things, but in electrophysiology, your heart rhythm disorders, there are chances for us to be able to cure things by procedures. One of them is ablation. Ablation is through the tip of a catheter, we can pinpoint the cause of the rhythm problem and we can burn there, without causing any damage to the patient, eliminating the rhythm problem for good. For instance, for patients with Wolff Parkinson White there is an extra connection between the upper and lower chambers and if you pinpoint that and eliminate the problem the patient will not need to be on medications for the rest of his or her life. This is the main reason why I went into this field. The second reason was to be able to prevent death in people that are prone to having rhythm problems that can potentially kill them. By implanting a defibrillator, we can save their lives and the defibrillator will get them out of abnormal rhythm problems and save them. I’ve seen many patients who have survived with the defibrillators I’ve implanted over the last 30 years.

Manasa: So you have had quite the bit of journey to where you are now. So currently, what job positions do you hold within UAMS here.

Dr. Paydak: So I’m a professor of medicine since 1995. I am the director of the electrophysiology lab and electrophysiology fellowship program since I came here 13 years ago, since 2010. And I became the associate chief of the Division of Cardiology in 2017 and I also member of the promotion and tenure committee for the university, for the College of Medicine. These are the main positions that I hold, for now.

Manasa: That’s more than enough

Hannah: That’s perfect. It sounds like you have done a lot of research in your training leading you here. Are you currently doing any research or have any particular research interests?

Dr. Paydak: Yes. We are actively doing research with our students, medical students, with our residents, and with our fellows, both cardiology fellows and EP fellows. I was just talking to one of our medicine residents who interested in going into pulmonology. One of the things we want to look at is, we use amiodarone most of the time, short term. It’s the most effective medication we have, but it does have a lot of side effects. So I was just suggesting we can look at the amiodarone related side effects over the last 13 years I’ve been here and we can especially look for the lung related side effects, since he wants to go into pulmonology, for instance. We have published recently a report on using the graphic trends for differentiating supraventricular, ventricular tachycardia and this is a special project for me because we utilized our senior medical students that rotate with me for this EKG course and arrhythmia course. They became our subjects. So what we did was, we asked them to look at the telemetry of the patients to detect whether the patient is having supraventricular tachycardia and what type is it. Is it a sinus tachycardia, meaning the normal heart beating faster and faster like when we exercise. Or is it a sudden onset, sudden offset rhythm problem. And just by looking at the telemetry they were not sure, but then when we looked at the graphic trends they showed us whether there is a sudden increase in the heart rate and it will be in the shape of a rectangle or a square versus whether there is a gradual increase in the heart rate and gradual decrease in the heart rate that will be a bell shaped curve like when we exercise. So after looking at those graphic trends, their accuracy increased to better than 95%, for fourth year medical students. This is a paper that our chief, one of our cardiology fellows right now is the first author, I’m the senior author. So I’m very proud of this paper because we got our senior medical students involved as well. And we are doing mostly clinical research and we have done some research that is dedicated to UAMS patients only and we have published them. We have also done some database driven research and we have had publications and circulations and etc. So we are currently doing both clinical research and database driven research with our fellows.

Manasa: And can medical students get involved and reach out to you if they are interested?

Dr. Paydak: Absolutely! Absolutely! So, I have to tell the story of one of our phenomenal residents who came to me as a first year medical student. She said she would like to do research with me and we did a paper together on utilization of rhythm controlling medications in pregnancy. She was the first author and I’m the senior author. She wanted to go into cardiology, but then she got married and now she is gonna work as a faculty in internal medicine at North Little Rock Baptist Hospital. I’m sorry that she’s not gonna go into cardiology but this is an example of one of our medical students, first year medical students, has published a paper with us. And one of our other medical students that did research with me is now a cardiology fellow actually, he is gonna be graduating from our program. So we get our medical students involved and also we get Dr. Mehta, Jay Mehta, who is our research guru involved with our research projects and get his input as well.

Weijia: That’s really good to hear. Personally, I have been having some trouble finding research, so I’m glad doctors are open to med students. Aside from research and your job, I was curious what are some of your passions outside of the hospital?

