Solving Healthcare with Dr. Kwadwo Kyeremanteng: Recent Episodes
Kwadwo Kyeremanteng
Solving Healthcare is a podcast series launched in September 2019 by the Resource Optimization Network. Led by Dr. Kwadwo Kyeremanteng, a palliative care & intensive care doctor based in Ottawa, these podcasts will feature interviews and discussions on the topic of improving healthcare delivery in Canada. Underpinned by the values of cost-effectiveness, dignity, and justice, these podcasts will challenge the status quo, leaving no stone unturned as we explore gaps, assumptions, and different perspectives in the pursuit of finding solutions to problems in Canada’s healthcare system
Note, views expressed belong to the host only.
In this episode, we are joined by Catherine Brennan, a remarkable advocate for women's health. We discuss the topic of menopause and perimenopause. Catherine also shares her personal journey of seeking treatment and embracing hormone replacement therapy. With a strong commitment to empowering women, she discusses her mission to help individuals take charge of their health and proactively seek support. We explore the nuances of women's health, delve into the transformative phase of menopause, and highlight the importance of self-advocacy. Join us as Catherine Brennan inspires listeners to navigate their health journeys with confidence and resilience.
Listen now on Apple & Spotify
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In this episode, we are joined by Dr. Lara Briden, a prominent naturopathic doctor specializing in women's health, author, and podcast host. Dr. Briden shares her expertise and insights on a wide range of topics including menopause, hormone therapy, and the concept of evolutionary mismatch. We also discuss navigating menopause and the various treatment options available, including the use of estrogen therapy. Dr. Briden's knowledge and holistic approach provides listeners with a deeper understanding of how to optimize women's health during this transformative stage of life. Listen to this enlightening conversation as we explore the complexities of menopause and the realm of personalized care and well-being.
Listen now on Apple & Spotify
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In this episode, Dr. K shares a lineup of updates and new initiatives. He dives into the achievements of The Huskies A2 hockey team, proudly sponsored by Crossford, the exceptional services of Kelly & Kerry Real Estate, the empowering work of Integrate - Healthcare Collective, and the upcoming Reversing Diabetes Summit. Plus some info on the importance of mental health with Better Help, the benefits of LMNT electrolyte replacements, and more!
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In this episode of the podcast, we speak with Meghan Walker, an Entrepologist (On-tre-polo-gist) and Naturopathic Doctor. Meghan shares her insights on delivering the best care for patients, optimizing healthcare, and the importance of personalized care. We discuss the areas we need to overcome as healthcare providers, the benefits of getting curious about our own health, and the role of innovations and technology in healthcare. Meghan emphasizes the importance of taking ownership of our health and making informed choices that align with our unique needs and goals. Tune in to this episode to learn more about how to optimize your health and well-being.
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BetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up HERE for 10% off.
http://betterhelp.com/solvinghealthcare
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In this episode, we are joined by Dr. April Elliott, a life, leadership & certified executive coach. Coach April works with people nationwide to help them achieve their goals and lead fulfilling lives. Coach April shares her insights into the coaching process and how she helps her clients develop self-awareness, build confidence, and overcome obstacles in their personal and professional lives. Through her compassionate and empathetic approach, Coach April provides practical tools and strategies for her clients to transform their lives and reach their full potential. Listen more about Coach April's work as a life and leadership coach and discover how you can apply her insights to your own life.
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BetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up HERE for 10% off.
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In this episode, we are joined by Shawna Hughes, a Canadian Registered Holistic Nutritionist who specializes in treating children with ADHD. Shawna graduated from the Canadian School of Natural Nutrition and has since been dedicated to helping children achieve optimal health through a holistic approach. Today, we discuss the relationship between nutrition, medication, and ADHD symptoms in children. Shawna shares her expertise on how diet and lifestyle changes can improve ADHD symptoms in children and discusses her approach to assessing young patients, and how she creates personalized plans that address their unique needs. Tune in to learn more about how Shawna's approach to nutrition, ADHD, and how she works with parents to support their children's health.
SPONSOR
BetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up HERE for 10% off.
http://betterhelp.com/solvinghealthcare
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RESOURCES
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In this episode, we speak with Karina Mackenzie, representative of Wanderlust. Karina shares her experience in leadership within the wellness industry and the origins of Wanderlust, including everything they do from hosting yoga and meditation festivals to running yoga studios, and more! We discuss the growth and success of Wanderlust, the challenges and opportunities faced in the wellness space, and the importance of mindfulness and community in today's world. Karina also shares insights into her personal journey and the lessons she has learned along the way. Join us for a thoughtful and inspiring conversation about wellness, leadership, and personal growth.
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BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up HERE for 10% off.
http://betterhelp.com/solvinghealthcare
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Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe
In this quick solo cast, Dr. K shares everything from the new book, 10 Optimal Health and Wellness Tips. It breaks down everything you need to get on track and maintain positive well-being. Dr. K gets into some topics from the book including, nutrition and increasing your protein intake, intermittent fasting, weightlifting, yoga, stress management, improving your sleep, meditation, and more!
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BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up HERE for 10% off.
http://betterhelp.com/solvinghealthcare
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In this episode, we are joined by Dr. Michelle Peris. Michelle is a naturopathic doctor with a clinical focus on women's health, pediatrics, digestive and hormone health, and fertility optimization. Michelle joins us today to speak with us about The Wild Collective and a group health approach, including some shared experiences and their focus on female empowerment. Michelle is a health advocate passionate about helping women of all ages tune into their bodies. She shares with us a bit about her background and how she now supports her patients through body literacy.
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BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up HERE for 10% off.
http://betterhelp.com/solvinghealthcare
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RESOURCES
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In this episode, we are joined by Dr. Ardelle Piper. Ardelle is an obstetrics gynecology specialist and works with the health community to help them learn more about menopause. Today she speaks with us about how she chose her career path and her work on midlife women’s health, pre-menopausal and peri menopause care. We also cover safe hormone replacement therapy and dissolve a few myths surrounding the concern with some previous studies.
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ADDITIONAL RESOURCES
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Sign up HERE for 10% off.
http://betterhelp.com/solvinghealthcare
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In this episode, we welcome Janette Yee to the show. Janette is a Perinatal Athletic Therapist of over 20 years and works with athletes specializing in running and rugby injuries. Janette is focused on helping mothers postpartum, today she shares how she helps pregnant athletes and provides in-home pregnancy care. We also hear about how Janette helps moms navigate postpartum rehabilitation, bridging the gaps in healthcare to take a woman safely from conception to childbirth and returning to safe exercise, cesarean birth prep, and more!
Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.
Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
SPONSOR
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up HERE for 10% off.
http://betterhelp.com/solvinghealthcare
Use Discount code “solvinghealthcare"
OFFERS
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In this episode, we welcome back Toronto-based author, nutritionist, and founder of the Academy of Culinary Nutrition, Meghan Telpner. Today Meghan shares a little about her past, her diagnosis with Chron's disease and how it affected her lifestyle. Meghan shares how she reversed her symptoms through meditation and culinary nutrition, focusing your mind, and more! We also enjoy a guided meditation presentation developed by the HeartMath Institute, showing us how to tune our breathing techniques and feel at ease and peaceful.
Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.
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In this episode, we welcome Marie-Josée Forget. Marie-Josée is a bilingual Pelvic Health Physiotherapist, educator, and mentor with 18 years of clinical experience. She operates a private physiotherapy practice focused on treating pelvic floor dysfunction and teaches courses related to pelvic anatomy and health at Pelvic Health Solutions. Marie-Josée Forget speaks with us about women's health. We learn about perimenopausal, and menopausal women and their pelvic health. How your pelvic health affects your lifestyle and sexual health, Kegel exercises, navigating perimenopause, menopause and more!
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TRANSCRIPT
KK: We are on the brink of a mental health crisis, and this is why I am so appreciative of the folks over at BetterHelp. It provides the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists that are helped make professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today. Go to betterhelp.com And use a promo code ‘solvinghealthcare’ and get 10% off signup fees.
SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive. One of the blessings that is given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change, the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast@gmail.com, reach out on Facebook at Kwadcast or online at drkwadwo.ca
KK: Welcome solving healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of ‘Resource Optimization Network’ We are on a mission to transform healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved.
KK: Kwadcast nation welcome back. We have a tremendous episode with MJ Forget. She is a pelvic floor specialist in physiotherapy and sees a lot of perimenopausal women and was really knowledgeable in terms of the issues that she sees firsthand. Many people can benefit from a pelvic floor physio, for example, if they're having incontinence, pain or with sexual health, this is such an important aspect of things. Then she dives into how holistic the approach must be how the physio can actually make some significant strides. How lifestyle changes can impact things. Honestly, I learned so much in this episode. So, we'll jump on it right away here. But first, I want to give a quick plug to our latest newsletter on substack kwadcast.substack.com. Where you can stay up to date with all our releases, our blogs, or blogs or guest appearances, courses all are on one site and it's all point. Check out kwadcast.substack.com and jump on the train. So, without further ado MJ Forget.
KK: Welcome to the show. We we've been talking more about women's health, specifically, perimenopausal and menopausal women. One of the areas that I must say it was a bit foreign to me and I didn't realize it was such a big issue was pelvic health. So MJ you've been at this for a while, like when you started? You said over 20 Maybe 25 years?
MJ: 25 years? Yeah.
KK: What lured you to pelvic health and like how big of an issue has is pelvic health ben for people?
MJ: When we graduate from university, you know, and the medical fields we get to find areas of interest when we graduate and that's kind of all that we do. And you know physio, some of them want to do orthopedics and work with sports teams. When I graduated, I went to the hospital system, which is a lot of what physios do, and I worked in ICU and I worked on the floors, I did orthopedics, post knee posts, hips, and it really wasn't where my passion lied by any means. But it was a really great introduction to all thing’s physios working in a hospital setting. So, when I thought about where do I want to go? And what do I want to do? I always had an interest at the time what we call more women's health. Now we call it pelvic health because again, all genders have pelvic health issues. I had classmates who did their thesis on incontinence. I remember thinking at the time oh my gosh “That's something that we can do?”. It really wasn't anything we were taught in university, nobody really talked about, again pelvic health, women's health, women's health issues, menopause, that was never covered in our degree. So, I took my first course and Alberta back in 1997 and I never looked back. I had no idea how much pelvic health issues was a problem. Remember 25 years ago, nobody talked about any of that. Nobody talked about bladder control issues or bowel control issues. Certainly, nobody talked about menopause, and nobody talked about sexual health, which is a lot of what we do in pelvic health. So, I started my career, like I said, I was in my early 20s and that's all I've been doing now, for 25 years. This is where I'm at.
KK: Wow. You alluded to, you didn't realize how big of a problem it was, like how big of a problem truly is it?
MJ: If we talk just about incontinence in Canada, if we just talk about general stats in Canada, 3.3 million Canadians have bladder issues in Canada. When we think about gender differences, one in four women, one of one to nine men, so it's significant. It actually gets a little worse as we age. That's an issue with menopause. So, if we think about the female population, there's about a 20% to 30% incidence of incontinence in our young adulthood. Think of like your 20s and 30s. Then that spikes up to almost 40%. By the time we get into middle age, which is kind of the perimenopausal menopausal age. Then it goes up as high as 50% in our elderly, which is a really big concern. One of the main reasons that our clients get admitted into nursing homes is because of bladder issues, and fecal incontinence rate, loss of bladder and bowel control is usually kind of an event where families then have a hard time maybe coping with taking care of their of their loved ones, and that will increase admissions to nursing homes. So, we're not talking about small numbers. It's a significant number and we have an aging population in Canada. We have a lot of people going through perimenopause and menopause. One of the biggest risk factors of incontinence is actually menopause. We have a lot of people right now who are entering kind of that phase, you know, and I think in Canada, the stats are that there's 10 million of us in this age group in perimenopause, heading into menopause in Canada. That's a big number.
KK: It's massive. And I think this is what's motivated us to cover some of this content because these are years of productivity, have high needs, like moms that are in that perimenopausal age where you're active with your family, your career paths, like a lot of people this is where they're starting to peak in their careers, a lot of demands just to be to be on the workforce, like when I think of health care workers. So, anything we could do to make them more functional and thrive. I think we need to really look at. I don't know if I realized that, like this is kind of like the peak or one of the main concerns during the perimenopausal perimenopausal menopausal timeline. What can you do? What do you do to help?
MJ: There's so much we can talk about this for hours, but we'll try to kind of keep in to keep our timeline because I can get started. I mean, if we're just going to focus on, we’ll talk the impact of perimenopause and menopause. Like you said, it's such a difficult time. You know, people going through perimenopause and menopause, like you said, are working. They are often parents, with children that still require a lot of our attention. Plus, sometimes we're taking care of our parents as well. We're kind of like in that middle group where we're busy with our careers. We may or may not have children, but we also may have parents that we help and it's a really stressful time, and quality of life really starts to take an impact. So typically, when people come to see a pelvic health physiotherapist, or a physiotherapist who's done postgraduate studies in pelvic health, what we do is we are often seeing people that come for problems of bladder control and bowel control. So that would say that's kind of when I started that was the most of what I've seen, but we also help our patients with sexual function and the ability to have pain free sexual intercourse, which is a big issue again in perimenopause and it can actually worsen and menopause as well. We help with conditions called pelvic pain, pelvic pain can be anything like you know, our patients telling me I have vaginal pain or rectal pain, and when I treat my population of men it could be prostate related type of pains. Pain in the pelvis. A lot of pain in the pelvis affects sexual function and has an impact on your bladder and bowel function. So, it's all related together. When you come and see a pelvic health physio, what's important to know is we take what they call a biopsychosocial approach to care. So that means when you come and see us, we're looking at you as a whole person. What's really great about our profession is we have the luxury of time, because when you come and see us, we have an hour on assessment with you. Follow up treatments can be half an hour, 45 minutes or even an hour. So, we have the luxury of time, and we have the luxury of talking. S o the main thing that we always want to do is let people tell us their story, you know, why are you here? What's bothering you? And how much is this bothering you? Because again, when it comes to menopause, or bladder issues, or sexual function, these are not subjects that people want to talk about easily, right? There's a lot of taboo, a lot of embarrassment. A lot of my clients think they're the only ones who cant have intercourse anymore than the only ones who are losing bladder control and can't, you know, run a marathon. Everybody thinks they're the only ones but there are in fact, not, the stats are actually quite high in terms of impact of blood, bladder, health and sexual health on our patients. So, we talk and then we address all things incontinence, bladder, bowel, sexual function, and things like constipation and pain in the pelvic area. So, we do all of that. It's quite a bit and it spans quite a lot of topics. We also talk about lifestyle because lifestyle is important. On the on, on maybe my first visit or second visit, I'm going to talk to you about are you sleeping well? Are you managing your stress well? Are you having any issues with your mental health? depression, stress, anxiety that you're not managing? Well, how are you feeling hormonally? Because part of what we do and what I've noticed during COVID a lot as well is we've kind of become a little bit of the gatekeepers, I want to see we really had to help our patients navigate the healthcare system, and a time that it was really difficult to navigate the health care system. I always tell my clients, I'm here to help build your team around you who do you need to help you navigate perimenopause and menopause so you can live your best life, because as physios, we have to stay in our scope of practice, we can't do everything. So, if I talk about nutrition, I can talk about why nutrition is important, but I'm not allowed to give you advice on nutrition because it's not in my scope. But I'll send you to the people who do that. And the biggest challenge and menopause is that for a long time, there was nobody to send people to. Right? If you think about, you know, how many menopause clinics do you know, that exist out there? Right. There's one at Mount Sinai. There's just not a lot of menopause clinics that are run by a gynecologist and maybe have a nutritionist and a psychologist all working together and maybe with a pelvic health physio, that'd be great. That could look at that whole biopsychosocial approach to care to really help our patients navigate menopause. I think that's now starting to change. I think now, you know, the tagline right now is menopause is having a moment while menopause is having a moment. I think partly because there's a lot more of us in our field talking about it on social media, there's definitely some gynecologist now that are much more vocal on social media, talking about hormones, talking about safety of hormones. When I started 25 years ago, hormones were a no go, there was so much fear around all things hormonal replacement therapy, and it was really difficult because as a physio, I could see how devastating some of the symptoms of menopause were and there wasn't really a lot of options for my patients at the time as to what to do about it. Because everybody has such a fear of hormone, whether it's topical hormones or hormonal replacement therapy, and I think that that's shifting as well. So, we talk about all of these things with our clients when they come in. Then we help navigate and say, Okay, if you're struggling with nutrition, who could we send you to? If you're really struggling with your hormones, who are the hormone, menopause, hormonal experts out there to send you to? If your mental health is an issue, who do we send you to for that so that you can kind of work on your anxiety and your depression and your stress? There's been a lot of stress, you know, in the last few years, and then as physios, we take care of more that kind of the physical kind of component of incontinence, pelvic pain, bowel health, constipation and sexual health.
KK: You know, what I'm really appreciating is you’re saying MJ is how holistic the approach is, it's not so just the physical aspects and the rehabilitation, you need to know how it's affecting your life, how you're doing from a lifestyle perspective, stress level, sleep, how well you're eating, and just approaching it that way. That's what I'm finding really encouraging about this is that you know, you're just not soloing the approach, it really comes down to how the person is doing as a whole. In my opinion when it comes to so many issues in medicine, this is the only way like, you need to really address so many of the needs outside the actual physical concern. Another thought just came to mind too, is just hearing all the, the symptoms that so many perimenopausal and menopausal women have to go through it, it just, it really is sad that so many people have had to go through without it go through all this without attention. You put it together, the hot flashes, the mental health concerns, weight issues,
MJ: the insomnia, the anxiety
KK: Then you add the pelvic pain, the incontinence on top of that
MJ: It's significant, and it's all today can be a very overwhelming time and our client’s life, because, again, they're so busy, they're under a lot of stress, they have a lot of obligations. Then they're dealing with, you know, ‘I can't have intercourse with my partner, it hurts too much. I'm leaking urine, I can't exercise. Now I'm gaining more weight. I am going through perimenopause, I got insomnia, I can't sleep’. That has huge repercussions on the human body. It's important that we all talk about those things. And it's important that we recognize the lane that we're in as, as health professionals and find the right people, for our clients so that they get better. I think you know, again, it's the tides, I think are changing that we're taking a little bit more of this kind of like sort of biopsychosocial approach, looking at the whole person. Also giving permission to our clients to talk to us about these things that it's okay to talk to me about your bladder issues and your sexual health concerns and, and your stressors in your life and how maybe you're having really hard time balancing work life balance and seeing how we can help with that. We can all help with that, in our own way.
KK: Absolutely. Give us a sense, MJ when someone walks into the office what some of the stuff you're assessing? what do you do as a physio to help patients that's within your scope? the exercises? help me understand the potential and the things that you do to help address these issues.
MJ: So, once we've listened to everybody's story, and they tell us what their main concerns are, and what their goals are, in terms of what would they like to achieve with our time together. We do a lot of education, and education can be like I said, lifestyle, sleep, how are they functioning with nutrition? Are they exercising? are they happy? Are they stressed? then we really go into the function of the pelvic floor. So, if we talk about the main concerns most of our clients are coming in with often it will be bladder issues, bowel issues, it will be sexual health issues, and maybe constipation issues, like some bowel issues, that all tends to act up in perimenopause. That's when we take out our props. I have lots of props to explain to people about the pelvis. Because again, we are not taught anything about the pelvis as human beings. And if we think about our education in our primary schools, in our high schools about pelvic health, there's none of that. So, we often don't really know about the pelvis, right? And where the pelvic what's happening to our pelvis. If we look at this wonderful pelvis has been with me for 25 years, so it's falling apart.
