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.
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
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.
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.
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.
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!