Dr. Paydak: Oh, I am a big sports fan. I played soccer in my youth on my high school team and also ameatur soccer in Turkey and one year in the Netherlands. When I was an electrophysiology fellow, I played soccer in the Netherlands. And then I ran cross country in the U.S. because when I came to the U.S. as an exchange student, my high school unfortunately did not have a soccer program. So they asked me to become the kicker of the football team. So the first time I am trying to kick, I am kicking and the guy that is the holder isn’t very happy and I said ‘What’s wrong’ and he said ‘Can you try and kick it a little bit higher’ because I was kicking under the bar, like soccer style. So when I started to kick it over, I became their kicker and since then I have a great passion for American Football, soccer, both my kids play soccer, and one of them is playing basketball now and the other one is at college now, at UC Berkeley, he is playing intramural soccer with some Turkish kids there, that he met over there. So sports is my biggest out of hospital hobby. The other one is playing chess, again with my kids and also I have been playing for years. It gives you an advantage of troubleshooting and analyzing, etc. so I would advise any student to learn to play chess and then to play it. And traveling, you know we go to Turkey every year to visit my family, but we have also traveled in Europe and I had a couple of clerkships during my medical school years actually, one year in the Netherlands, one year in Denmark, one year in former Yugoslavia. As a matter of fact, I saw my first pacemaker implantation when I went there for a clerkship at the end of my fourth year of medical school, in Yugoslavia.

Manasa:  That’s awesome!

Dr. Paydak: I just said ‘this is very nice, very interesting’ and now I am implanting pacemakers.

Manasa:  Full circle *laughing* So we know a little about your passions outside of the workfield, and then we wanted to ask you a little bit about your dreams, beliefs, and things you want to see in the future. So what are you currently working towards in terms of your goals for things you want to happen in the next few years or the next few times past that as well.

Dr. Paydak:  So one of the things I am really proud of is having this course for senior medical students that I started about 10 years ago. I myself had difficulty in learning how to read EKGs and even at the end of my one year of training in the Netherlands, my boss was confused that I couldn’t read EKGs as well as intracardiac electrograms. And then I made it a passion for myself to learn how to read EKGs which is still a learning process for me, even as a professor. But I also had this desire to teach the medical students, senior medical students, how to read them. And this is the only, I told our dean that this is the only program in the whole United States where we teach systematic reading of EKGs to our medical students, not all of them, the ones who choose my course. And unfortunately we have to limit the number to 10 a month because of limited space and etc. But my dream is to be able to teach every student that graduates from UAMS, how to read EKGs systematically and for that we have a plan with one of my fellows. We just applied for a grant to be able to start a podcast actually.

Everyone: *laughing*

Dr. Paydak: To be able to teach to all of our medical students how to read EKGs in a question answer manner. And also to be able to do some research related to this. Believe it or not, one of our senior medical students who is now becoming a resident of ophthalmology is gonna be the senior author but we do is we do pre and post test for the EKGs and then seeing, hoping that there is gonna be an improvement, we will be able to publish this and it’s gonna be the first. So my dream, personal dream, is to be able to teach at Harvard Medical School and I have had the opportunity a couple of years ago to be able to go there and work there, but I unfortunately couldn’t get the job because I wasn’t doing epicardial VP ablations or afibril ablations and etc. But that’s my personal dream. But I am very happy that we have this course and it’s my target, my hope, that we will be able to teach it to every student who graduates from UAMS. I wanna use the podcast idea and I wanna use also maybe lectures, maybe three lectures or so we will be able to add maybe two more sessions just for reading purposes. Maybe in 5-10 sessions we will be able to teach you guys.

Hannah: That sounds very helpful, as someone who we’re currently studying for step and all the outside resources, it sounds like the podcast is a wonderful idea and will be beneficial to more than just UAMS students as well. So going forward, what changes would you like to see in healthcare or what are some of your main concerns about healthcare as it is now.