KK: People listening, you might have to be extra descriptive, extra descriptive
MJ: Okay, so when we look at the pelvis, if I take the muscles out of the way, this is the front of your pelvis. So that's your pubic bone. By turning the pelvis around, that's your kind of your spinal column and your tailbone would be right here. And if we look at the bottom, while the bottom is all muscular, it's just muscles down there, and you have layers of muscles, and we call it because we're not very clever. We're calling it the pelvic floor muscles. There's a lot of fancy terms in anatomy, so we won't go through that but for the sake of purpose, the pelvic floor and there's layers. The first layer, which is the most superficial, so meaning that you can touch it from the outside. These muscles here go from your pubic bone to your tailbone here at the bottom, they wrap around your clitoris, and your vaginal opening, and then they also wrap around the anal opening. All of these muscles here, the main function of these little muscles are that the vaginal opening or for sexual function, which is why sometimes we can have difficulties with maybe having an orgasm, libido, desire orgasms, and maybe we have pain with intercourse. These muscles which are under voluntary control, so we can learn to use them, they must contract, but they must relax. When things go in the vagina, all these muscles must have the capacity to stretch into expand, and that should never cause us pain. So that's this first little group. We'll maybe dive into kind of sexual function a little later. But that's the first little group. Then deeper inside your pelvis, you have another group of muscles that are deeper inside your body. These muscles, they're quite big, quite large, they wrap around your vaginal opening and your anal opening all the way from your tailbone at the back to your pubic bone at the front, those are your bladder and bowel control muscles. So if I take that muscle out, just to show you how big it is, the big muscle, front to back. When you laugh, when you cough, when you sneeze, when you lift things that are heavy, these muscles tighten around your urethra, or tighten around your anal opening so that you don't lose bladder control, you should be able to hold on to those muscles to get to the bathroom on time. Then when you sit to go to the bathroom, they relax this stretch the expand to allow us to go to the bathroom. So, when people come to see us for bladder issues, bowel issues, or sexual health issues and sexual pains, what we're trying to determine is what's happening to that little group of muscles, what's happening to that pelvic floor. I always tell my clients, there's two groups of you. There's a group that come that comes to pelvic health physio, where when we evaluate the function of their pelvic floor, they just lost a lot of strength and endurance. We see that in perimenopause and menopause because this is my hormones are important. When you go through perimenopause, your hormones are starting to dip down. They're not gone yet. But your estrogens are dipping your testosterone and your DHEA, which are your androgenic hormones are decreasing. We need estrogen for muscle strength, and protein synthesis and collagen. When we have a loss of estrogen, we start to lose muscle strength, we start to have what we call sarcopenia. Right. And that starts to increase as we age if we're not moving and exercising. So, estrogen is really important for muscle function to testosterone, which we have, we don't maybe have as much as our male counterparts. We do have some in it, it is important because it helps with muscle strength and muscle tone. That impacts the pelvic floor. So, I may have someone who has never had babies never, never could not have children or decide not to have children who come to see me, and perimenopause and menopause and they'll say, Why am I having incontinence, I never got pregnant. Well, that's because even if you have not had children, you're gonna go through menopause, you're gonna have those hormonal fluctuations. You can still have some symptoms of menopause and one of them could be incontinence. And the other thing what these pelvic floor muscles do, which is really great when they're working well, and you're able to use them properly, they help decrease the sense of urgency and frequency, right. So, some people say I go to the bathroom all the time I'm peeing every half an hour, I'm getting up three, four times a night to go to the bathroom. When we help regain function of these pelvic floor muscles to reduce incontinence can also reduce urgency and frequency and the need to get up at night. So, group number one may have a lot of weakness and loss of strength in their pelvic floor. Again, that happens in menopause with the loss of our hormones. A lot of the symptoms tend to worsen about seven to 10 years after you're done having your menstrual cycles remember that you are menopausal if you've gone 12 months without your menstrual cycle, usually symptoms of menopausal peak a kind of that seven to 10 years. I's about honestly, they're saying about 50 to 65% of the population may have actually some symptoms, you know, at those seven years, post menopause. Second group of people that often come in is when we evaluate their pelvic floor, they have all the same symptoms will have bladder issues or going to the bathroom a lot. But then they tell us they have pain, they have pain with sexual activity. Then when we look at their pelvic floor, they actually have too much tension. Okay, and that's a problem because if you look at this little layer of your pelvic floor, these muscles that wrap around the vaginal opening and your clitoris, so these are your clitoral muscles. So important to have orgasms if you have too much tension in these muscles like this when things going in the vagina start to hurt. Again, that can start to be a problem in perimenopause and into menopause, again because of hormonal changes. What happens is, you're going through perimenopause, or menopause, or maybe you're in menopause, your estrogen levels have dipped down. Estrogen is like the fountain of youth, estrogen plumps up our tissues, it increases blood flow to the area, it provides elasticity to all of our tissues, and that's your labia, and at the vaginal opening. This area is really, really rich in what we call estrogen receptors. And of course, when we go through perimenopause and menopause, that's a decreasing, and so things get a little thinner, things get a little drier, and things lose the elasticity. What often can happen is, my clients will have intercourse, and it hurts, and maybe they bleed a little bit, because again, you know, when estrogen goes low, everything gets a little drier and more sensitive, and they've been prone to maybe even some tearing, well, then that pelvic floor is actually very clever, these muscles here, they're there to protect us as well. So, if you have pain, then the next time you think about engaging in sexual activity, your brain is going to say, You know what, that really hurt last time and right away, we start to tense up our pelvic floor. And then we get caught in this vicious cycle, where we have that episode of pain because of hormonal changes, then it hurts and then our pelvic floor tenses up. Then we keep trying to have intercourse, but then we keep irritating that area, then the pelvic floor just increases in tension and increases in tension. That can lead to more pain, with sexual activity as well. So, I always tell my clients that we need to figure out which of the two groups do you belong to? Do you have a pelvic floor that just needs strengthening? Or do you have a pelvic floor that maybe requires a little bit more stretching and relaxation, to help you regain proper sexual function? You know, having sexual function without pain? In everything that we do, you know, we always take that step back and go, Okay, well, you know, what are the stressors in your life that also increases muscle tension, right? So, stress and anxiety, and lack of sleep, all increase our fight or flight response. And that's why sleeping is so important to kind of really get you restorative health, you know, and to make sure that we're refreshed in the morning, managing our stress is really important, because when you're under stress through the day, and you're in that fight or flight responses, all your muscles tense up, including your pelvic floor, right? So, then what we do is we do a physical exam. This is kind of where, you know, doing a really good explanation of the pelvic floor is really important. So, I have these really great models that I've designed over the years. And what I do is I show all of the muscles, so you've got muscles at the vaginal opening, that can be the reason you have pain with sexual activity, you've got deep muscles inside that your bladder and bowel function muscles. So, when we do a pelvic exam, we do not use speculums. We don't have you in stirrups, it's not like kind of a pap, we're going in manually with one finger and we start on the outside and we just have a look at all these muscles to see are they causing you any discomfort that could actually explain some of your pain with sexual activity. If we're able to do that, then we can go in. We can look at all of these bands, all of these muscles that you see here that's colored, these are all your pelvic floor muscles. We can evaluate all these bands of muscles right side left side to determine Are any of these muscles causing you any pain, because pain with sexual activity can be pain at the opening? or some people will tell me you know, it's deep inside. ‘It's like I can't like we have to stop it hurts so much deep inside’. Then we evaluate these muscles I say, ‘Okay, if I said to you try to contract, try to squeeze those muscles, especially with people that have incontinence, bladder or bowel, I'll say try to contract your pelvic floor’. That's where we're assessing strength and endurance, okay, how strong are your muscles? You know, how much endurance and power does your muscles generate? And if that's lacking, we're gonna work on that. So that's kind of the physical exam and the physical exam is as per our client's comfort levels. So, some people on day one will say, I'm not comfortable with a pelvic exam, maybe they need a visit or two to get comfortable with the idea. You know, some people are not aware that that's what a pelvic health physio is trained to do. We are trained to do pelvic exams for the purpose of evaluating what's happening to all these layers of pelvic floor muscles. So, you can regain bladder control bowel control, and sexual function. The other thing that this pelvic floor does, it's like a shelf, it holds up our organs and so a lot of our clients will say, ‘I feel like feel like something's falling out of my vagina’. They get diagnosed with something called the ‘prolapse’, which is everything kind of softening up and estrogen is important for that because estrogen is what we need to have strong ligaments and strong tendons. A lot of times heading into perimenopause or menopause, somebody may have had a prolapse when they had their, two, three children in their early 20s, and did absolutely fine. But now they're starting to have symptoms because their estrogen levels are decreasing. That's really altering kind of the function of what we call the collagen fibers in their tendons and in their ligaments. We have a lot of ligaments that hold up our organs, and everything just kind of soften. So obviously, nothing's ever going to fall out of your body. It's never going to happen but everything softens a little bit and part of what we have to do is strengthen that pelvic floor if needed to kind of create that supportive system from the bottom. It really is all about exercise. It's about exercise.
KK: That was going to be my next question, maybe with that first option of picking up someone that is having issues with incontinence, assuming you're addressing the lifestyle issues, and so on. But what's an example MJ of exercises or type of exercises that they will be using to try and rectify the problem?
MJ: Everybody's heard about those famous Kegels right? Everybody's heard about Kegels
KK: I’m doing them right now
MJ: Kegel, he was a physician; he was a gynecologist back in the 50s. Dr. Kegel and who's who had done kind of a lot of research on the field of the pelvic floor. We call them pelvic floor exercises. So yeah, we teach our clients how to properly contract their pelvic floor. What's important to know is that you can read online on how to do cables, and how to engage your pelvic floor, but they're not easy to do. It's important to see a pelvic floor physio, because a lot of people think they're doing them properly. Then they come and see us and they're confident ‘Oh, no, no, I’ve been doing my ‘Kegels’ fantastic, I think I'm good’ and we test them, and they're not doing them properly. We tend to cheat a lot. When we try to engage your pelvic floor, we're holding our breath, maybe we're squeezing your bum, or we're sucking in our belly. Really, you should be able to squeeze your pelvic floor, you can think about I was kind of give the example to my clients, I'm like, imagine a little ping pong at the opening of your vagina and just try to grab and pick up your ping pong and for my patients that have penises, I'll say try to lift up your penis, right. Those are some of the things that we explain. That's how you think about engaging your pelvic floor or think about stopping gas. The reason it's so important for us to do a pelvic exam is from the outside, I can't tell if you're doing a proper pelvic floor exercise. When we do a pelvic exam, it really tells us how well you are using those muscles. If you have pain, then we're at least kind of finding out that there's too much tension and if you have too much tension, I'm not giving you Kegels to do. That makes sense, right? So, if you're coming in just for incontinence, I evaluate your pelvic floor, there's no discomfort, when I'm palpating those muscles and you're good to go. Yeah, then we're going to work on some strengthening. If you're already here, and then you've got pain, with intercourse, maybe it hurts to go to the bathroom, you're not peeing really well. So the muscles are not relaxing, and I evaluate your pelvic floor and there's too much tension, well, I'm not going to give you more Kegels to do. So, in that case, we're doing things to relax the pelvic floor, and this is where we do breath work. And we do yoga-based movements, a lot of pelvic openers and yoga, a lot of breathing, maybe some meditative type of practices to help relax that tension. Once we relaxed that tension, once the pain goes away, then maybe we can do some strengthening, if that's what your body needs at that time. That's why it's so important for us to do an exam because again, I can look at you and I have no idea if you've got a pelvic floor that's too weak or a pelvic floor that has too much tension but when we palpate it we can see and then we can give you the proper exercises
KK: This is good because once again I think there is a lot of women that are struggling with these concerns and with that are maybe at a loss. Are there a lot of pelvic specially physios out there? for example if people want to get access to someone of your caliber and this is not something you could be doing virtually either right?
MJ: I did a lot of virtual; I still do. Virtual is really good for is sometimes even just the initial assessment like the first time because we do talk so much and we do a lot of education. So during COVID we did quite a lot of virtual and I continued to do so and sometimes that day one. Maybe you know if you've got COVID You can't come into the clinic well then, I'll just do a virtual with you do all the education and then you come back in to see me for kind of an in person visit when you're feeling better you know when you're not sick, things like that. So there's a lot of us doing virtuals as well. The best place to kind of find a physio in your area that has the qualifications to do a pelvic exam and to do pelvic health, is to look at the website called pelvichealthsolutions.ca and there's a find a physio feature there. You can actually click in your area, look at people's names, it shows all the courses they've done, so then you can kind of look at, oh, this person's done a menopause course, great. This person's done a hormonal health course. That can help you choose a physio in your area. That's a really great feature that we have. pelvichealthsolutions.ca is a great resource. There's a lot because we're, when I started 20 odd years ago, there was four of us in Ontario doing pelvic health. Now we have hundreds of physios who decided to take pelvic health courses as postgraduate training. We are not without pelvic health physios out there to help anybody who has a pelvic floor, anybody who has incontinence, anybody that has any problems with sexual health, anybody with constipation, there's so much we can do. Like I said, we've become resources for our clients to help them find the right people to go see whether it's nutrition, stress management, mental health and whatnot is really part of what we do to help her patients navigate perimenopause and menopause.
KK: Wow, MJ, pure gold. In terms of knowledge and resources I must say, this was some of the best explanations of the issues when it comes to pelvic health. This is the stuff as a physician, you hear about these concerns, but the way you just simplified it, using language that all of us can understand, conceptualizing it in ways that we will understand. Putting it into, for example, two frameworks, or two patient populations that you typically see, you're the GOAT.
MJ: Thank you! That's why we say to people, if you're not sure at least come in for the first visit. So, you get a chance to chat, you know, and that's a nice thing about doing virtual, you're not sure about it, we'll do a virtual and we can talk through and I think a lot of people then realize, ‘Oh, there is help for me, oh, sexual, sexual dysfunctions and payment sexual activity’. That's not okay. No, it's not okay. It's not okay, that you're not sleeping through the night because of hot flashes, right. Then really talking about the research and the evidence behind what we do. And we have a fairly high level of evidence in what we do in terms of treating incontinence and prolapse and pelvic pain. Having a chance to talk to our potential clients about that is good. Again, to make everybody feel more comfortable with topics that are not comfortable to talk about. I mean, there are still a lot of taboos around bladder and bowel health. There's a lot of taboos around sexual health. There's a lot of taboos about talking about menopause. Because we've been told, while menopause is just part of life and deal with it, suck it up, right, suck it up, you know, don't complain about it, you know. I think, I think our clients are starting to get fed up with feeling so poorly, and so discouraged about their quality of life. Like I said, it's not insignificant, there's over 30 symptoms of menopause. If we can improve any one of them, I think we're doing well, to help navigate, you know, and these challenges that our clients have. We have great research, I was just reading, just to get ready for today, that strength training again, we're physios you know, we're all about exercise motion is lotion. We encourage our clients to even get out like I always tell my clients, even your pelvic floor loves to go for a walk, just walk outside. The thing with walking is that you're outdoors in the fresh air in the sunlight, you're getting your vitamin D, you're setting your circadian rhythm, there's good research to say that if you get outdoors in the morning and bright sunshine for a good walk, you're gonna sleep better at night. Right? But strength training, which we again love to encourage your patients to do reduces hot flashes by 44%. you know, again, this is kind of in the purview of a pelvic physio or any physio is we're all about, you know, strength training to help mitigate the effects of losing estrogen and testosterone, right, strength train to reduce your hot flashes by 44%. Wow, you know, strength training to reduce osteoporosis because that increases when we hit menopause as well, because of all the hormonal changes, strength training to improve your insulin resistance so that you can lose weight and strength train for your pelvic floor because when you're strong, your whole body, everything's strong, even these little muscles here, and so kind of giving permission to your clients to exercise, but it's hard, right? because, you know, it's time, you know, and part of what happens in menopause is that people are overwhelmed with stress, and people are not taking the time to do the things they, you know, that we all get told to do, you know, eat well, sleep well ,exercise. So, it's kind of helping our clients navigate, you know, where could they find time to sneak in a little bit of exercise? What can they cut out? Right? What can they let go? What's not important, you know, and, you know, talking about the importance of strength training, I think, again, it's an eye opener. So that's why the education is so important, because when we educate people go, ‘Oh, okay, well, that's a good reason to act’ maybe that's the one thing you needed to hear, to allow you to go and think about strength training, and it doesn't have to be a lot, you know, just a couple of, you know, 10-15 minutes a day can maybe be a good start. Because the impact is so amazing, just like the impact of yoga and osteoporosis and yoga and constipation and it doesn't have to be an hour of yoga, you know, I can help find a video, that's like, 15 minutes, maybe you do that before you go to bed, right to help you sleep and so education is really key, and to, to really help our clients navigate all of these crazy symptoms they have and making sense of it all. Hopefully, get that buy in that motivation that something that speaks to them that says, okay, I am going to try to make a change. When it's hard, you know, you know, one of the things that happens with our clients and menopause is they stopped exercising because they're losing bladder control.
KK: Yeah, that was actually one of the things you're mentioning the resistance training. To create the habit, it's not about the result always. You got there, you did your part of the process, even if you get to the gym for that five minutes, and you didn't do all the exercises you were planning to do, but you're getting that that habit developed. So, yeah, as you alluded to, it's hard to do all these things. But to develop the habits, I think is, is where, if you could develop the habits, you'll be moving in the right direction.
MJ: Yeah. And I think the more information people have about the benefits, beyond what we already know, right? I mean, we kind of go, weight loss, and I gotta quit smoking, but sometimes you can actually reduce your symptoms of menopause this way or that way, you know, again, that might be enough to persuade someone to say, okay, you know what, then I do need to carve out time in my day, I need to let go of the things that maybe are not that important, and really spend time on myself, and really improved my sleep, and improved my nutrition, and improved my stress management and try to think about exercising, because again, it doesn't take a lot to make a really big change. It doesn't take a lot to go for a walk, I'm happy if you start off with 10 minutes, I'm happy. If we decide Yoga is the best way for you to manage your stress or to help with your IBS or osteoporosis that you're doing even 10 minutes of it. 10-15 minutes of it. We start small, and we build on that. We provide encouragement, because again, we all have bad days where we fall off the rails, and it's okay, we're humans, we're human beings. As long as you just keep at it, you'll start to see some changes. And, and like I said, it's building a team, because our clients need to have the right people helping because MJ can't do everything for everybody like that, you know, if we're only one person, so who are the menopause experts out there who are the nutritionists out there who have a really good interest in menopause and Hormonal Health. Who do you go see if you're having insomnia, right? Because there's CBT there's cognitive behavioral therapy for insomnia. Okay, who are the people for that? Do you want to get hooked up with a personal trainer to kind of motivate you to strength training? Okay, let's find you someone to do that. It's all about building a team and it's all about dialogue, and always talking about these things and giving our patients permission to talk about what's bothering them, and to be open about their frustrations and you know, if they're having frustrations with their weight loss and okay, let's see who's out there who can help you with that.
KK: MJ, this has been grand, it's been grand! How do people get a hold of you? I am working right now, I'm in downtown Ottawa. I'm at a clinic called Killens Reid physiotherapy, killensreid.com, we're three pelvic physios at that clinic. There's myself, my lovely colleagues, Natalie and Sophie all of which can help you with menopausal issues. You can look at that pelvic health solution website to find people in your area. It's a great resource. That's the group that I'm one of the teaching instructors for pelvic health. You can see how many great pelvic health physios we have all across Canada. There are also naturopaths, who have taken our courses that are listed. So, if you want to maybe work with a naturopath who has a knowledge of pelvic health, they're listed on there as well. We have some nurse practitioners that have taken our courses, who again have developed an interest in pelvic health. You can find all those people on the pelvichealthsolutions.ca website. Killensreid.com to reach the clinic that I'm at, you can I have a website as well mjforgetpt.ca. I'm on Instagram ‘mjforget’. There's lots of different ways to find us and, and to kind of help you with all your symptoms.
KK: I love it. I love it. Thank you, MJ, for the knowledge that you threw down the holistic approach the benefits of seeing the likes of you, I really appreciate you coming on. This is awesome. I appreciate any opportunity to talk about all things pelvic health, and I appreciate all of you've done again, because you've taken quite a holistic approach yourself as someone in medicine right in really thinking about nutrition or sleep or stress or you know, exercise mindfulness and it's always nice to talk to kindred spirits, I say.
KK: Thank you so much. Alright, well, I hope you've enjoyed that episode. Please follow us on Instagram YouTube, Facebook, TikTok, Twitter at kwadcast. Please leave any comments kwadcast99@gmail.com. Leave a five-star rating on wherever you listen to podcasts. Leave a review. Check out our newsletter at kwacast.substack.com. Everybody stay beautiful
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In this episode, we are joined by a fantastic group of employees from Bayshore HealthCare. A Canadian-owned company, Bayshore HealthCare is one of the country’s leading providers of home and community healthcare services, providing customized care plans and solutions that allow clients to remain in the comfort of their own homes. Today, we get to hear from a few of their dedicated employees about their health and wellness journey, wellness in the community, personal care, challenges faced through the pandemic and more! Our panelists share with us their diverse backgrounds and how they impact their community as well as their amazing experience working with Bayshore HealthCare.
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In this episode, we are joined by Dr. Alfred Atanda. Alfred is an orthopedic surgeon specializing in sports medicine. Today Alfred shares with us everything about his initiative, Sports Link MD, a telemedicine service for youth athletes, connecting them with specialists efficiently. Alfred also shares with us some of his past, how he balances work and his personal life and talks about physician wellness, physician burnout and his work to help optimize the physician experience, racism in the workplace and more.
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In this episode, we welcome Neil Pasricha. Creator of ‘The Book of Awesome’ Neil is a New York Times bestselling author and journalist. His work has spent over 200 weeks on bestseller lists and hit over 2,000,000 copies sold across dozens of languages worldwide. A proud Canadian, currently living in Toronto, Neil holds degrees from Queen’s University and Harvard Business School, his first TED talk gained notoriety as one of the 10 Most Inspiring of all time. Today Neil shares with us his journey toward happiness and bits of his past that inspired him to focus on mental health and well-being. He gives us incredible tips on how to start and end your day and how he continues to help people live healthy, purpose-led lives through intentional living.
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In this episode, we welcome back Dr. Lucy McBride. Lucy is a Harvard graduate with expertise in the long-term management of hypertension, heart disease, lipid disorders, diabetes, mental health issues, and more. She joins us again today to talk about women's health. We go over everything from hormone replacement therapy, to different forms of hormone replacement, perimenopause, and more. Lucy addresses the medical risks and issues with taking estrogen, and we learn about the many alternatives to hormone replacement therapy. Later in the episode, Lucy answers a few questions from our listeners and gives some great feedback!
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In this episode we welcome critical care nurse practitioner, Kali Dayton, DNP, AGACNP. Kali is a member of the Society of Critical Care Medicine and host of the ‘Walking Home From The ICU’ podcast. Kali works closely with international ICU teams to help transform patient outcomes. They focus on early mobility and management of delirium in the ICU. She joins us to chat about her early days and experience in the ICU, sedation in patients and the effects of mobility of patients in the ICU, medications, how she helps with patient healing and more. Kali tells us about what inspired her to start her podcast and shares a story about her experience with an ICU survivor.
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TRANSCRIPT
KK: We are on the brink of a mental health crisis. This is why I am so appreciative of the folks over at BetterHelp everybody the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today go to better health.com And use a promo code solving healthcare and get 10% off signup fees.
SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive. One of the blessings that has given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast99@gmail.com or reach out on Facebook @kwadcast or online at drkwadwo.ca
KK: Welcome to ‘Solving Healthcare’, I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of resource optimization that one, we are on a mission to transform healthcare in Canada. We're going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved.
KK: Kwadcast nation super exciting episode I got flowing with you. We got Kali Dayton. She is a nurse practitioner that has taken ICU delirium, ICU mobility so seriously, she's got her own consulting firm. She also has her own podcast ‘Walking from the ICU’. Such a great phenomenon. So, we got her you'll hear this episode. It's a live cast that we did a couple of weeks ago. I'm just proud of her. Someone that's taken getting people healthier and out of the ICU and functional seriously, and we need more of that going on right now. We're only gonna see higher demands. So, without further ado, I'm gonna bring Kali on but first, check out our latest newsletter, kwadcast.substack.com It has everything Kwadcast, our episodes, or newsletter, guest blog appearances, guest vlog appearances, you’re gonna love it. Kwadcast.substack.com Check it out. Without further ado, I want to introduce you to Kali Dayton. Welcome to the podcast.
KD: Thank you so much for having me on. I've been following your podcast; I appreciate your mission. I see a lot of our objectives are in line.
KK: Oh 100% 100%. So, Kali, can you walk us through your story? You're a nurse practitioner. That is, like I said, changing the outlook for critically ill patients. How did you get here?
KD: Absolutely. I'm sure a lot of my listeners know my story very well. I started out as a brand-new nurse, many years ago, over a decade ago, in awake and walking ICU. That's just what I call it now. That's the term that I've coined to describe what they do there. In the interview in my naivete, I was just excited to be there. I had no idea what they were talking about when they asked, ‘Would you be willing to walk patients that are on ventilators?’ and I was willing to do anything, right. I was just brand new graduate. I said yeah, of course absolutely teach me everything. I didn't understand the magnitude of that question until probably three to eight years later. Because when I started working there, no one made a big deal out of it, for decades and that ICU it's a medical surgical ICU, its high acuity, they've had a COVID ICU throughout the pandemic. They've maintained it this practice of allowing almost every patient to wake up, usually right after intubation, unless there's an actual indication for sedation. What's been intubated on mechanical ventilation is not an indication for sedation. So, unless they have an inability oxygen with movement, seizures and cranial hypertension, something like that, otherwise they are awake. They're reoriented and they're allowed to communicate, tell us what they need. We manage their pain according to what they tell us. They're usually mobilizing shortly after within hours after intubation, and throughout the day, and throughout their time on the ventilator. So that was completely normal. No one told me ‘Hey, Kali, this is the gold standard of care. This is the model for all early mobility protocols in the world’ Everyone knows about this ICU. No one told me that. So, I spent a few years there thinking that that was normal critical care, medicine, knowing none the wiser. Then I became a travel nurse, and I went to other ICUs in the in the United States. My very first contract when I walked into the ICU, it just felt different. But I knew I expected things to feel different, right? It's a new environment. But everyone was in bed. Everyone looked like they were asleep. There were very few signs of life, and I got my patient assignment, and the patient was sedated and on the ventilator. I didn't know why they were sedated. I wanted to continue my routine, do a neuro exam, hopefully get the patient in the chair ready for physical therapy, because that was my routine, in the wake & walk ICU. A lot of times physical therapy comes out of that patient is in the chair waiting for the physical therapist, take them on a walk even on the ventilator. So, I asked my orientee nurse, ‘Hey, can I get this patient up and take him for a walk?’ and she looked at me in horror and said, ‘No, they're on the ventilator. They're intubated’ What didn't make sense to me, because I've cared for at least hundreds, maybe even 1000s of patients that were on the ventilator and were awake and walking. I had no idea what she was talking about. I said, ‘I know that they're intubated. But why are they sedated?’ ‘Because they're intubated?’ and I say, ‘Okay, but why are they sedated?’ and we went in circles. That was the first time it ever crossed my mind that a patient would be automatically sedated, just because they were intubated. I quickly realized that that was the common perspective throughout the ICU, that I was the odd man out there. Here's the thing. Despite my years of experience, treating patients like that, I knew how to do it. I didn't know why we did it. No one had taught me what sedation actually does. No one taught me what it's actually like for patients, and how much it changes outcomes. So, in that environment, I didn't have the tools to support my approach and my practices and to advocate for my patients. I was still kind of a new nurse, and I was, you know, you just had to fit in in the ICU. There's so much peer pressure, there's the culture is such a huge part of it. I ended up just taking the ‘When in Rome’ approach and I just went with what I was surrounded with, and I ended up following along sedating my patients. I didn't really obviously know the difference. I mean, I saw a difference in outcomes. I saw patients stay on the ventilator for far longer. I missed the human connection, I noticed that there were a lot of tracheostomies and nursing home and LTech discharges that I did not see the way can walk in ICU 93% of survivors from that high acuity medical surgical ICU that I came from, went straight home after the after the ICU.
KK: That is nuts. That is nuts.
KD: That's what I thought was normal. So, I was noticing things, but I couldn't really put my finger on it. I couldn't advocate and I just went with it. Right. I even laughed at some of the nursing jokes about yeah, I hope my patient sedated, and totally snowed today. Thinking that that was funny, and it wasn't till years later that I was in grad school. Of course, even in my acute care doctorate program, nothing was mentioned about sedation or mobility practices. It was just assumed even in our case studies, it was assumed that if a patient came in with pneumonia, they were going to be sedated if they were on a ventilator. I was on a plane ride, and I sat next to a survivor. When he heard that I was a nurse and ICU nurse, the color dropped from his face. He started telling me about his experience over four years before that moment when he was a patient. He told me what it was like to be on a ventilator. He just barely mentioned the ventilator. All he could fixate on was what it was like to be in the middle of a forest with his limbs nailed to the ground and trees were falling down on him and he couldn't run away. Demons were coming to the sky and lots of things that he still couldn't talk about, because he was so deeply traumatized. I was stranger on this plane and he’s sobbing to me, telling me about what he experienced. Of course, I wanted to diagnose him and I said ‘it sounds like you had ICU delirium’ but that meant nothing to him. I came to realize as I listened with real empathetic ears, that that wasn't just a nightmare. Those weren't hallucinations. Those were vivid and real. He was psychologically scarred as if he physically lived through those scenarios. I was really shaken. I really hoped that he was one in a million, because he was telling me that for year after discharge, it was really difficult to relearn how to sit, stand, walk, swallow, that was really hard. The hardest part was that for year after discharge, every time he closed his eyes, he would be lost back in that forest back in that scenario, and he could not sleep. So, the depression, anxiety, physical disability, I didn't ask about the cognitive function because I didn't enough know enough to know that he wouldn't be at high risk of having post ICU dementia. He said that he still had not returned to his career. His life was over. He said ‘I know I feel bad even telling you this, I should be grateful to the ICU to him for saving my life, but my life is over. The life I knew before the ICU is gone. I lost my life in the ICU. If I were ever to become sick, I would never cross a toe back into the ICU. He was a DNR/DNI in his 40s, with no other real comorbidities because he never wanted to live through that again. I think what he meant by that was ICU delirium. I had worked in the ICU about six years. We have never I never heard anyone talk about anything like that. So, I thought this must be a fluke, he must be one in a million. So, I went survivor groups. I thought I would have to post and ask survivors questions. No, the second I got into survivor group, I just scroll through and almost all their posts were about the trauma suffered under sedation and these medically induced comas, what it was like to not be able to balance their check book, read a book, read a clock, like they were barely able to text. These are people thinking ‘How long is this going to last? my brain is not the same’. So that is what got me into looking into the research. I was shocked to find decades of research, exposing the harm of our normal practices. Yet we continue to do those things and I was back in that awake and walk ICU. Seeing a completely different way and I've seen this contrast from what I experienced for years as a travel nurse. Then where I was currently at as a doctorate student, nurse, and then I started working as a nurse practitioner, in that same ICU. That's when I started this podcast ‘Walking home from the ICU’ to show what they were doing in the ICU and now it's turned into ‘how do we revolutionize our normal practices in the ICU?’
KK: I got so much here, first. I never even would have comprehended or would have thought that your initial experience, I didn't realize that your initial experience was people were able to ambulate and get out of bed and reduce the amount of sedation.
KD: People are gonna say ‘Oh, well, that must have been, you know, long term mentors or not that high acuity’ They were the first ICU to publish the study back in 2007, showing that it was safe and feasible to walk patients on ventilators and in that study, they had PF ratios less than 100.
KK: What that means in nonmedical folk is that your lungs were extremely damaged and require a lot of supplemental oxygen to make sure your saturations are high enough that your oxygen levels are high enough. So, this is the sickest of the sick. From a breathing perspective, getting up and hustling and movement answered. So that is amazing. From a personal side, it must have been an absolute mind F that you couldn't, that you went from one extreme to the other. I'm doing tell you from my I've worked in several ICUs in my country, and the latter is the norm, people aren't getting up on a ventilator, you know, they're not getting, they're barely getting up into a chair on a ventilator.
KD: They aren’t even getting sedation vacations, they're snowed.
KK: One of my main jobs in the ICU when I walk in is minimize the sedation and even often I've seen in practice, they're getting Dilaudid or opioid infusions for no real reason to be honest with you. They're not post op. They have no pain syndrome and we're given pain medication in infusion, which accumulates and what you're describing to amongst patients, my other job is in palliative care when they get toxic or delirium. Delirium from medication. Yeah, that can be traumatic, these memories, these images. That must have been an absolute frustrating experience to go from one version to the other.
KD: I was just really confused. I mean, I was still I feel like I'm still new in my career and impressionable. No one taught me the why that's the unfortunate thing about a lot of our medical education is we're taught how we're taught task lists, but we're not taught the why that allow us to critically think and see a bigger picture. I feel like looking back I was really victim to that. I but I would still ask every ICU ‘So, shouldn't this patient get up? Can I get them up?’ because it I knew that was beneficial. I wanted that and a lot of it for me was, I wanted to see my patients get better. When you're walking a patient moments later, you know that they're progressing, you get to connect with them, you get to know who your patients are, I had no idea who my patients were, they were just bodies in the bed. That's not why I got into medicine. So even just selfishly, I wanted them to be off sedation, had I known that by taking off sedation, we could decrease their seven-day mortality by 68%. Oh, I would have been all over that, but I didn't know. I did work in one ICU, where they had some level of ABCDEF bundle, which is a protocol to help guide teams to minimize sedation and get patients up. There's such a spectrum of compliance and different approaches to it. So, I was taught to do an awakening trial, which means you turned on sedation. The purpose really should be to get them off sedation, it should be sedation cessation, but I was taught. So, you know, at five o'clock in the morning, we must turn down sedation, it's super annoying, I know but just turn it down. Wait to see them thrash - that's how you know, when you see all their limbs move that they haven't had a stroke. When you can tell they can't tolerate the ventilator, then you turn the sedation back on and call it a failed trial, just chart it. I was confused. I didn't know what the objective was, I didn't know what we were doing. I didn't know why they were agitated. For her to say it's because I can't tolerate the ventilator. That was confusing to me because I'd seen so many patients tolerate the ventilator. I didn't understand delirium, and I hated awake new trials. They were laborious, they were stressful, they felt unsafe. It's hard to see patients between delirium, it's hard to see them be so uncomfortable, and you can see the terror in their eyes. But again, when in Rome, I just did what I was told, unfortunately. So, this is my journey now is almost my penance for the harm that I caused my patients during those years.
KK: Well, Let's be honest, Kali, you can't be looking at it that way, man. We all remember sedation is the norm. What we're doing now is trying to advocate for change. I can't emphasize enough the change can be dramatic for people like it really comes down to function. If you in the ICU and you're paralyzed into intubated on sedation and analgesia, you're not moving, like you're not using your muscle. Then when you're trying to go back to what you want it to where you want it to be. I think a lot about our COVID patients. They were in the 40s/50s/60s, that are trying to get back to working, trying to get back to doing the activities that they love to do. When you think about this not only are you impacting their ability, like they're not getting to their functional level, but what's it doing for their family. Now you got a loved one that's got to take care of them, that might have to take off time off work too. It just is an absolute amplifier when people can't be functional.
KD: For those that maybe don't work in the medical field, or even especially those that do, here's what we're not talking about the bedside, here's what we're not telling patients and families. When we go into surgery, they give us informed consent, they tell us here are the remote risk that things that could happen, right. What we don't do before intubation for patients and our families is tell them the actual risks of sedation. We don't understand ourselves that sedation is not sleep, it disrupts the brain activity so severely that they don't get real REM cycle. So, my perspective is that it's a form of torture, really, I mean, that's what we do, and war in the military, we deprive people of sleep, and that's what we're doing to our patients when we give medications that make it so they cannot get restorative sleep. Many of our study, sedatives are myotoxic, meaning that they're toxic to the muscles, so it causes more muscle breakdown. Then on top of that, if there's absolute disuse when you're stopped sleeping deeply sedated, you're not even contracting a muscle usually. So that disuse makes it so that our muscles break down more. That disruption of sleep often caught is one of the mechanisms that causes delirium, which is acute brain failure. It's an organ dysfunction. That can turn into long term post ICU, dementia, cognitive impairments. So, they cannot return to their normal lives can't take care of their families can't go back to their jobs because they can't. Cognitively their brains can't function the same way anymore. They have this post ICU PTSD because of those vivid scenarios that they live. I'm not going to call them hallucinations, because that's, that's not accurate. Those were real to them. We just don't see that big picture of sedation, and we just don't even question and I do that a lot in my life too. They're things that I'm just taught that I don't question, but we don't question whether or not sedation is necessary. Sometimes it is. When we understand how risky it is, then we can do a true risk versus benefit analysis for each patient to say, ‘they're intubated for this reason, does that necessitate sedation?’ If not, let's get it off and see what they need. Let them communicate. Let's prevent delirium. Your platform is all about preventative medicine. In the ICU you come in with one acute critical illness and we sign them up for chronic conditions?
KK: Absolutely, as you said, like it really is about what can we do to prevent this from becoming a chronic condition. Honestly, it's a culture change, from what I could see. What's sad about medicine, is that we have data to support how bad things are or how good things are. The amount of time we invest in create that change is limited. If you look at the data for sedation vacation, so that same principle of, turn off someone's sedation, periodically, that we know that has positive outcomes, like we know that, but you could go through an ICU, throughout any country in North America and the odds are that they're not getting it routinely. Why doesn’t that happen? That’s why I’m proud of Kali. Number one, being a champion of this, ICU care sucks, but a lot of us that will end up in there. So, we want to be able to optimize care, but also like just doing some about it. It's one thing to want to bring attention to it but also, being an activist. I think it helps. So, you’ve got the podcast, Kali, you've done some other work, how else have you been able to increase awareness? You could even get into like, what the podcast also has done for you or in the people around you?
KD: So with a podcast, I started that right before COVID hit. I don't know if your god person but I, God told me to start a podcast in December 2019. I barely even listened to podcast didn't know how to start one, but I couldn't. I couldn't rest. I knew exactly that I had to start, I had to put out 32 somewhat episodes by the beginning of March of 2020. I didn't know why it had to be so fast and so furious, and survivors came out of nowhere. I interviewed my colleagues, researchers, it was just this miraculous setup that just came together, put out all these episodes, and then COVID hit. I thought ‘well now it's all gonna be all about COVID, and no one's gonna care about this’. God back handed me and said, ‘This is for COVID They're gonna be millions of people on ventilators, how is this not relevant to COVID’. So, I continue to throw out COVID Even though I recognize that the ICU community was not really in a place to revolutionize. The hard thing is that this could have been so beneficial to COVID we created more work for ourselves with the sedation practices, you talked about awakening and breathing trials. Once I just looked at only wake & breathing trial started sedation, turn it off once a day and then turn it back on. Decrease ventilator days, by 2.4 days, days in the ICU decreased by three days in that hospital decreased by 6.3 days, when we're in a staffing crisis, we need to have a process of care that's efficient actually gets patients out of the ICU. Instead, we created this bottleneck where patients are now stuck on the ventilator because they're too weak to breathe on their own. Even if their lungs are better. Now they need tracheostomies. They're stuck in a ventilator. We can't at least in the States, we couldn't get them to LTACH because LTACH’s were too full of all the other COVID long term patients. So, then the ICU wasn't rehabilitating these patients, and so then they develop more hospital complications, and then they ended up needing more care. It's just we created so much more work for ourselves. It just was a hard time to really take on a new endeavor and totally change your practices. But during COVID, everyone ran back to the 90s. Not everyone but a lot of people ran back to the 90s. As far as using benzodiazepines, higher doses of sedation, deeper sedation longer times, there was so much fear. We did a lot of fear-based medicine. So, I just kept chugging along with my podcast, knowing that the community was going to need healing after all of this. We were going to need a lot of rehabilitation within our own clinicians, but also within our practices. So now, teams are coming to me saying what we're doing now. We're still doing COVID care even these are not COVID patients, we're still we're back to deeply sedated patients. Where are we lost so many seasoned clinicians, new clinicians came in during COVID. They've been trained to deep deep, deeply sedate, they don't know how to move patients they're scared to. But one team said I look on my ICU It's not an ICU, these aren't ICU patients. These are LTACH patients. These are rehab patients that we're not rehabilitating. We're bottlenecked. We can't get these patient outpatients out, we can't get new patients, we're stuck. We're creating that kind of scenario. So now, I work as a consultant and I do training with the teams, I teach them the why the reality of delirium, giving them a picture of an awake & walking ICU using real case studies, pictures, videos, so that we have a vision of what could be I feel like the ABCDEF bundle when it was rolled out in the mid 2000’s good change happened, a lot of things moved forward. I do feel like we didn't explain fully the why behind it. Until every ICU clinician hears the voice of survivors, they won't be afraid of sedation, they'll still be inclined. We started, we continued this start sedation automatically, then at some subjective point down the road, start to take it off, when they come out, agitated, turn it back on, we just didn't, we didn't give them this perspective of ‘Hey, most patients should be awakened walking. Here's how to treat delirium and here's how the team works together’ we put a lot of it on nurses, which is not fair, feasible or sustainable. So, as I work with teams, I tried to really give them a foundation of why, and then how, how to treat patients without automatically sedating them. When the sedation necessary. How do we navigate appropriate and safe sedation practices? When do we use it? How do we mobilize patients, I go on site with teams and I do simulation training, we do real case studies and practice and the whole team practices together. Because it's a skill set, we think about pronation, when we started printing patients, everyone was terrified. And it took so many people and it took so long, you know watching every little line and now teams flip them like pancakes, right? It becomes a skill set. So, I tried to get them opportunity to practice that on a pretend patient. So, they can think through critically think through the scenario, think through delirium, thanks for ICU acquired weakness, then practice mobilizing patients with different levels of mobility.