Dr. Paydak: You see, I’ve been a little bit biased of being raised in Turkey, where the healthcare is provided to every citizen, like in England, like in Canada. So the other day I was thinking about this and I am still, again it doesn’t fit with the capitalist system of the United States as well, but I think it will be my desire that the biggest country in the world, the richest country in the world can provide healthcare to all of their citizens, whether they have insurance or not. But again, you know we need to educate our public that they have to abide with the rules of healthcare themselves early on, for instance in England I heard they wouldn’t do a bypass surgery to a smoker, for instance. So the public should also be educated to abide with the rules and then I think it will be better to prevent disease from happening rather than trying to clean up the things after the crash.

Hannah: As the old saying goes, prevention is the best medicine.

Dr. Paydak: Exactly

Weijia: Absolutely, so what’s one piece of advice you would give to med students in general, aside from playing chess?

Dr. Paydak: Okay the most important advice I give to anybody in life is: read the newspaper. Half an hour, it doesn’t matter what newspaper you read, it can be New York Times it can be Washington Post, it can be Arkansas Gazette, which I read every morning. But I start my day by reading the newspaper, it gives me a lot of knowledge about Little Rock, about the state, about the country, and about the world. So this is something that I have done since my childhood. My uncle used to send us newspaper everyday and the first thing anyone, my aunt is telling me that even before I knew how to read I would just go and try to read the newspaper before she read it herself. So that’s the most important advice because, especially with the interviews and everything, it will help you tremendously but I think it will also help you to become a more complete person and physician, if you know what’s going on in the city, in the state, in the country, and in the world.

Manasa: A better person as well as a more whole physician that can relate to patients better.

Dr. Paydak: Yes

Manasa: Okay so one question for you, is what is the best advice you have gotten over the years?

Dr. Paydak: I think my uncle whom I lost years ago gave me the best advice and it’s: if you are the best don’t worry about the rest.

Everyone: *laughing*

Dr. Paydak: So this is something that I’ve been trying to teach my kids as well so when they complain oh the coach played him more than I did, then I say ‘look if you’re the best you don’t need to worry about these things, just try your best at least, you can’t be the best at everything,’ as you know. But give me the best, give me your best, that’s what I’ve been trying to do everyday and that’s what keeps me going. And doing all these duties of clinical work, teaching, research, and administrative work.

Hannah: Alright, so our last little question for is a two parter it is: if you’re willing to be a mentor to students how should they best contact you or what is your preferred method of contact.

Dr. Paydak: I think that sending an email will be the easiest way because I am accessible to all the medical students and my email address is hpaydak@uams.edu. And I will be happy to meet with you for shadowing me in my clinics, attending/joining my procedures, or participating in our research projects, or in other activities you would like to get involved.

Hannah:  Wonderful! Thank you so much for talking with us today. We really appreciate you taking the time out of your really busy schedule to participate in our podcast and help out our students.

Manasa: And is there anything we haven’t talked about so far that you want to make sure our listeners know about today.

Dr. Paydak: Okay I have to tell you this, I learned this from Dr. Robert Robertson, who is the head of surgery. The other day i was reading a pamphlet, again my love of reading everything and there he said ‘nothing beats experience’ ‘nothing beats experience’ so again I have had four years of EP training and I have been in this specialty for 30 years, sometimes, we have to make hundreds of decisions every day but the thing I find most helpful is my experience over the years and its something that you young students are gonna accumulate each day that you work with us and work at UAMS, but that’s something your are gonna realize when you become as mature as myself or as old as myself I should say. But that’s something that I learned from Dr. Robert Robertson and I really appreciate it.

Manasa: Well you have had a tremendous journey and we are very fortunate to have you here at UAMS.

Dr. Paydak: Thank you, thank you. Good luck to you guys during your studies and again if you choose to attend my EKG reading arrhythmias course, I look forward to working with you guys.

Hannah: Well thank you so much!

Dr. Paydak: You’re welcome!

Weijia: Thank you and listeners, if you have any comments, concerns, or suggestions, please feel free to reach out to us and let us know your thoughts!