KK: My brain is going like, the whole time, it's like you need to come see our group.
KD: Let's do it. I’ll hope on a plane tomorrow – I can’t actually. I’m going to Kentucky tomorrow, but let me know I'll be there!
KK: We would absolutely love to have you. Just knowing where a lot of clinicians lack is hearing the voice of the people that have gone through it. Clearly, that's been a motivator for you in terms of why we need to pivot and provide less sedation to our patients and mobilize our patients and avoid them from having all these secondary complications as a result of being immobile. The means are there.
KD: The data is strong; the data is really powerful. I mean, decreased mortality by 68%. Who doesn't want to do that, right? So, but almost even more powerful are the voices survivors, when you hear their voices in your head when you're sitting in a patient. It's haunting COVID, there were times when patients could not oxygenate the movement. I had to sedate them. I hated it. I just felt sick because I, I just didn't know what they were experiencing. I didn't know if they were in pain. I didn't know what was going on underneath that they were going to live with us the rest of our lives, it's because of the survivors that have interviewed on my podcast, they are the educators.
KK: Yeah, I have so many ideas going through my head. I would love after when we jump off, links to the some of the episodes from the survivors that we can pass along to our group, to our show in general, but our group to give a sense of what it really is like to go through this. Yeah, our patients don't come I mean, every once in a while we get a patient come back and say how they're doing but they don't give us the they don't give us the negative side, they really focus on showing some gratitude.
KD: Which is good, but if they came back, it's probably because they weren't too traumatized to come back. The ones that don't come back. I mean, why would you go back to the place that you are sexually assaulted?
KK: Yeah, no, yeah
KD: It’s like to trigger and some people can't even go the same street as that hospital. On my website under the resources tab, the clinician podcast, at the bottom, the page is organized by topics. One of those topics is survivors of sedation and mobility, as well as survivors of an awake & walk ICU. So, you can hear their different perspectives and testimonies, it's organized by different topics.
KK: You’re an organized cat, I'm looking at it right now. I can tell you, you're very structured and organized just by the way your website is set up. It's on point.
KD: It's curriculum. This is education, this is not just a hobby. I mean, this is we've got to make sure we get the right information to the right people.
KK: You’re so boss. You're gonna be running an organization one day, and ICU, I don't know. I see big things for you.
KD: We'll see. I mean, I have a lot of optimism for the future of critical care, going to conferences, meeting with people at the bedside podcast listeners reaching out. It's not just me that cares about this. That's why I continue is that there are so many people that I call revolutionists, sometimes as the lone voice in their ICUs. But they're bringing big changes, they're making waves there so my motivation with podcasts is to provide the ammo, the quiver the arrows in their quiver, so that they can share that with their colleagues get more buy in, so that they don't have to reinvent the wheel. It's a lot to change a perspective and change a culture. It's hard.
KK: Yeah, and maybe just seeking some advice, we had Dr. Wes Ely on the show and how to create some culture change around this issue. I want to hear your perspective. Kali, how do you think you do create that culture change? Because you bring this up to many staff, and they'll be like, ‘Oh, they're gonna extubate themselves? Oh, we're short staffed. This is not gonna be able to work.’ What are your thoughts?
KD: Yeah, this has been a lot of my journey is figuring out what are the barriers? and how do we address them? I think we're over the checklists. I think it is important to systemize and protocolized our practices. When we implement these kinds of changes, we this can't just be “Hey, Nurse, take off the sedation’ that is not going to work. They have some valid fears at all I had ever seen. With a patient coming off sedation. After days, two weeks of sedation, I would have a lot of inhibitions. When I'm busy. I don't have time to wrangle that patient. I don't have time to make sure they don't self extubate. I have a
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whole episode on unplanned extubations, but delirium increases the chances of unplanned extubations by 11 times. So, it's just changing the perspective understanding what is delirium? why should we be panicked about it? What causes it? We are practices are some of the biggest risk factors and culprits of delirium in the ICU, and to learn doubles that are in hours required for care. So, when we're short staffed, why would we create a delirium factory? When it doubles our workload? It doesn't make sense, but when that's all we know, we don't understand that there's a better way to do it. So, my approach when I go to help a team have culture change is to, again explain the ‘why’ give a perspective of what could be, here's what patients can be like, when we don't sedate them. If they when they wake up after intubation, it's like coming out of a colonoscopy. Endotracheal tubes not comfortable. Here are some tools to help make it more comfortable. Here's how we can talk to them. Give them a pen and paper, I would get agitated and panicked. I couldn't communicate. Here's how you involve the family, here's the toolbox to help you succeed and have that patient be calm & compliant. And they will protect their tubes. I've had patients write ‘please be careful my tube’ That's what I need to experience. So, when you find a couple of case that isn't so easy hits, easy wins. Allow your team to see a patient awake, communicative, calm in even more while on the ventilator, the perspective starts to shift. Then they start to ask, okay, that was easy. That was fun. That changed outcomes. They walked up the ICU. Who else can we do this on and it starts to have a domino effect. So suddenly, we expect him to just shut up and do it. That's, that's not going to cut it. I don't think that I think that's partially why the ABCDEF bundle rollout, years ago was not has kind of gone away, because we didn't provide the why. We also, again, I think starting sedation, and then taking off later, is a lot of work. We should only do that if it's absolutely necessary. Otherwise, I mean, I have an episode with a hospital in Denmark, they do the same thing and that allow patients to wake up right after intubation. They are so much easier, more compliant, because they don't have delirium, we have to understand that that agitation is usually rooted in delirium, we have to come to really be terrified of delirium.
KK: I'm really enjoying this, I'm really liking this because it's even at that added perspective of saying, ‘Hey, your workload is going to be worse if people are delirious, so let's avoid going delirious in the first place’ Let's just get a grip on this bad boy, out of the gate.
KD: You're all about preventative and it's like, Let's prevent one of the biggest culprits of mortality. Delirium doubles the risk of dying in the hospital. So, people say we don't have time to mess with all sedation practices, like let's just sedate them and like, save their lives and figure it out later. No. By doing that, by increasing the risk of delirium, we could double their chances of dying. So, if we care about mortality, then we will care about our sedation practices. We also know that ICU acquired weakness is really laborious. When people imagine mobilizing patients on ventilators. What they're imagining is taking off sedation days to weeks later when they're delirious. They can barely lift a finger and now we're trying to mobilize these, you know, 200 plus pound adults to the side of the bed. That's dangerous, laborious, it takes so many people. If a patient walks into the ICU or into the hospital, hypoxic hypotensive, whatever. We have moments later, we haven't stabilized. Why can't they walk? Did we cut their legs off? Right? So, once we have oxygenated, perfused, what's the harm in sitting outside of the bed and seeing how they do when they're not delirious, they can tell us how they're feeling. We can provide more support on the ventilator; they can probably walk better than they did come in and hypoxic. Once they're stabilized hours later, or even 24 hours later. So that is so much easier when they maintain their ability to walk. So, in the COVID ICU, many patients were standby assists to the chair with a nurse while they were on a ventilator, because they're alone in the room, right? Physical therapy could go in and work with a patient, just scoot the ventilator wall to wall as they're stuck in their rooms, help them stand or sit, step on steps, they were alone in that room with these patients, because they were strong enough to do it, because we didn't allow them to be under myotoxic sedation and I would say rot in the bed. So, all of that plays into an ease of workload. Then obviously the get off the ventilator sooner, get out of the ICU sooner. It makes the workload easier. So, it's a little bit of an exchange and efforts in some ways. Yes, you must talk to a patient. Yes, you must assess them a little bit more. But also, could during COVID, I was hearing about swapping out propofol bottles every hour, picking up to go in and out to titrate vasopressors that we were getting just because of the sedative and hypotensive effects. All of that is effort but wasn't necessary and wasn't beneficial.
KK: I'm telling you, you are changing the boogie. Yeah, changing the conversation and perspective. This is something that can dramatically impact patient care. If we could get the buy in, in the culture. Wow.
KD: You know, people will say ‘Well, we don't have we're trying to save $25 million this year. We can't afford to pay our payer clinician some extra time for education or whatnot’ The ABCDEF bundle, even in their spectrum of compliance, decreased healthcare costs by 24 to 30%.
KK: Oh, yeah.
KD: ICU acquired weakness increases healthcare costs by I want to say 30-40%. Delirium increases healthcare costs by 40%. ICU acquired weakness increases healthcare costs by 30.5%. So, by having a process of care that prevent those complications with decreased healthcare costs. So why wouldn't we, right?
KK: 100%. We even we had a paper out last year showing the financial impacts of ICU delirium. We always think to have the opportunity cost, that money could be diverted into more staffing, more resources for physio, optimizing nutrition, all these things can be enhanced. If we, if we make it a priority.
KD: I think it's one of our one of our strongest cards to play for staff, safe staffing ratios. To say staff is better, we'll get better care in this using this protocol. We will save you so much money so it's investing thousands to save millions or billions.
KK: I love it. You’re speaking my language. We are definitely going to have you back in some capacity. I don't know that for some reason. It's not just gonna be the show. I really want to get you talking to our group. Maybe regional rounds, or something. I don't know what it's gonna be. It's something that we need to hear more of talked about the patient experience, your own experience and the drive like what's pushing this. Knowing my people a lot of intensivists and an ICU nurses and allied health professionals, we want to achieve this, get our patients to a point where they are better. Really better, not just alive, but thriving. This starts here. I really do believe it starts here. So I just want to give number one, Kali some mad love on what you're doing and continue to hustle, it's paying off. Second. How do people get to know you a little bit more? and about the show and the consulting and so forth?
KD: So, have a website www.daytonicuconsulting.com. There's more information about consulting services available, the podcast is on there, the podcast has transcriptions and citations organized by topics.
KK: So organized folks.
KD: 116 episodes, and I really didn't even know how much of a what's called a rabbit hole that this would become. There's so much to learn about the science behind what we're doing as well as the patient and clinician perspective. So, check that out, find the topics. If nothing else start at the beginning. I think the beginning lays a foundation, I was very intentional about how I organized it at the beginning to lay a foundation of ‘why’ and ‘how’ comes later. I'm on Instagram @daytonicuconsulting, Twitter, Tik Tok. Go ahead and set up a consultation with me send me an email and we can chat about your team, your barriers, even your family members what's going on? I'm obviously obsessed. So, I'm here for you! let me know.
KK: So good. So good. Thank you so much for joining us. Those on the chat group or that are watching live. You want a piece of this episode just tap NL into the chatbox will give you a copy the video and the end the podcast when it's released. Awesome work. Congratulations.
KD: Thanks for caring about this.
KK: 100%
KK: Kwadcast nation that's exactly what I'm talking about changing the boogie right here in ICU care. Follow us on Instagram, YouTube Tiktok Facebook @Kwadcast Leave any comments at kwadcast99@gmail.com, subscribe to our newsletter. Essentially, it's like a membership you want to know more about Kwadcast nation. Go to Kwadcast.substack.com Check it out. Leave that five-star rating and continue to allow us to change boogie in unison. Take care, peace. We love you.
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In this episode we welcome Indigenous medicine woman and best selling author, Asha Frost, to speak with us about homeopathic medicine, spiritual journeys, healing, and more! Asha is a member of the Chippewas of Nawash First Nation and has a BA in Psychology from the University of Guelph and a degree in homeopathic medicine. Her book ‘You are the Medicine’ is full of powerful teachings and has guided thousands. Today we learn about Asha's path through Indigenous medicine, racism, creative ways to heal yourself, spirit animals, and much more! Asha is an incredible mentor and she also leads us through a moving guided journey, and gives us some great perspective into mental health.
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TRANSCRIPT
KK: We are on the brink of a mental health crisis. This is why I'm so appreciative of the folks over at BetterHelp. The largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today go to betterhelp.com and use a promo code ‘solvinghealthcare’ to get 10% off signup fees.
SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive, but one of the blessings it has given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast99@gmail.com, reach out on Facebook @kwadcast or online at drkwadwo.ca
KK: Welcome to Solving Healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of ‘Resource Optimization Network’. We are on a mission to transform healthcare in Canada. We're going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved.
KK: Kwadcast nation, welcome back! We got a great episode with Asha Frost, and I tell you this, this one was extremely moving. We talked about ways of healing thyself, looking at creative ways to not only bank on conventional methods of healing, but also looking at spirituality, looking at our mental health, the mind body connection to create healing is tremendous. We go into some of the indigenous ways that could improve our overall health, we go through a guided journey, which as you'll hear was extremely moving from my perspective, I was a little verklempt after that one. Then we talked about we talked about racism, we talked about our own experiences within healthcare, she tells her story about being treated like an animal, within the emerge our own experience not that long ago, which I think a lot of people need to hear. It’s tough to hear, but it's just another reinforcing message that we got work to do. So, looking forward to you guys hearing that. Before I forget, please check out our new substack kwadcast.substack.com. We have all our jam on there. We put all our jam on there, our newsletter, previous episodes, we're all in on substack. Video, video messages, our community chat, you could chat we have a chat community on there too. So please check it out. You guys gonna love it. It's a better way of us staying connected. So, without further ado, check it – Asha Frost. Kwadcast nation, man this is a real privilege today, folks. It's a real privilege today because we got Asha Frost, who honestly, I just met in November. We were both that ‘Impact’ live, amazing event put on by Meghan Walker. Your keynote, everybody was talking about this bad boy. I got to connect with you backstage. Show me your book, all the magical things that you're doing. I was like, she's got to come on the show folks. Asha’s got to come on the show. So welcome to the kwadcast.
AF: Thank you. That's quite the introduction. Thanks for having me
KK: Oh, man! It’s the least I could do after all the magical stuff you're doing Asha. Seriously, this is an exciting show for me. So maybe, to give context to why you're doing all these workshops, the book, the essays, I think a lot of it comes from your personal experience. So maybe just tell us a little bit about how you've gotten here.
AF: Sure. So, I'd say my healing journey started when I was 17. I was diagnosed with lupus. At that time, doctors didn't really know a lot about lupus and the antibodies that were positive in my bloodwork really were like quite serious. So, they were saying ‘You're gonna have to go on medication for the rest of your life, you're might not have children, you might not live a long life’ and of course, as a 17-year-old, I was really scared. At that time, I lived in a really, I'd say, non diverse town. So, there weren't a lot of indigenous people. My grandparents had been in residential school, I had been colonized away from our medicine ways or away from our ways of healing and knowing and being. So of course, I thought, oh, we'll try the medication. So, I did, and I got so many side effects from the prednisone and the anti malarial drugs. So I knew there had to be a different way. I went to university and at that time, I got really sick because of the stress of university, and somebody said, why don't you go see naturopath. That sort of opened up everything for me, I saw naturopath at about 21. Then I thought, ‘Oh, my goodness, there's a remembering of myself and my blood and my bones calling me back to these ancestral ways of knowing and the earth’ and I had to uncover that. That was like the beginning of my journey just going on this. It's always just been ‘How can I heal myself?’ and then, of course, as I heal myself, I share that with the world. So that was the beginning.
KK: Wow, wow. So really, unfortunately, having a relatively serious diagnosis at a very tender age of 17. Going through the conventional treatments, were you finding you were getting better when you were taking the conventional meds?
AF: Not really, I'd say, no, it made me so much sicker. I just I've had new symptoms that I wasn't experiencing with the lupus symptoms. So, it wasn't making me better. I thought, well, this doesn't feel like it and maybe if I tried it longer it would have, but it just didn't feel like a really good exchange of I'm taking these and I'm feeling worse in my body. So, it wasn't helpful at the time, I have subsequently taken little small doses at times that have been helpful, definitely. But at that time, it wasn't helpful.
KK: So you walk through this, this journey and will really having an incentive to heal thyself, like really looking at ways to heal thyself, and going through natural paths and so forth. What came of it? what was it mostly, nonconventional medications, was it meditation was a nutrition what changed for you? And was it effective?
AF: Yes, so I saw a naturopath who was amazing at homeopathy. She prescribed a remedy. It was all so new to me and I thought, this is kind of neat and she told me ‘this is going to match your physical symptoms, but also your sort of personality, your essence, your emotional body’ it really looked at the whole being, and it made sense to a part of me. I remember taking that that remedy, and my hair was falling and at the time really bad, and that got better. I remember my joints were really achy and not got better. So, I got really interested in lit up by homeopathy. It actually inspired me to go to school for homeopathic medicine, because it helped me so much in my own journey that I thought ‘I want to offer this to others’
KK: Wow. So basically, you wanted to help create that magic for other people. You saw how the homeopathy improved your quality of life, and improved your symptoms, and wanted to create that. That loveliness for the greater for the greater masses. How has that journey been? when it came to getting people healthier - how's that been for you?
AF: I loved having a private practice. I loved sitting with people, I loved holding space for their highest vision of who they were. Everybody I feel like we are sort of conditioned to feel like there's always something wrong with us, you know that everything over the messages are always coming at us that there's something wrong with us. I believe that my private practice held space for the truth that you have this vital force, you are divine, how can we just remind your body? how can we remind your spirit? so my practice ended up turning into like a homeopathic practice. But then of course, I started to weave in indigenous ways of being and knowing and indigenous healing because that's who I am at the core. That's what I was discovering about myself. So, it was a combination of spiritual healing and then the homeopathic medicine.
KK: I think that's what really attracted me to what you were what you were throwing down, was this the ‘spiritual’ component adding that indigenous side. Who you are to a healing practice and delivering it to patients. I must say, as ignorant as possible. I have no idea what that would look like. I have no idea not only what it would look like, and just the impact it can have. So, walk us through the potential and what treatment would look like, what the outcomes could be. I mean, I don't know if you need to give a specific case, but just give us a sense of what the potential is from your practice?
KK: Well, I tend to attract a lot of people who had anxiety or depression. That was like a lot of mental health that tended to come through my practice. So, people would want to get off meds, like anxiety meds, or depression meds, and we would just do that with their doctor, they would be tapering, and then this homeopathy would support sort of their tapering off and bring them back to sort of that truth that they do have something within the MEK and help them balance themselves and come back to that healing. So, I saw a lot of a lot of folks with that. I saw a lot of folks with autoimmune conditions because that's what I lived. So, I tended to know a lot about that. I'd say that people's arthritis got better. Their fatigue got better. They their movement was better; they just had more ease and grace in their lives. I think, on the spirit level, they felt more connected to who they were, and for some reason, that just trickled down to their physical body. So, they would feel more connected to themselves through guided journeys, or meditations, or I would do hands on healing. They would come home to that truth, but they have power, they have presence, they have medicine, and for some reason that like switching on that light bulb really helped people.
KK: That's amazing. We talk a little bit about on the show, that whole mind body connection, how it's all tied, how you feel, how you're doing upstairs affects your body and your ability to heal and to get better. I'm just really interested to hear what its like to walk through the term, how did you phrase it again, you're walking journey? Your guided meditation? what does that look like?
AF: Yeah, so from an indigenous perspective we really believe in the power of dreaming and visioning and quiet because that's when you can hear spirit. So, getting somebody in that state of quietness, when they're listening to their own connection to spirit was so powerful. So, what maybe animal spirits might come in to help with medicine that they want to offer, or it might be their ancestors, or their grandmothers or their guides. So, there was a lot of spirits support, helping people and then some of the sorts of techniques that were used were of a shamanic. I've taken a lot of training around like shamanic enters, there's a lot of energy healing energy work, that would shift some of the blockages maybe for a vital force to flow through more effectively. It always came back to that person, again, like sort of seeing and remembering, oh, my goodness, I can do this, like, I have sovereignty in my own being and body. I have I have power, because I think sometimes in the medical system, we can sometimes feel like we don't. Our power, we kind of give it over to say, ‘well, you have all the answers’ and that might be true. They might have answers, but we have answers to.
KK: Yeah, we have an ability to call on to contribute to our own healing. Right. I mean, like I said, this is not the typical approach to medicine, I've been practicing almost for 20 years. We don't often add a spiritual component and, and, and so forth. Do you like how the results been in your practice? Asha, when you add these elements, on top of everything else that they're receiving? How do you feel the response has been?
AF: Well, I no longer practice privately anymore, but I had a practice for 15 years, and it was really busy. So, the word of mouth was always really, really strong. I was booked solid with a waiting list. I would say the results were really, really amazing. People tend to leave my space, just feeling uplifted and feeling better. So, I wish I could quantify that with like, you know, we had this many cures or whatever that is, but I think that's the difference between being healed and being cured. I think we look for a cure, but we kind of forget about, what kind of healing leaps have we made? how much more satisfaction do we have in life? how much more peace do we have in our heart? how much more gratitude and joy is emanating from our system and ourselves? I think those things are maybe not measurable, but they are really important.
KK: Oh, man. Absolutely. I think especially now, I feel like this is so valuable coming up, post pandemic where people were from a spirituality perspective, from a mental health perspective, just beat down. We're seeing the resurgence, unfortunately, of so many ailments, which is obviously very complicated because of lack of access to care, people weren't getting screenings, and so forth. This is something that I feel like could be so valuable to so many. I think one of the magical things that you're doing ashes is, is creating that at scale now, you're really trying to make this accessible to not just a patient in front of you, to everyone. So how are you doing that right now?
AF: So, I closed my private practice maybe four years ago now. At that time, I wanted to bring all these teachings online. I created like a global membership with indigenous teachings and healing. I loved doing that. So that really like scaled up the folks I was able to touch. At that same time, I got a book deal by through Hay House, and that has just expanded my reach, I think, to all the people that I can touch with my words. Writing that book is just it's so interesting, because you write this book, and this little cocoon was in the pandemic, my littlest was two, and they were home. It was kind of a disaster, but I put myself in this little cave. I wrote this book. I didn't realize I didn't really think ‘Oh, these words might actually touch people, oh, these words might actually be shared by people’ I just kind of thought I'm gonna write this, put this out there. Now it's rippling out way bigger than I could have ever imagined. It's just rippling out in so many ways. That's the most important thing for me is that people remember who they are. They're touched by my words and it kind of ignites something within them. That was my intention for the book was that they could see that that presence that they are, it's called ‘You are the medicine’ that they are the medicine, they carry medicine. And they can share that with other people too because we need that message shared, I think.
KK: Absolutely. Absolutely. Obviously, the book is out you do public speaking engagements. I saw also you're doing workshops amongst folks, walk us through that, is it small workshops? Is it organizations? who are you seeing?
AF: Yeah. So, for the longest time, when I was in my private practice, I did healing circles. That was a way that my medicine was shared. I was doing a lot of those probably hundreds and hundreds of healing circles. Then when my book came out, actually last year, it came out last March. Folks begin to ask me to come and speak to bigger audiences. So, it's lit me up. So huge, so yeah, it's some like health conferences. People really need healing right now, so people are asking me to come and do like opening ceremonies as an indigenous person to offer some messages around like cyclical living. It's really the vibe of healing. Everybody just seems to need it. So, I've been invited to do that and it's something that I've always wanted to do in like a bigger scale. So, it feels so in alignment, I hope it continues, because it's really something that lights me up. But yeah, those workshops, you know, I do smaller workshops, during the pandemic online as such, that's how we connected so I was invited to a lot of people's programs to share, and to offer that healing component to their work too. So, I love being asked into spaces.
KK: What are the principles that happen there? When we're doing a healing practice or speaking to the masses is it is it a matter of ‘Hey, folks take more time to be with yourself and, and or listen to this guided meditation’ what's some of the take homes people leave with when they when they hear Asha throw down?
KK: So many times I speak of the medicine meal because our traditional medicine meal speaks about the importance of the whole system. So, I'll take us through the way of living seasonally and cyclically and listening because we are Earth. All of us have been colonized away from that that truth that we are we do live seasonally, and we go through our highs and our lows, and the world wants to tell us ‘no, you have to be hustling all the time’ and then we end up in burnout. So many of my messages are around because I've had to do it myself. How do I come home to the medicine of rest? How do I come home to the medicine of listening? all the things that the world pulls us out of my message tends to be around that and I love working with animal spirit medicines. The animal teachings those are brought a lot into my teachings and then we always do a guided journey. I have done this with thousands of people. I can say that almost everyone that I've ever worked with has seen an animal spirit or they're able to see sensor I do believe that I can hold a space somehow that can get people visioning and get people into that space where they're connecting to something greater than themselves.
KK: Wow. Wow. So how do how do people get in more in tune with resting and listening? How do we get more in tune with our seasonal aspects of life?
KK: Such a good question, I think it's really hard. I think the first question to ask ourselves is about our relationship to the systems. how has colonization impacted us? How has the patriarchy How is capitalism? just feeling the impacts of that collective energy and how we've marinated in it, it's just sort of an acknowledgement and validating ‘Oh, right, we come by this honestly’ because we were born into it. And this is like the, the energy that's up all the time. There's a lot of unwinding. Especially if you have ancestral wounding, or generational trauma that is connected to a lot of the folks that I work with do have. So, we have to dive deep into that healing and say, ‘our ancestors did this so we don't have to anymore’ We can take that like labor off of our back. We're allowed to invite in rest and ease and abundance and it's hard for folks of color to really lean into that, because our cells are telling us something different. It's a lot of journeying, reflecting, going into our dream time, I think it's like simple of just like rest actually going to bed earlier to say ‘Oh, my dream time is here, It's going to offer me some medicine and some wisdom’ Can I allow myself to have that? So might be like sound kind of strange but to me, going to bed early during this winter season is a way that I receive so much wisdom.
KK: I mean, it makes sense. It's a time to hibernate, recharge, with the sun going down that much earlier there's a lot of a lot of things pointing towards being more restful during that time. The other question? this might be a tough one. I'm putting you on the spot here. What's the guided journey? I don't know if we could do one or if that’s too difficult. I want to get a sense; I think our listeners will get the chance to showcase Asha skills. You know?
AF: I would love to.
KK: Yeah. If you're interested, let's drill down.
AF: Definitely, we're talking about rest, we're gonna set the intention for this journey, to connect with an animal being so you know, we talk about spirit animals or animal spirits. We want to do this in an appropriate way where we're appreciating this animal. So, I'm just going to start by saying whatever comes forward to you, to trust what you get, to trust if we've not worked together before, your spirit knows. Then in a way after, when the animal comes to honor it with deep gratitude, because it's an important practice and teaching. We're gonna start with closing our eyes and if you're seated, you can just feel your feet on the ground. We acknowledge the earth beneath us, the land beneath us. Just feel the land beneath you. I'm going to acknowledge that I'm on the lands of the Anishinaabe. We are still here. Feel the spirit of the land and all that it's seen and experienced, rising up through your feet, warming you comforting you, grounding you, with every breath you take. Today we ask for all of the beings that wish to support and guide and surround us to be present here. We call upon the sacred door an opening to the spirit world. The store is shining with golden light and around the light. There's this rainbow light. We feel this rainbow light spark ling and shining so bright. But as you walk towards it today, it flushes and washes upon you. Washing over you and you begin to feel sparkles of reds and purples and violets, greens and golds, pinks and turquoises in your own cells and tissues for you our prismatic being shining and sparkling here. As you walk through, you see the land beneath your feet, your feet are bare, and you sink your feet into the soil, squishing your toes with every step. You continue walking, feeling yourself being led down this path and in the distance, there is an ancient forest. The forest looks so inviting the trees and the plants that are here are familiar to you in some way. You walk yourself over to this forest. As you step in, you breathe and the medicines that are here. The medicines that are perfect for your body and your spirit today surrounds you. With every step, you walk in deeper, the forest gets a bit darker, surrounding you with care, holding you with love. As you walk deeper, we set that intention. That intention for the animal spirit that is helping us the most right now to appear in some way. As you are closer, there's a clearing where the sun is peeking down through the trees. As you walk closer, we asked for that animal to become clearer, more powerful, and to appear for us in some way. Notice what you see, listen to what you sense or feel. who arrives for you? Trust this animal gets closer to you. You ask them ‘why are you appearing for me right now? What are you here to remind me of that I have forgotten about myself?’ and do you listen. You ask this animal ‘What is the word that I need to carry with me in my heart? The word that will remind me of who I am this year?’ and you listen. This animal becomes really sparkly, it wishes to align with your energy. You step into this light, and you feel this rush of light source through your mind body and spirit. The medicine of this animal dropping in tear being you feel that message in your heart that it was just to offer you. You feel yourself walking back out of that forest with that message from that animal making your way all the way back to that path where you started carrying that animal medicine with you, honoring it with gratitude and love and moving it all the way back to the door. Taking a breath here, the animal places a gift in your hands so that you may remember them that you are walking with them. You walk through that door and then you breathe yourself back into your space. Feeling your feet on the floor feeling the lands beneath your body and when you feel ready you can open your eyes. Welcome back.
KK: Wow. Wow, that was quite an experience.
AF: what did you see? if anything?
KK: It was some form of bird, a hawk or something like that. The message was like love, just focus on love. Past me in terms of an object image just some rocks, but yeah, love. Bird, love, rocks. That was moving.
AF: Yeah, it’s always is different based on the energy that I'm sitting with. But today, the animal really said, ‘I want to come into your heart’ So when you doubt your path, or you forget who you, place your hands there and just activate that energy there. I got a big moose. I got a moose. So, that was beautiful, but it was just really to remember that like they are here for us, to remind us to come home to ourselves. You can honor that Hawk in some way. Get your kids to make a little altar for it.
KK: Absolutely. It’s funny as you were saying, animal I was thinking Lion. I don't know why I've been thinking about lions lately. A lot, too. I thought that's where I was gonna go. But the image that came to me as you were speaking was a hawk. It was a bird was substance.
AF: You know, for the listeners, I know everybody the questions ‘what does it mean?’ Right? And there are different ways you can look up. The first question I'd ask myself is ‘what does it mean to you?’ Right? What does that animal? How does that animal move in the wild? What strengths do you think that animal has? How does it carry itself? All those things are the medicines it's bringing you. Then of course, you can look up on Google if you want to see like, what is the animal spirit? Next year, I'm doing an Oracle deck that will have all the animal cards in it so that I can say you can look at my Oracle deck and see what they mean. But right now, there's a couple of books ‘Animal Speak’ by Ted Andrews is really good, too.
KK: Wow. It must be pretty powerful. Doing this in a group setting. I'm curious to hear what people like the feedback that you get after having such a amazing, guided journey.
AF: Yeah, people always, it's something I know because I've practiced so many times and edit so many times that it's opening up some sort of portal to some sort of different understanding and people always come back touched. So that's a common people say they feel touched or like part of their spirits moved.
KK: I mean, I'll be honest with you, that's how I'm feeling at this time. Touched. Something changed. So, thank you, Asha, for allowing me to be part of that. That was something. If you hear a little bit me being a little off. It's because I am a little off. After that, was emotion. It’s a bit vulnerable. Why love? Why the hawk? It's, it's clearly something that was needed. Once again, thank you. Asha.
AF: You’re welcome.
KK: I can't remember if it was at the conference, at the conference or, or another time, but, you know, we often talk about systemic racism and the experience of being a person of color when it comes to being treated as a patient. I wonder if some of this ties into your experience, and I don't know if you've had any, any experience that made you really concerned about how systemic racism affects our people?
KK: Yes, I had one incident. It's so interesting, because I doubted myself for so long, I gaslighted myself for so long thinking of that was nothing but then when I had the capacity to think about it, it was it was definitely something. My eldest was two at the time. I remember just, he wasn't a good sleeper. So, I was really overwhelmed and burnt out and I got a really bad pneumonia. I was caring for him, I kind of left it a little bit too long. By the time I got to the hospital, I couldn't breathe at all. It was very serious. In the wintertime, I always wear my mukluks because that's what I wear. I think I probably had beaded earrings on when I went to the hospital. They put me in a corner, which I understand lots of people have had that experience. There's not room and all of the things but I was there for a really long time considering I couldn't breathe and I was really, really struggling. Then when the doctor finally came in in the middle of the night he said to me, he looked at me and he said to me, he knew I couldn't breathe. And he said, ‘How much alcohol have you had to drink? And do you have a home?’ Those were the first things he said to me. So, he didn't ask me how I was doing or what I was struggling with. I think I was so shocked by that, that I just I froze, I said ‘Yes, I have a home with my husband and my son, and I haven't drank any alcohol’ I sat with that probably for a good six months, not really knowing what that meant. Then, you know, it sticks with you. So, I started speaking about it, because at that time, that was like 2014. But indigenous, I feel like we've been so invisible across Turtle Island. That continues to happen. So, it wasn't really until the children were found her in the residential schools that people released her talking about some of these issues. So, I held on to it for quite a while before I really started writing about it and sharing about it. Of course, people are shocked and they say ‘how, like, how does this happen?’ the truth is, it happens all the time, every single day. Oftentimes, I think indigenous people just feel like we just suck it up, like, well, that's just part of who we are. That's what everybody thinks we are all about. So, we don't speak on it, because it's, nobody's gonna hear and listen to us.
KK: What you're describing I'm sorry, you experienced that. I've seen it firsthand. Okay, folks, I've seen this st firsthand whether I was med student in Edmonton, whether it was being a trainee or staff person in Ottawa, you name it. This, unfortunately, that attitude towards racialized folks was, but especially when I'm talking about with indigenous population is a reality. I talked many times, the episode we did with Mike Curlew about Sioux Lookout, not that long ago, have segregated hospitals, running out of medication, running out of sedative medications, antibiotics in our own country. Yes, we have been increasing the awareness, which is great. In terms of these issues, like George Floyd, the residential schools, you're hearing a movement and you're seeing that push towards diversity, inclusion, and equity, and so on. But I'll tell you this, this is not enough. I'll just say, we're moving in the right direction, but it is not enough. These attitudes are deep seated. They’re systemic. From my perspective, maybe I've got a little bit of edge here, but it's like no more. No tolerance for this st. I am just done. I've been in those experiences to Asha, where you, you question? ‘Oh, maybe it's not really me, or maybe its what I was wearing’ I'm now at this stage. Fk that. I'm sorry. No, enough, is enough. I hear these stories and it just breaks my heart. Folks this is one example. Picture yourself. You're relatively new mother is right, with your two-year-old. You've been fighting off going into a hospital because you want to be there for your family, you can't breathe because you have pneumonia, and some cat comes in and asks you how much you drink? Do you have a home? what part of me is screaming ‘I have a problem?’ Just by the way I look you make these assumptions. How are you feeling at that time? How vulnerable do you feel you bring your life in somebody's hands, that is judging you out of the gate? This is this is not right and I hear these, I hear the naysayers ‘who gives a st about D&I and all that stuff’ If I'm being honest, there's ways to approach it and there are ways not to approach it, and I think people are trying, but this is why diversity matters. This is why it matters. This is why you need people at the table, at your boardroom, in your exec room that look like us. So, they could so they could address these needs, they could put awareness to these needs and do all we can to prevent it from happening to some of our most vulnerable folks, enough of abandoning these people. I'm just so sick of it. I'm so tired of it. I know I'm making this about me a little bit I'm sorry, a few months ago my kid got my eldest kid got called the N word at school. I gotta say, it was very triggering for me, I look at my nine-year-old son and knowing now that his innocence to a certain degree has been taken away from him. He knows now get that sense that we've many of us have had, you and I have had that we're being judged by our appearance. He now knows what that's all about. I don't want that for my kids. I don't want that for my boys. I know it's a reality. I know are gonna have to go through talking to them about how they conduct themselves with police. I will have that conversation. But you and I shouldn't need to have that conversation. It's just heartbreaking hearing like this not that long ago. How old is he now?
AF: He’s ten so that was eight years ago.
KK: Eight years ago, but st. Like enough? I just went off there unexpectedly. But it's just like I said, I get triggered by this st. How did that frame your practice? Do you feel like that change the way you deliver? Care? Did you like it? Was that motivating in any way? How's that shaped you?
AF: Well, something I was really, really present with was the fact that I am in a privileged indigenous woman, and I have a ton of support family friends. I have a home; I have a ton of that and it impacted me so deeply. I just think about folks who don't have that type of support system, to even go bring it to a therapist, or to even like, you know, it just keeps building up building up building up. So, it really struck me in that way. It really struck me that I need to be a voice for those who don't have a voice or a voice who don't have those who don't have the capacity to speak up. That's when I started speaking up on social media, I can't not do this. So. And then I wrote this letter called ‘Dear White woman that wants to be like me’ because at the time, I would just see a ton of whiteness. I know people hate this term, white women, but it was white women, it wasn't black women, it wasn't South Asian women, it was white women taking our teachings and our beautiful things and then using them for their profit or using them for their advancement. Obviously, all these white women rising in the spiritual places on social media and in their online businesses, and I thought ‘I've been in business for 20 years. Why is this? How, like, why is this happening? What like, why am I so invisible?’ it just hurt to have these things taken and no acknowledgement of where you're taking it from, of the history of our country of indigenous people. So, when I wrote that letter, I wrote it on my blog, and I thought, oh, maybe like 20 people will read it. It went viral. And I think 25,000 people shared it. I think it was at hospital incident that just kind of led to this, like, speak up, let your voice be heard, even if it's scary, all those things. Then when that went out really wide. I said ‘there's no turning back now’. This is this is the truth. This is the truth about how our country doesn't see us. I want to be a voice for those who cannot speak it.
KK: I want to really commend you Asha for being that voice, because it's not easy. You have to go to a difficult place anytime you speak up. When we speak to issues such as this, go to your own experiences. It’s great to have that courage and to have that will and it's what we need. It's what we need. That's why we have a mentorship program for black youth that are aspiring to be physicians and then go into the medical field and one of the things that I'm trying to do instill in these guys is it's okay to be authentic, I want you to be you, I want you guys to be you, for your mental health your overall wellness. There are a lot of messages that being you is not safe, but I'll tell you, we're gonna change that. We're gonna be our authentic selves walking through the door, so that you could thrive. It’s similar to the Impact event just like enough of just surviving people. I want you cats to thrive. When y'all excel, I want you to get a seat at the table and realize that you could achieve your dreams. When I give that example of walking into a hospital and a young black kid was a patient and he saw me he's like ‘Wow, that's incredible. There's a black doctor here’ at the time, I thought it was awesome. I'm being a role models to folks. At the same time, I was like, how? Why am I a unicorn? I shouldn't be special. There's no way I should be special. So like a lot of you know, racialized community members don't even think this is a reality. Us doing what we do, they don’t think it’s a reality. So, you know, putting ourselves out there being an examples, being a voice to say like enough is enough to important.
AF: I realized how long I carried sort of so much responsibility over responsibility. When the, the children were discovered, I said ‘If every Canadian could take one piece of like, what's on my shoulders, you know, if you could just carry some of this with us, and really be allies for our voices’ Yes, we do this and it's important and we have to and we're so tired of always having to do this. I'd rather just go dance in my living room to be honest, I want to call him that grace, ease, joy, abundance. Speaking the truth doesn't always do that. I know I'm making huge changes for the next generations. I feel like it's so impactful and also I'm tired. So, I would love to like invite folks to like, can you also just like, you know, spread some awareness and care. Just care.
KK: Yeah, more importantly be that ally. I mean, just sit with it, think of the kids in that school. Think of a kid who is alone, away from their people, abused and dying alone. How can you not have compassion? Most of us are our parents, think of your own child. Really sit with it. Think of your own child being away from you and being abused and neglected. This happening in our own country, these attitudes persist, that we could treat people like animals. Still to leave that and not have a lens of compassion or not want to be an ally. Screw that, man. It's time. It's time. I'm, I'm ready to drop kick some of this racism stuff in the pelvis. I've always been a bit. You know, we need to do better but George Floyd, residential schools, seeing it in my own child. You know, for me we have no choice but to speak up. We really don't. Oh my God, this is an emotional episode, Asha. Going from love, the anger to sadness. I'm exhausted. This that's a sign of an amazing interview. So, I wholeheartedly want to thank you for all that you're doing - your courage, your voice. The ability to reach so many folks is what we need and just being creative to like, to you thinking outside the box on how I can reach more and more folks. I really want to commend you. Can you give folks the best ways of connecting with your book? ‘You are the medicine’ , your website, I also want them will have a link to ‘Dear White women’ too
AF: Yeah, my websites ashafrost.com and if folks are open to looking at oracle decks, I have my Oracle deck coming out the end of February. It's called ‘Sacred Medicine’ Oracle. It is so beautifully illustrated. You get to choose a medicine for your day, every day. So, I invite folks into that next part of my work and then follow me on Instagram asha.frost. I'm there most often.
KK: Your IG is fresh and growing. Listen, thank you so much for joining us on the show today. You've truly moved me. I know you're gonna move many of our listeners too, thank you so much.
AF: Thanks for having me.
KK: Thank you so much for joining us. I hope you enjoyed that episode. Please check out all our content on Instagram YouTube, Tik Tok, Facebook, Twitter @kwadcast. Check out our Substack that's where we have everything housed now. I'm telling you changing the bogey. Leave any comments at kwadcast99@gmail.com. Leave that five-star rating. Everyone would give some love to your loved ones. Let's start healing together.
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Episode Summary
In this livecast episode, we welcome back Dr. Zain Chagla, Dr. Stefan Baral, and Dr. Sumon Chakrabarti to address some of the issues we've seen throughout the pandemic, new variants and what to expect with future variants, discussing what we've done well over the past few years, misinformation, the effect of social media and the messaging on Twitter, the role media plays and the influence of experts on policy, public health agencies, booster shots to combat new variants and who actually needs them, where we are at with public trust, and much more!
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"In this episode we welcome back to the show clinical phycologists Dr. Karen Dyck and Dr. Melissa Tiessen. This one is all about self-care. Getting in touch with yourself, wellness and more!"
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Episode Summary
In this minicast Dr. K has a big announcement! A brand new initiative, reversing metabolic disease, virtual health, and more great news for 2023!
Thanks for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.
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BetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.
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KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
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SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
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SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
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SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
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Follow us on twitter, TikTok & Instagram: @Kwadcast
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SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
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SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
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SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
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Solving Healthcare is a podcast series launched in September 2019 by the Resource Optimization Network. Led by Dr. Kwadwo Kyeremanteng, a palliative care & intensive care doctor based in Ottawa, these podcasts will feature interviews and discussions on the topic of improving healthcare delivery in Canada. Underpinned by the values of cost-effectiveness, dignity, and justice, these podcasts will challenge the status quo, leaving no stone unturned as we explore gaps, assumptions, and different perspectives in the pursuit of finding solutions to problems in Canada’s healthcare system
Note, views expressed belong to the host only.
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
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Episode NotesSOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use the Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use the Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM or facebook.com/groups/solvingwellness
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionals
SOLVINGWELLNESS.COM
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shop
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter, TikTok & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
Episode NotesSign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.
Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://t.co/jxsWRsnWwH?amp=1
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SPONSOR
Edward Lifesciences:
Our company is driven by a passion to help patients. We partner with clinicians to develop innovative technologies in the areas of structural heart disease and critical care monitoring to help patients live longer, healthier and more productive lives.
edwards.com
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING
solvinghealthcare.ca or kwadcast99@gmail.com
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
solvinghealthcare.ca or kwadcast99@gmail.com
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING:
solvinghealthcare.ca or kwadcast99@gmail.com
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING:
solvinghealthcare.ca or kwadcast99@gmail.com
SPONSORS
BETTERHELP
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING:
solvinghealthcare.ca or kwadcast99@gmail.com
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
SPONSORS
NUTRISENSE
Sign up with Nutrisense and use Promo code: SOLVINGHEALTHCARE and get $20 off:
https://www.nutrisense.io/?utm_source=SOLVINGHEALTHCARE&utm_medium=web&utm_campaign=partner
EPISODE 104 DR. JASON FUNG & STEPHEN TUCKER
For the full episode, go to:
solvinghealthcare.ca/cancer
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
For the full episode, go to:
solvinghealthcare.ca/cancer
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
KEYNOTE SPEAKING:
solvinghealthcare.ca or kwadcast99@gmail.com
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
- https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Seminars & Merchandise.
solvinghealthcare.ca/shop
Use promocode kwadcast20 for 20% our seminars
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Today show is sponsored by:
BetterHelp.com
BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone. Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"
Trulocal.ca
Shop for clean, locally sourced meat products online and make fewer trips to the grocery store.
Go to trulocal.ca and use promo code “SOLVINGHEALTHCARE25” to get $25 off your first order!
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Trulocal.ca
Shop for clean, locally sourced meat products online and make fewer trips to the grocery store.
Go to trulocal.ca and use promo code “SOLVINGHEALTHCARE25” to get $25 off your first order!
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Trulocal.ca
Shop for clean, locally sourced meat products online and make fewer trips to the grocery store.
Go to trulocal.ca and use promo code “SOLVINGHEALTHCARE25” to get $25 off your first order!
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Trulocal.ca
Shop for clean, locally sourced meat products online and make fewer trips to the grocery store.
Go to trulocal.ca and use promo code “SOLVINGHEALTHCARE25” to get $25 off your first order!
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
SPONSORS
COVID-19: How to Manage Stress and Build Resilience
solvinghealthcare.ca/resilience
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
SPONSORS
COVID-19: How to Manage Stress and Build Resilience
solvinghealthcare.ca/resilience
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
SPONSORS
COVID-19: How to Manage Stress and Build Resilience
solvinghealthcare.ca/resilience
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
SPONSORS
COVID-19: How to Manage Stress and Build Resilience
solvinghealthcare.ca/resilience
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
SPONSORS
Trulocal.ca
Shop for clean, locally sourced meat products online and make fewer trips to the grocery store.
Go to trulocal.ca and use promo code “SOLVINGHEALTHCARE25” to get $25 off your first order!
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Show notes by Michael Pratte
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Purchase the recorded summit:
https://solvinghealthcare.ca/lowcarb
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Aug 9th, 330PM EST
https://drkwadwo.ca/low-carb-ketogenic-approaches-to-health/
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Outro by 12-year-old Mason Hartwick, Power Chords
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Aug 9th, 330PM EST
https://drkwadwo.ca/low-carb-ketogenic-approaches-to-health/
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
Aug 9th, 330PM EST
https://drkwadwo.ca/low-carb-ketogenic-approaches-to-health/
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://www.educationfoundationottawa.ca/students-in-crisis/bridges-over-barriers/
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
https://drkwadwo.ca/low-carb-ketogenic-approaches-to-health/
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Give A Mile
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Low Carb & Ketogenic Approaches to Health:
Solving Healthcare and the Resource Optimization Network present our first virtual summit!
https://drkwadwo.ca/low-carb-ketogenic-approaches-to-health/
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
For Lara's Courses, here's the link:
https://jq191.isrefer.com/go/tt/solvinghealthcare/
Use promo code SOLVINGHEALTHCARE to get an exclusive discount for Lara
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsors
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
For Lara's Courses, here's the link:
https://jq191.isrefer.com/go/tt/solvinghealthcare/
Use promo code SOLVINGHEALTHCARE to get an exclusive discount for Lara
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
solvinghealthcare.ca/podcast
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to the podcast:
Solvinghealthcare.ca
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Episode NotesSponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
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Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
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Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sponsor
The Flipside Life’s inaugural virtual event, "The Better Together Project" on July 9th:
https://tfsl.eventbrite.ca/?discount=SOLVINGHEALTHCARE
Kim Sutton:
http://solvinghealthcare.ca/kimsutton
Charity
Help children in need in our community. Check out our charitable initiative,
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-
ottawa/3796079647/donate?campaign=33
Merchandise
Shop our Solving Healthcare merchandise and help support our community! All proceeds will be going to Bridges Over Barriers
https://solving-healthcare.myshopify.com/
Find André Picard’s latest book, MATTERS OF LIFE AND DEATH:
Public Health Issues in Canada here: http://www.douglas-mcintyre.com/book/matters-of-
life-and-death
Listen to Dr. Goldman’s podcast, White Coat Black Art:
https://www.cbc.ca/radio/podcasts/current-affairs-information/white-coat-black-art/ and his new podcast “The Dose”: https://www.cbc.ca/radio/podcasts/the-dose/index.html
Brian's books
Secret Language of Doctors: https://amzn.to/2MhH6Dc
The Power of Kindness: Why Empathy Is Essential in Everyday Life : https://amzn.to/2ZVOf4b
Follow Dr. Philpott on Instagram (@jane_philpott) and Twitter (@janephilpott)
Follow Mr. Picard on Instagram (@picardonhealth) and Twitter (@picardonhealth)
Follow Dr. Brian Goldman on Instagram (@nightshiftmd) and Twitter
(@NightShiftMD)
Newsletter
Have you signed up for our newsletter yet? Keep track of everything going on at Solving Healthcare by subscribing at the link below:
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manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=124e477919
Webinars
Subscribe to our expert-led, interactive webinar series:
https://resourceoptimizationnetwork.us19.list-
manage.com/subscribe?u=45cbdf2bcb2b4aaebef54a196&id=ed860b52f9
Catch up on our previous webinars on our Youtube channel:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
How to subscribe to podcast
Make sure to subscribe to the Solving Healthcare podcast! You can find us on Apple Podcasts, Spotify, iHeart Radio, Castbox or Simplecast. Links to each platform can be found below:
https://www.resourceoptimizationnetwork.com/solvinghealthcare
Social platforms:
Twitter https://twitter.com/kwadcast
Instagram https://www.instagram.com/kwadcast/
Youtube
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w/videos
Simplecast website:
https://solving-healthcare-with-dr-kwadwo-kyeremanteng.simplecast.com/
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds are going to The Ottawa Food Bank
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
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Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds are going to The Ottawa Food Bank
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
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Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
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Sign up for our newsletter at: https://t.co/DhTElki6I2?amp=1
Outro music by 12 year old sensation, Mason Hartwick, 736 Blues in G!
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
https://t.co/DhTElki6I2?amp=1https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
https://t.co/DhTElki6I2?amp=1https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
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YouTube:
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Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
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Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
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Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
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YouTube:
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Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
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Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Video link:
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Feeding Frontline Staff COVID-19:
https://www.gofundme.com/f/feeding-our-frontline-workers
Bridges Over Barriers:
https://donate.micharity.com/education-foundation-of-ottawa/3796079647/donate?campaign=33
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Feeding Frontline Healthcare Providers:
gf.me/u/xstpfk
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
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https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
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Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Episode NotesSign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up with Audible: https://amzn.to/2T44qsx
- An unmatched selection of audiobooks performed by world-class talent.
- 3 titles for each month of their gift membership: 1 audiobook + 2 Audible Originals.
- 30% off any additional audiobooks.
- Anywhere, anytime listening with the free Audible app.
- Free and easy audiobook exchanges.
- An Audible book library they'll own forever.
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Department of Medicine site: https://ottawadom.ca/solving-healthcare
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Solving Healthcare Merchandise.
https://solving-healthcare.myshopify.com/
Proceeds will be going to Ottawa Inner-City Health
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
https://www.facebook.com/kwadcast/
YouTube:
https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w
Sign up today: http://betterhelp.com/solvinghealthcare
and use Discount code “solvinghealthcare"
Critical Levels:
http://www.criticallevels.ca
Resource Optimization Network website: www.resourceoptimizationnetwork.com/
Follow us on twitter & Instagram: @Kwadcast
Like our Facebook page:
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Transcript:
Kwadwo : 00:00 Yo, y'all wanted more of André Picard. We are delivering. We're talking cannabis. We're talking PharmaCare. We're talking medical assistance in dying. We're talking privatization of healthcare. Episode 14 with André Picard. Let's go.
Kwadwo: 00:18 Welcome to Solving Healthcare. I'm Dr. Kwadwo Kyeremanteng. I'm an ICU and Palliative Care physician here in Ottawa and the founder of Resource Optimization Network. We are on a mission to transform healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their families, because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified and just for everyone involved.
Kwadwo : 00:53 Thanks for tuning in everybody. We are super excited about this episode with André Picard. We cover a lot. We cover some of the questions that we saw on social media, on Twitter and on Facebook, but what I want you guys to really take away from this episode is how a lack of clear objectives and goals within our healthcare system really can impair care, and impair resource utilization. I think that was a huge eye-opening point that André and I get to talk about here in this episode amongst the other things, but it's a real eye-opener. Every other area within business, healthcare, your own health, your career goals, you, all of us have clear goals and objectives, but what are our goals in healthcare? Is it to reduce infant mortality? Is it to improve on mental health services? What are our objectives? These are the real questions we should be asking ourselves.
Kwadwo : 01:56 Okay. Before getting into the show, I want to tell you about our sponsors, Betterhelp.com As I said, I love these guys. They are online counseling service that provides accessible, affordable, and convenient counseling services that are readily available by a video chat, via telephone, via text messaging, and they cater to your needs, whether it's teen counseling, whether it's marriage counseling, whether it's health care providers, addressing compassion fatigue. They're fantastic. So if you guys are looking to sign up, use promo code Solving Healthcare, and you'll get a 10% discount on their services. Our other sponsor today is The Podcast Critical Levels. This is hosted by my boy Zach Cantor and this show's awesome. It's about paramedicine and the issues around paramedicine, but they also dive into issues that involve us all. Specifically, he had a great episode with Dr. Zemek about childhood concussions, which as a father of three boys that are involved in hockey, I was completely engaged in. It was a great conversation.
Kwadwo : 03:08 This guy's going to be a star, so you guys are game, listen to him on iTunes, Spotify, or Stitcher, anywhere you could listen to podcasts and, it's a guaranteed gamer man. Good job Zach. Lastly, I want to give a shout out to the Department of Medicine at the Ottawa Hospital. These guys have supported this show tremendously. I want to give a shout out to Abhilash, Sandra, D D, Tracy, you guys are amazing. They've assisted with marketing, on updated website on the Department of Medicine page. I'll leave links to that on the show notes. It is proper, but yeah, love you guys for all the support and uh, appreciate it. All right, let's dive into it. André Picard, the author of "Matters of Life and Death." And you heard him on Episode 13. Amazing journalist, 40 years of experience and he really delivers on this episode. We talk about it all and I can't wait for you guys to listen to it. So we're just going to dive into it. Enjoy Episode 14.
Kwadwo : 04:14 So I touched a bit on universal healthcare and in how, I'm not sure in Canada we can truly say that we have universal healthcare. I'm wondering if you had any thoughts in terms of privatization. You know this is coming up a lot in terms of ways of making healthcare more sustainable, dealing with wait times and so forth. What are your thoughts in terms of privatization?
André Picard: 04:40 Well let me start with the universality part of the puzzle. So we have, in Canada we have this notion that we have a universal system, but we have the least universal universal healthcare system in the world. I think once you put it in those terms, you go, "Oh hold on. Is that true?" Because we cover hospitals and we cover physicians a 100%, we cover very little of everything else. We cover about 45% of drugs publicly. Well, 30% of home care, uh, 30- 35% of long-term care, 6% of dental care. We're all over the map and it's irrational. So we don't have a universal healthcare system. So that's the first part of the puzzle. I always said, I like to use the analogy of a basket. So we have this Medicare basket of services. Right now we have a basket that's very narrow and very deep. It's hospitals and physicians.
André Picard: 05:29 We pay for all of it, even though some of it probably shouldn't be paid for. And then the other stuff we don't cover near enough. So I think we need to make this basket a lot wider and a bit shallower. So we cover a lot more, but we give some people some responsibility for the rest. So that brings us to the, the second part of the privatization talk. And I think a lot of the talk about privatization in Canada, the way to shut down any discussion about healthcare is to say, "Oh, you're going to privatize, we're going to be like the U. S." Well, I think that's it. I think that's nonsense. I think it's a false dichotomy. I think the reality is every, no health system can cover 100% of everything for everyone all the time. So we're going to have some private healthcare,. We have to realize that from the outset.
André Picard: 06:18 So the question is not will we have private healthcare? The question is where do we have it, how do we regulate it, and how do we make sure that everyone gets the essential care that they need at an affordable price? So that's, you have to have these philosophical parameters and then how we deliver the care. To me, it doesn't really matter. I don't care if it's delivered by a privately, publicly a mixture. What matters is that people get the care and that it's accessible and that it's affordable. So that that's my philosophy. I get some grief for that, but I think that's how we have to have the discussion about privatization. It's not black and white. It's about how do we regulate it, how do we ensure that it's delivered fairly and comprehensively, et cetera. I think in Canada, the problem we have is we have a badly administered public health care and badly regulated private health care. So we kind of have the worst of both worlds. A lot European countries have a lot of private health care, but it's very strictly regulated. It's not a free for all the way it is here. So there's different ways to, to have get that balanced right. And again, you've got me on my pet topic.
Kwadwo : 07:27 That's part of my game. It's interesting because actually I've never heard it framed that way is that we're the, how'd you put it, in terms of universal healthcare, we're the...
André Picard: 07:36 ...the least universal in healthcare.
Kwadwo : 07:39 Yeah, I like that. And I mean cause it's often people forget that they're like, oh we don't have any private health care in Canada. But you know, if I go see a physiotherapist I'm paying out of pocket. And it's true. It's like where do we want to put our private resources? I mean, well some of the topics that come up or worries I hear people mention is like resource drain where like some of the best surgeons or physicians or whatever, allied health professionals, would just strictly go into the private sector. But it's kind of like you mentioned if you regular, if you're like anything that you're going to do that's semi new or complicated will take some nuance. And so yeah, you know, maybe you need to restrict how much time physicians could spend in the private sector. Maybe that's a solution, but certainly to think that we can't have any element of private healthcare in 2020 or beyond I think is a bit ignorant at this point.
André Picard: 08:41 Well, you're right. It's about setting parameters. So if you look at a country like France, a many doctors practice in the public system and the private system, but there's strict regulations. So if you want to work in the private for every hour you give to the private system, you have to give an hour to the public system. So that's, that's a way of getting some balance there. It's not a, you know, it's not an either or. In Canada you can opt in many provinces, not all, but in many provinces you can opt out of the public system and then you can charge whatever you want. There's no limit. I'm not sure that's a good system. Now very few doctors do because our Medicare system is actually very generous for doctors and it's a good system, very little bureaucracy compared to systems like the U. S. So there's the greatest beneficiaries of Medicare have been physicians. We shouldn't forget that.
Kwadwo : 09:27 Yeah. I feel like it's so taboo, but we need to go there and I, I don't know what, will make us go there. What I'm getting at is what is our breaking point? Because baby boomers, are getting to prime time, health care, utilization, age, you know, we keep saying that we can't keep this up in terms of healthcare delivery and spending. So what's next? Like what do you see? What's going to happen in Canada in your, in your humble opinion?
André Picard: 10:00 Well, you know, I think that we have to realize that healthcare is really important to us. Uh, we have to find a way of delivering it. And as I said before, we obsess a lot too much about the cost. Do we spend too much on healthcare? I am often asked that question and I always give the same glib response.
André Picard: 10:16 I always say, I have no idea because I don't know what we're trying to achieve. So we just spend, you know, we spend the way we spend, we don't have any set public health goals in Canada. So unless you have goals, it's hard to save for we're getting, achieving what we're trying to do. So I think that's, we have to do some basic stuff.
Kwadwo : 10:34 What kind of goals would you have us, would you have in mind?
André Picard: 10:38 Yeah. So I look to many countries do this. So you look to a country like Sweden. So Sweden publicly publishes every year a list of its public health goals. So for example, I take one in Canada and Canada, we have an abysmally the high rate of child mortality compared to most of the world. So I would say in Canada, we want to bring our rate of child mortality from three per thousand to two per thousand.
André Picard: 11:05 That would be a public health goal for me. And then we find out a way to do that and we spend the money that's necessary to do it. So that that's how you have, goals and then you work to achieve them. People often get uncomfortable when I say, "You know, we have to treat it more like a business." And that's what a business does. A business says, here's the goals for the year. Often those goals are related to profit, but we don't have, that doesn't have to be the goal in healthcare. The target, the goal can be, you know, we're going to ensure that our child poverty rate falls by X percentage points or that, the cesarean delivery is going to be less disparate from one end of the country to the other. So there's all kinds of goals you can set once you have goals. It's easier, I think, to, to figure out how to spend appropriately.
Kwadwo : 11:48 You know where you're trying to go. You have purpose.
Kwadwo : 11:53 Yeah. It's funny cause you always hear on a lot of whatever endeavors that you, you, you go on that, you know, you need to set goals and, and write them down or discuss them, be clear on what your objectives are. And it's funny if you asked me what, you know, what are the goals are Canadian healthcare system, that's not an easy question. Yeah. To make Canadians healthier or whatever. But is that really specific enough? Is that like, what does that actually mean? You know? Yeah. No, that's a, that's a great point.
André Picard: 12:25 When I, when I do talk to, I often ask the audience, I say, what, what is the statement of purpose of Canadian Medicare? So we spend a quarter of a trillion dollars every year or $256 billion on healthcare. What is its purpose? So I often ask that to audiences and the question, the answer is always silence. So I tell them, you're right, we don't have any, you're all right. You don't just answer nothing. And when you put it in those terms, I think people go, "Wow, we spend all this money and we don't, what's the purpose of it?"
Kwadwo : 12:54 Yeah, wow.
Kwadwo : 12:56 I'm actually speechless because yeah, what really is our goals, you know? Yeah. I mean it's, even if you think about it in, in specific niches, like you know, when I'm in ICU, I know my goals are clear. When I'm in the Palliative Care, my goals are clear. You know, when they, when we look at a system level, it's not clear at all. You know, we might have a bunch of issues but we're not prioritizing them. We're just blanketly throwing money in and dealing with fires. Wow.
André Picard: 13:29 And Palliative Care is a really good example. You know, you have very specific goals once the patient is there, but whatever. What are our goals as society to ensure that the right patients get there? In Canada between 17 and 35% of people who should have palliative care get it. We do a terrible job of ensuring people are treated well at end of life. And you know, I can't, it's hard to imagine something that's more important than alleviating people's pain at the end of life to not see them die a horrible death. And we just haven't, we don't have goals. We don't have, we haven't made that a priority. You know, again, it's the Canadian classic thing. Once you're in power, you know, you're in palliative care, we have fabulous Palliative Care. So many people are denied access to that, that it's criminal.
Kwadwo : 14:16 Yeah, and the thing that people may or may not realize is even when it studied the benefits of early Palliative Care, like there's a study out, it's almost 10 years old now that it was stage four cancer patients got either early Palliative Care or just standard care up to the discretion of their team. And the patients that got early Palliative Care, not only were their symptoms improved, but they actually lived longer, ironically. And so, yeah, I mean you're definitely preaching to the choir in terms of Palliative Care resources. I mean, you know, when you, when you look at trying to improve the experience for the family, for the patient, making sure that the, you know, they're not suffering and you know, even from a resource point of view like the patients are less likely to occupy acute care beds as a result. It's just a, it is a bit mind boggling that this is not emphasized more.
André Picard: 15:12 Yeah. And it's a reminder. What you're saying is reminder. I don't, I don't think we lack money. I don't think there's any lack of money in our system, we're one of the biggest healthcare spenders in the world. But I think it's how the money is allocated, is the problem. We don't spend smartly. We don't get value for money.
Kwadwo : 15:27 This is, this is my, I mean, this is like my mission, Andre. It's like I see it day in, day out us putting in money into interventions that have no benefit. Even, there's a simple, this is a very simple example, but you know, I think it clarifies things you could have if someone comes into the ICU when they're, they need to be resuscitated with IV fluids. There's normal saline that you've, we've all seen that costs maybe a $1 .30 and then there's some more sophisticated fluids that cost about $50 to $60 for the same amount of volume.
Kwadwo : 16:03 So 60 times a price with no, like if you could study it through the union, there was no additional benefit for you getting that fluid. You know, and we, we spent thousands on it and if there's no reason for it. You could have an oral antibiotic that's just as effective as an IV antibiotic, but people will still order the IV one because it makes it feel better. Throwing away money just cause, you know, for lack of understanding or just because of a lack of lack of a will to change, it's just, it's all over the place. And then instead we could be putting it into places that matter. That's a, this is, I don't know if this is what drives me nuts. You know, I see my physio-therapist position gets cut , I see my social worker position get cut, things that actually are going to make a difference into the patient experience and improving care.
Kwadwo : 16:56 I'm going to have to cut these positions. Yeah. It's crazy to me.
André Picard: 17:00 Yeah. And you remind me of, I remember visiting a unit for girls with eating disorders at a hospital and they had cut the psychological care so they were no longer getting psychological care. So what was the result is they ended up spending many more months in hospital. I had great, a tremendous cost, way more money than it costs to fund a psychologist. A different budget, et cetera. It's just a lot of irrational stuff like that happens and it just, it actually costs more money, not less. I know people, 90 year olds with dementia and cancer are getting a hip transplant. What's the good of that?
Kwadwo : 17:36 Absolutely. It's and stuff that has been studied and we know are unlikely to benefit and we still offer it. And you know, I mean when you give that example of arguably who might be the most valuable person in an eating disorder ward, I would think it would be the psychologist. Wow.
Kwadwo : 17:56 That reminds me, we did get a bunch of questions on Twitter when we were doing this show and, and one of them, you're a popular man. One question that like really stuck with me and, and I don't think there's an easy answer to this, is how do we break the cycle of these four year,
Kwadwo : 18:18 cycles where governments are in power. And so they, the budgets are reflective of that. So there's so much sort short, shortsighted, you know, budget, budget, intervention cuts because we got to balance the budgets despite the fact that some of these cuts are gonna make things worse in the long run. Is there a solution to this problem?
André Picard: 18:38 Well, again, yeah, I think there is a solution and again, we can learn from looking at other jurisdictions. I think one of the things that distinguishes Canada is the level of political micromanagement. So there's way too much interference from that. The Health Minister's office reacts to what's on the front page of a newspaper. That's how our system runs. It's like I always call our health ministers, firefighters instead of fire prevention officers, that's what they should be doing. They should be setting the philosophical goals, as I talked about before. These are the goals that we want to achieve and we should have professional administrators running the system so that, that's what I see when I go to countries in Europe, like the Netherlands and France, they're professionally managed. They're run like a business. And the government essentially keeps their nose out of it, and the public doesn't want their noses in it. So I think it's really to let the managers manage.
Kwadwo : 19:30 Mmm.
André Picard: 19:30 One of the worst jobs in Canada has to be a healthcare administrator because you have all this responsibility and you have no power and you're constantly second guessed by politicians. It's a terrible position to be in. So what do they do? They just cover their butts. They try and not make waves and we just go along, you know, try and keep quiet and nobody wants to catch the attention of the Ministry of Health because it's always going to be bad news. So I think it's this professionalization, that we have to aim for. And it's weird cause we don't do it in any other part of our government. You know, the Transport Minister doesn't call and tell the airport what flight should be going out. And that's, that's how it works in healthcare. It's absurd. So I think that problem is easily solvable, but it's going to take some, some political guts for people to say, listen, hands off, I'm going to let the, you know, Ontario Health. So, you know, say take Ontario Health, this new system, theoretically you should be able to do that. That should be an independent entity. Government gives them their allocation of money, go for it, run it that it should be run that that's how a system works in most countries and that's how it should work here.
Kwadwo : 20:42 Have you seen a province, the healthcare system that works better than others?
André Picard: 20:47 That's when I traveled around the country. I always know that's going to be the first question when I do a talk. I'm obsessed in Canada. Are we the worst or are we just sort of in the middle? That's everybody wants to be in a major of Canadians. So I think, I think the answer to it is we don't know cause we don't measure things very well. I think anecdotally we know that every province does some stuff really well. So we all have areas of excellence. I often describe Canadian Medicare as "islands of excellence in a sea of mediocrity". We have a lot of mediocrity. We have that but have a lot of great stuff. So New Brunswick has tremendous paramedicine. Manitoba has really good homecare. Quebec has really good primary care with CLSC's.BC has a really good handle on its drug program. So there's all of these provinces that do things well.
André Picard: 21:37 And the frustrating things for me is we don't learn from each other and copy each other. We do quite the opposite. We always try to reinvent the wheel. But to get back to your initial question, who does it best overall? I'll just go with my gut feeling cause again, there's no measures, but I think these days, I think it varies. I think Alberta used to have by far the best health system, sort of a pioneered the regionalization model, and it does it really well. It allowed the regions to, to run in the way we talked about, you know, you're the boss and you run it and the government keeps its hands out and until the government started meddling again, that worked really, really well. So I think Alberta was a leader for a long time. I think now probably Saskatchewan. Saskatchewan is a really good size, but a million really good size too to run a system.
André Picard: 22:26 Ontario is kind of a dog's breakfast. They're trying to fix this with a reorganization, but it's really the most disorganized system as a result. I think one of the ones with the, with the worst outcomes, unfortunately. I don't think there's a best and I don't think there's a worst, but there's a lot of good and there's a lot of bad overall. Unfortunately.
Kwadwo : 22:45 No, I can appreciate your answer. I'm originally from Alberta and one of the things that was taking place before I left was single electronic medical health record. You know, they had this, I'm forgetting the name off the top of my head, but you know, taking the bull by the horns and saying, you know, this is ridiculous. We should all be under one system and oh it should, all hospital charts should be able to speak to each other to a certain extent.
Kwadwo : 23:15 And this was, I mean this was in 2005 when I left, so yeah, I do. I could, I could see where you're coming from. And yeah, at the time they still had the like a health authorities is what they would call them. Like which pretty much had as you described, a free reign. Relatively speaking to, to work in the way that was most effective for their community. It's a really good point you bring up though. It's, you know, a little bit more independence for some of these administrators to, you know, to try and do the right thing for their, for the community and to be able to get to their needs. Yeah, I mean that's a, that's a fair point and that you don't hear about every day, but yeah, certainly in Ontario this is what we're attempting. All right. I'm going to ask you a bit of a controversial one too.
Kwadwo : 24:02 Is there a party that you feel like since you've been doing this for 40 plus years, it seems to do a better job of this than others?
André Picard: 24:11 Well, you know, the, I think one of the biggest problems in Canadian politics is that there's very little difference between the parties, violent agreement on, you know, essentially the status quo. And that's, to me, it's always frustrating to me during election campaigns, there's very little discussion of healthcare because there's no disagreement. Everybody sort of has this, well, Medicare is great and we don't want to talk about it attitude. NDP, Conservative, Liberal, all the same approach. And I think a lot of it goes back to there's a famous quote to attributed to Joey Smallwood, who is the premier of Newfoundland, one of the Fathers of Confederation. He once said that, "I've never had a discussion about healthcare that didn't lose me votes." To this day, politicians feel like that...
André Picard: 24:56 You start talking about healthcare and it becomes a losing proposition because you can never satisfy everyone. So the parties kind of agreed to to say nothing. We have these little discussions around the edges occasionally because there's never any serious talk of performing healthcare regardless of the party. So short answer, no, there's not one that's better than the other. What we do know is that the lesser a party's chances of being elected, the more bold their promises are for healthcare. So that, that's the sad reality.
Kwadwo : 25:24 Fair enough. Okay. I'm going to touch on a few more questions that some of the our friends were, were asking. So in terms of new cannabis legislation, what's your, your overall opinion on our approach?
André Picard: 25:43 Yeah, so I've been long a proponent of, I, don't believe that, you know, drugs should be regulated the way they are now.
André Picard: 25:51 I'm a big believer in, legalization of all drugs because I believe people are going to use them and we have to make it safe for them to use, and educate them, et cetera. So that's my premise that I operate from. Lots of people don't like that view, but I have a very libertarian view about drugs and I think it's viewed from a public health perspective, that that's the most rational approach. Now when we take cannabis, I think that legalization of cannabis was long overdue. We started discussing this in the 1970s with the Lyddane Report and finally two years ago we got around to legalization. Now what's happened since then? I think it's been kind of a bust in a bust economically, socially, medically because we've replaced this criminalization with a whole bunch of stupid regulations. There's way more laws about cannabis use now than there were before it was legalized.
André Picard: 26:45 So it's kind of a, we've undermined what we were trying to do. From the business perspective, that's the story that gets the most attention in Canada is our cannabis companies are all going bust, because they're, the sales are not what they expected. We could have built an industry here that export it, its knowledge around the world, but, there's so much red tape and regulation that we've denied ourselves that, right. So, and I think we've kind of messed up this good idea. We've get it done it very, very badly unfortunately. So the reality is what the reality is, a lot of people still buy on the black market. The government stores have a product, but they have long wait lines. You know, there's the Canadian way. We wait for everything. We even wait for in line outside to buy our pot. So I think it's kind of been a huge disappointment, unfortunately.
Kwadwo : 27:35 Yeah. It's, um, I do hear you about the, from a like a public help perspective on legalization cause certainly, you know, putting somebody in jail or putting them in a spot where they can't have a job based on a substance that people are going to use anyway. It seems, you know, um, not right. But my concern personally is the use, especially amongst the youth. Like I think there's some detrimental affects that maybe we're not appreciating. Like I know we see a little bit more psychosis in lead adolescence, early adult age. I just kind of wish it was studied a bit more before we're like, hey, you know, let's just throw it out to the world, but you know, I, do hear from the public health side for sure.
André Picard: 28:27 You know the youth, the youth issue, whether it's cannabis, whether it's vaping, whether it's tobacco, that's a particularly challenging one.
André Picard: 28:34 And those things are all illegal. It's always been illegal for young people. Probably always will be. And that's not the issue. That's not the way we're going to deal with that demographic. We have to, we have to teach them. Uh, we have to recognize that they're young people, so they're going to be risk taking. They're going to be experimenting and we have to deal with that reality instead of being moralistic about it and saying, "Oh, we've got to ban, vaping, we've got to ban cannabis." They're going to use it. So let's make sure that when they do they do it safely, uh, they do it rationally as much as possible for a teenager to do anything rationally. I think we just have to be much more pragmatic about this stuff. I think that's, to me, that's the big lesson I've learned about writing about public health for a long time is. ..
André Picard: 29:15 You really have to put your opinions aside and be very pragmatic about this stuff and realize it's going to happen. So how do we make it as safe as possible? How do we reduce harm? Harm reduction has to be the driving force of our, our public policies. And the worst thing for harm reduction is, is prohibition. Prohibition is always failed regardless of the substance.
Kwadwo : 29:37 Yeah. Fair enough. I guess it's always the question, which I guess we don't know. It's just, you know, what is that safe level? What is a, what is the amount or the approach that, you know, is truly reducing harm. But yeah, a lot of questions in terms of, you know, the approach. How about, another question that came up was regarding PharmaCare. I think you've, you've written a bit about PharmaCare and Canada. Oh, any thoughts on that?
André Picard: 30:07 Yeah, so an issue we've written a lot about because it, it actually did get debated politically.
André Picard: 30:12 Again, I think PharmaCare is necessary. We need to, you know, we're the only developed country aside from the U.S. that doesn't include drug coverage and our, and our universal health plan. So that's something that's needed to be fixed for 50 years. So we have to do that. So we've done it to a certain extent, but we've done it in a very haphazard way. So we have 102 public drug programs in Canada. We have to make some sense of that. We need some, some more centralization, more logic. But I think the really important thing that's lost in the PharmaCare debate is we have to define what we mean by PharmaCare. So we have a lot of people talking about, you know, we need this single universal system. Sure. That's one way of doing it to be, it's not necessarily that way, but the most important thing is what are we going to cover for who and why?
André Picard: 31:02 So how are we going to get value for money, uh, for our drugs? And I think the way to do it is not to copy what we've done with, with the physicians and hospitals, we've covered those 100% and it doesn't work. We've had a lot of waste. We have a lot of, stuff that's not done because we spend too much in those areas. I think we have to be careful not to repeat the mistakes we've made earlier. I think we have to be a little smarter to decide what we're going to cover and that, that to me is the essence of the debate. There's no question that we should cover. Drugs are really important. If we're going to have universal healthcare, but universality doesn't mean covering every product for every person all the time. Ensuring that everyone has the essentials in an affordable way and those are different things .
Kwadwo : 31:49 That certainly was one of the few healthcare related topics that came up during this past election.
Kwadwo : 31:57 And that was a, it's funny, those are my exact thoughts when it came up, I'm like, what is, what does that actually, what does formal care actually mean? Like what are we actually debating here?
André Picard: 32:09 Yeah, there was no, there was no real debate. There were a bunch of platitudes that were uttered, but that wasn't debate because they, the parties never defined what they meant. You know, they said, we're going to bring in, in this program, but what exactly is the program going to be? And then, the fact that the Federal parties were debating this, neglecting the fact that ultimately it's up to the provinces, that that was a big problem as well.
Kwadwo : 32:32 Excellent. Excellent. So, okay, André, what are your thoughts on medical assistance in dying?
André Picard: 32:38 Yeah. So another issue that we took a long time to deal with. So I started covering that issue in the early eighties.
André Picard: 32:45 Then it got a lot of steam with the, in the early nineties with Sue Rodriguez kind of died off for awhile and then came back. So that again, we finally brought in this legislation to give people more choice at the end of life to minimize their suffering. So I think that was a really big important piece of legislation. Now the problem was that the legislation was, was flawed and it was inadequate and we, we've got to fix it. So we're at that point now. In fact, a new public consultations have just started about expanding the MAID legislation. So that's going to happen. The court has ordered it, but it's always frustrating with these issues, how slowly we go, how cautious the politicians are. Thank God we have an activist court in Canada. Or we, we'd have much worse health care. Of course, it forced us to do stuff that we know we should do, but politicians are too, too wimpy to do on their own.
André Picard: 33:37 So I read the important issue. I think we have to recognize it. Very few people are ever going to get an assisted death. That's going to be one, 2% very tiny percentage. But I think it's a really important philosophical point, a theoretical point that people have choice that end of life. I think that's what's most important about this debate is giving patients more control. And I think that we're going to see that now we're going to see the really tough ones. Does that apply to people with dementia? Does it apply to people with mental illness? Does it apply to children? There's some really, really tough debates coming. But again, I, I stay in my bubble about being pragmatic. I think we have to give people options and then we have to ensure at the same time that there are protections. So that these things aren't abused.
Kwadwo : 34:22 So basically what I'm hearing is we can't use this slippery slope argument as a reason not to implement this. People deserve to have that choice in terms of, how they want to end their life.
André Picard: 34:37 I don't know how many times I've said in my columns that not every slope is slippery, but I think we actually remember that, that that's kind of a banal argument. Not every slope is slippery there is, we have to have buffers in place to ensure there aren't abuses, but that doesn't mean denying people rights to want them. No one should be forced to take, to have an assisted death when they don't want to. No one should be choosing assisted death for lack of alternatives like lack of Palliative Care, lack of long-term care. That's unacceptable. Not no one should be denied and assisted death who wants it?
André Picard: 35:11 Who's making a rational choice? We can do all those three things at once. They are not mutually exclusive.
Kwadwo : 35:19 Exactly. In your book "Matters of Life and Death" you touch on transgender issues. Where do you see some of these issues in 2020?
André Picard: 35:30 Well, I think it's just an example of what we talked about at the outset, it's an evolution. You know, it's a new patient group, a new demographic that's standing up and being heard, and that the health system has to adjust. This notion of treating gay men was unthinkable in the 70s and 80s, no, they're a bunch of perverts, and we hear a lot of that same when you're around a long time, you start to hear these echoes and we hear that now about transgender, Oh, we can't possibly do that. We can't use different pronouns. Oh, the language has always been the same, but the things evolve.
André Picard: 36:03 Language evolves. Medicine has to evolve and I think this is these developments are good. They challenge us, they force us to think differently. Unfortunately, there are abuses or wrongs that happen along the way that forces us to deal with this, but I think it's, it's a very positive development that we're talking about. Like gender fluidity, that the gender is a social construct. I think these are really important things for physicians and few for future physicians to think about and to talk about. And how do they treat their patients well regardless of their gender or how they identify.
Kwadwo : 36:38 Super important topic and definitely one for a future episode. André, what about the wait times we're seeing overall whether in emerge or if you're waiting for a hip. Do you see any solutions in the near future?
André Picard: 36:55 Yes. So again, I think wait times is the systemic issue.
André Picard: 36:58 So it's about creating more flow in the system. It's about breaking the bottlenecks. You know, as we talked about earlier, at the long rates in our emergency rooms have very little to do with emergency care, right? They're all about bottlenecks. It's about inability to admit people, inability to, to get people out of hospital. We have this perversity in Canada called the ALC patients, (alternate level of care) patients who live in hospitals. I've done stories about this. I met a patient who's been living in a hospital for 10 years because there's no alternative for them. This makes no sense. It makes no sense from a business perspective and makes no sense from a patient care perspective. Ethically, all these things are wrong and we have to fix them. But you know, in some provinces, one third of all hospital beds, are ALC patients. They are people who have been discharged but have nowhere to go.
André Picard: 37:51 So these are, this is how you deal with wait times is you deal with things across the spectrum. No easy solution. It can't be overnight, but we have to correct the errors we've made of of bad planning. You know, we all, we hear often and over and over again, Oh well,it's the aging boomers. You know, that's what's overwhelming our system. We've known about the boomers for 60 years. No surprise here. It's just a bad planning, lack of foresight. And we have to fix it.
Kwadwo: 38:20 Agreed. But what can we do now? Like if I'm, you know, the Minister of Health or I'm a lead for a health authority and I got these tons of ALC patients, what can we do?
André Picard: 38:33 Well, I think, again, if look at it and say from a business perspective, what do you do in a business if you have this problem? You have a mixture of carrots and sticks.
André Picard: 38:42 So you start punishing hospitals that have ALC patients. Why did patients, you know, that perversity is that hospitals actually like having ALC patients because they require less nursing care. They're understaffed on nursing. They get paid the same amount of money, require less care. So it's actually a good thing for them, which is wrong. It shouldn't be a good thing. So you have to punish them financially. And that will solve the problem pretty quickly. They'll get them elsewhere. We have to incentivize people to have more long-term care homes. Most of our long-term care homes are private businesses and we have to ask ourselves why people don't go into this business. That's because the rates suck , it's because there's way too much regulations. We have to make it easier for people to provide spaces for people who need it. And then we have to deal with the other pieces of the puzzle, which is home care.
André Picard: 39:30 I think we've, put far too many resources into people getting home care just to get them out of hospital quicker from short-term surgery and we haven't invested enough in the chronic part of the puzzle. So again, from a business point of view, way cheaper to care for those ALC patients in their homes costs a fraction of the cost. So take that money and use it differently. And if you don't do that, then you're going to be punished. So the carrot and stick approach, all this stuff is solvable. And I know it's solvable because I see, I don't see these problems in other countries around the world.
Kwadwo: 40:05 Interesting. We kind of talked a bit about how to create change in healthcare and you do bring up the carrot and the stick. And I mean money talks. One of my main incentives to do research around costs is because that's the language that that's a change language.
Kwadwo : 40:24 That's the language of administrators, of politicians. So if you could show a financial benefit for any intervention, like that's when things actually start to move. And so withholding funds so that change can occur. You know, I think it can go a long way, but certainly just sticking with the status quo is not good enough.
André Picard: 40:48 But I would add the proviso that if you're going to have carrots and you're going to have sticks. People have to have accountability and they also have to have power. So you can't punish a hospital for having ALC patients, but not giving them the power to resolve it. I think, again, when you have a regionalization is supposed to be the solution to this, right? So the way a regionalization is supposed to work is that they should say, here's our overall budget. We're not spending it well by having these people living in hospitals, we should spend it on home care or we should spend it on long-term care facilities. So you have to have the power to move that money around and that that's how the issue will get resolved. Ultimately give people, accountability and power to fix things.
Kwadwo: 41:29 I love it. You know, trusting in the people that you've invested into, trying to make the healthcare system better.
André Picard: 41:36 We pay healthcare administrators a lot of money, let them administer.
Kwadwo : 41:40 Mmm, no, that's, that's a great point, André. One thing I like to do is always end on a positive note and allow our guests to talk about a story or a time where they've felt that your job has had a big impact in general. And you did give this story earlier
Kwadwo : 42:00 about, um, you know, the AIDS patient in Toronto, but is there an any other time where you felt that you covering health care and being as engaged as you have been, that you've really made a difference?
André Picard: 42:16 I think there's all those little stories like we talked about, you know, the one patient who, who got better care because of your story, little policy changes. Those are always moving. But to me there, to me, there are two big things in my career that stand out. I wrote for a long time about the tainted blood tragedy. So this came out of my coverage of AIDS. I started covering, you know, there were four groups who were infected with AIDS and one of them was always forgotten. This little group of hemophiliac and transfusion patients. So we started focusing on them and this became, this became a huge story. It became an exposure of one of the worst, probably the worst public health scandal in Canadian history. About 30,000 people were infected with HIV and hepatitis, not because of mismanagement of the blood system, because of lying to people because et cetera.
André Picard: 43:06 I have a whole book length version of this rant, but, that issue that the tainted blood issue I think is one of my proudest moments because it really did bring relief to a lot of people. There was more than $5 billion in compensation paid out. Ultimately, our drug regulation system changed profoundly as a result of that. And I'm not taking credit for that solely, but we did get the ball rolling. So I think that's really important story in my, my legacy, if I could put it that way. And there's another one very similar, but on a smaller scale that a very touching one was a work that I did with my colleague on the, thalidomide survivors. So there's a group of five people who are affected by thalidomide in the 1950s, sixties, left with, you know, missing limbs, et cetera.
André Picard: 43:54 Those folks live the long time suffering in poverty. And we came back to that a few years ago and wrote about these forgotten survivors. And again, the result was a quite a large compensation package. People getting their lives back, people who are forgotten, you know, we got to tell their story. And there's a lot of, a lot of touching, touching stories as a journalist to hear from that and when you actually change people's lives. So those are two of the biggies for me. But all the little ones day to day, you know, they, they keep you going.
Kwadwo : 44:27 Yeah, no, I got to tell you, André, it's truly is a privilege to be able to have this conversation with you. And I could truly echo the amazing, inspiring work that you've done over the years that has impacted Canadians and people worldwide and given people a voice, increasing awareness on many health care related issues. And I got to tell you, I learned a ton today. You know, I got no political, no policy, game. I'm not educated from that front, but the things we talked about today was super eye-opening, especially like the silo stuff and the regionalization aspect of, of things like the way you framed it. And it's just, I don't know, there's a lot to digest and a lot to think about, but, you know, I'm hoping my listeners are feeling similar to me and feeling pretty inspired and I'm truly grateful that you took some time to do this and I hope to have you on again.
André Picard: 45:30 A pleasure. And you know, I always remind people, you know, I, my job is to sort of summarize and to translate all this. I meet all these brilliant people and my job is sort of steal their ideas and make them pithy and accessible to the public. So I can't forget that I know nothing. I learned all this stuff from other people and I think my only skill is really being able to boil stuff down and simplify it and hopefully communicate it in a way that people can understand and act on.
Kwadwo : 45:55 Yeah. Well I'll tell you it's working. Awesome. André, thank you so much. There's going to be links to all your books, your Twitter handle, everything in the show notes and, thanks again for doing this.
André Picard: 46:07 Thank you. I look forward to it.
Kwadwo: 46:09 Thank you. Thank you so much for listening to Episode 14 with André Picard. I hope you all enjoyed it. If you guys want to follow him on Twitter, it's @picardonhealth. If you want to follow or support this show on Facebook, on Twitter, on Instagram at Kwadcast, you could send comments to Kwadcast99@gmail.com and please let us know how we're doing. We were looking to always improve on the show, the five star rating on iTunes. If you're up for it, leave a review. Thanks again guys. We'll talk soon.
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TRANSCRIPT:
Kwadwo: 00:43 welcome back everybody. Super excited about episode nine year with Jeffrey Turnbull. But first I want to tell you about our sponsor. Better help. This is a group of amazing online online counselors that provide online counseling via audio calls, via, via chat, via messaging, and it's affordable. It is timely, it's on your schedule. And these guys are great. They reach out after hearing episodes with dr Adrienne Matheson and dr Tamina Eapen. And um, I think they do amazing work. So if you want to sign up, you get a 10% discount using discount code solving healthcare. There are better help.com and uh, I highly recommend these guys. Okay. A couple of housekeeping things. We've been busting out episodes every week. And for the sake of my marriage, we're going to be extending that to every two weeks. Now that we've have a few episodes out. Now we're also going to explore different format.
Kwadwo: 01:51 We'll call them mini casts, where you get 10 to 15 minute episodes of, of innovative things that are happening within healthcare that, you know, there might be quite niche, but the idea is that it could be scalable, it reduces spending and provides better care. And so, um, that's another format we're going to explore. Okay. I'm going to tell you about our next guest, dr Jeffrey Turnbull. This guy is a walking angel and as far as I'm concerned is a hero. He works with the homeless population. Okay? He's done this throughout his career and his whole motivation is to give them a voice, humanize them, provide them with care that they should be receiving in a setting that is optimal for them. So he is the medical director of the Ottawa inner city health program, which provides full range of care to the hump homeless population, including safe injection sites, um, manage alcohol program.
Kwadwo: 03:01 And even palliative care and I got to work with him about 10 years ago in that environment. And it was truly, I don't even know what to what the word is. It was just eyeopening. It was humbling. It was, it was fantastic. The work that they're providing and it was a real, a true honor to have him on the show. And this guy, let me tell you, he's a baller. Okay. Like when I tell, let me list off some of his accolades. Order of Canada, order of Ontario queen Elizabeth, the second diamond Jubilee medal. I don't know exactly what that means, but that sounds proper. He's been the president of the CPSO, which is a college of physicians and surgeons of Ontario, president of the Canadian medical association, president of the medical council of Canada. And honestly, the other thing that's amazing about Jeff is he's truly a nice guy and he's held all these leadership positions. And I've always thought to be, you know, up there, you need to be, you know, you need to be a hard ass. You gotta be that militant leadership approach. And he is the opposite. He's been a true inspiration in terms of leadership styles and I it, he's amazing. So without further ado, Jeffrey Turnbull,
Kwadwo: 04:24 Jeffrey Turnbull, I got to tell you, it's a privilege man. A privilege is all mine. Oh, thanks for doing this. This is amazing. We are in, where are we actually?
Jeff : 04:35 So this is our office facility. So we're in the basement of that. Right beside you. Over there is a nursing station where we draw up injectable hydromorphone for the opioid substitution program. And above all, the next two floors are administrative and where our nurses work and set a, when they're not out in the shelters.
Kwadwo: 04:58 Wow. I mean we're going to get into this, but I know say right out of the gate, this stuff that you're doing is stuff that angels do. And I, it really is an honor to be here and it's, uh, it's been an honor to work with you in the past. Um, I want to ask you the day in the life of Jeffrey Turnbull in 2019 cause you, I mean if you look at your resume, it's pretty ridiculous. Uh, what is like not like for you?
Jeff : 05:28 So a very, very different, so it's not involved in the hospital and it's not involved in Toronto. So I'm not flying back and forth commuting. Um, I'm here and I've devoted my, my week now to the homeless. Um, today began with picking up eggs and at the farm and, uh, doing some farm work and then bringing Charlie to my youngest son to school. And then from there I
Jeff : 05:58 came down for our meeting, which is, I was actually in this boardroom where we go through the list of clients that we have at any one time. It's about 280 to 300. And they're in all of the facilities around us and we discuss each case and we have the care providers, but we also have housing people and social workers and addiction specialists, uh, that join us and mental health specialists. Wow. And we all go through each one of those cases about how we're handling them and what are the challenges that we're facing.
Kwadwo: 06:33 And I, I can't imagine that these challenges aren't, uh, many. So maybe give us a sense of if you had this magic wand to, to, to fix some of the issues that you see, like some, what are some of the major concerns that you come across dealing with the homeless population?
Jeff : 06:54 Well, the, the homeless, like many other vulnerable or disadvantaged populations, um, because of their circumstances, the poverty that they live in, the mental health or addictions, lack of education, concept of health, all of those things bring them to this environment, but it's this environment that prevents them from getting meaningful, reasonable care and moving away from homelessness. So, um, if I had a magic wand, as you said, what would I do? Uh, um, the, I think we really have to address all of those factors that bring people into a world of homelessness, addictions, mental health, and those are the upstream factors. So those are the things like, um, early childhood development, poverty reduction strategies, education, employment, um, uh, intact family structures, um, not having residential school systems, et cetera, et cetera. However, the, my life now is drinking from a fire hose and I just can look at only the complications of that. And so the 300 people that I'm looking after today, um, what's the best thing for them? It's improved public health policies. It's, um, better addictions management. It's better mental health treatment. Um, and it's bringing care that is traditionally hospital focused or primary care, uh, in a residential setting into their world on their terms, which is very, very different than what you and I've ever experienced before.
Kwadwo: 08:39 Can you, can you, can you paint that picture? Like what, what is it like to be taken care of such patients?
Jeff : 08:49 Well, um, can I tell you about a patient from this morning discussion? So he is, um, a guy who came to us yesterdays overdosed three times and the last two weeks, um, had to be resuscitated on two of those three times. The third time just woke up somewhere. Um, and his, when you talk to him, you know, you begin by saying, you know, how much, what's your addiction like? Well, he's taking, um, um, not only does he take a Dick, he's addicted to benzodiazepines. He's also addicted to, um, Nissan, a gram of Kadian every day, his thousand milligrams. He takes, uh, about two grams of what we call purple, which is, um, fentanyl mostly or all other stuff. So two grams. If you think about that, that's fentanyl's a hundred times more potent than morphine. So you can do the math. This is massive doses. And he has this history of mental health.
Jeff : 09:57 Uh, he's been institutionalized. He was, um, a product to the child welfare system. He was orphaned at a very young age. He's had a history of abuse and trauma. He has behavior management problems, um, violence and aggression has been in jail. And um, he's 38 and probably will not see 40, um, probably won't see three, four more months. And so the challenge for him is how do you actually, you know, turn the clock back for him? How do you start to treat his mental health? Well, he doesn't have a place to stay. He squats, um, and winter's coming. How do you treat his addiction? It's massive. You couldn't give him enough opioids to control that. And his impulses are such that whenever he has something, he takes it. And so he's at very high risk of overdose death. And so we were trying to think about could we put him in a housed environment, start treating as mental health, then make inroads on his addiction. Um, and all of these things are, you know, a constellation of impediments for him that will likely lead to his desk.
Kwadwo: 11:16 That's, that's it. That's incredible. Like the thing that breaks my heart is, you know, we, the general public, you know, we, we see people in these circumstances, they're on the street, they're asking for money and we're like, Aw man, get a job. Get that gate, get yourself cleaned up. You know what I'm saying? And just as you alluded to at the beginning, it's like, think about the factors that got them there. You know, it's like we say like, you know, getting like, get control of your life and do these things. But you got a question when you go through such trauma as you just described, this gentleman going through, is it like how much of his fate is in his hands? You know, like,
Jeff : 12:08 yeah, so, so very little at this point. If there was inroads earlier on when he was six, when he was not abused in foster care or when he was, um, uh, early on developing signs of, um, disordered mental state and, uh, struggling with his trauma. Um, if we had to intervene then in a more supportive environment, wrap services around it, it might've been different. But now I have a 38 year old and I have a 38 year old that's on massive doses of opioids who's overdosing, who can't control behaviors, is unemployed and lives in a world of poverty and doesn't have a place to stay tonight. I can't even find this guy, you know, like, it's not as if he's got a, an address. He can't get the usual entitlements. He doesn't have a health card, you know, all of that. So there's so many other built in obstacles for him to get care that it makes it almost impossible for him to get care. And yeah. You know, what happened to those people that, you know, we, we see, we attend many memorials obviously because of so many people dying. Um, in this context. And almost always there is a young seven year old in a cowboy outfit, a pitcher, you know, that their parents have brought and something happened between that seven year old in keloid pads and a couple of hat to that person who is 25 who just overdosed and died on King Edward and Marie,
Kwadwo: 13:45 you know, and this is something that I try and remind our healthcare team is, you know, that patient that we're seeing that got themselves in this situation, I'm doing this and they're doing air quotes. That's somebody's son. That's somebody's brother. Yeah. And you know, I almost wondered if Jeff didn't like the work you guys are doing is, is, is truly amazing. I wonder how much, like are there stories that you've come across or have seen where this has made a difference? Are they too far gone because of all the stuff that has happened? You know,
Jeff : 14:26 so no, there are, they are never too far gone. You can, you can always have an impact on their lives. So are there circumstances where we've taken, we've seen somebody who's on the streets, um, and return them to lives that you and I would think are normal employment, paying taxes, you know, um, they're not many stories like that, but there are, and so in fact that's, you know, keeps us going a lot. But on the other hand, those people who you see on King handwritten Murray that are in veteran alcoholics are injection drug users. Um, you know, who've been doing this for many years, you can improve the quality of their life very dramatically just by simple support, housing care, treat their HIV, treat their Hep C, um, treat their underlying mental health issues, support them, build trust, and do it in a, uh, in a, an environment that allows them to have control of their health outcomes. You know, the, that you may say, well that's palliative care, but that is in fact we're taking people and making their lives better, even though they have an underlying problem that probably they will never recover from.
Kwadwo: 15:49 Yeah. And the one thing, I mean, I got a chance to work with you over a decade ago and one thing that really stuck to me was how appreciative they are of the care. And I that it's always stuck with me when I, when I, you know, when you're, and when we were working, it was in the palliative setting, but when you're there to, uh, support their medications or that they hear, hear their story, it's, there was always a thank you. There was a genuine look in the eye and saying how appreciative they were.
Jeff : 16:29 And they are, they're enormously appreciative. And when you bring care to them on their terms, suddenly there's a new trust that's built. Um, you don't see them in a hospital environment. This is foreign for them. Where authority has always been a challenge for them. You say, Oh, you got a quote, can't go out for a smoke. Um, you know, and, and that, that bad series of behaviors that we see in a hospital environment are so predictable, but they disappear when you deliver care here. And they are charming, nice collegial people. I mean, they have their moments. There's no question about it. And they make terrible decisions sometimes, but frankly, nobody ever taught them how to make good decisions. And that's the world that they live in. And uh, um, it's not for me to judge what's right or for wrong. Um, my job is to pry and try and improve the quality of their life as best I can.
Kwadwo: 17:31 And I, the one thing I think that must be amazing for them too, and I don't want to put words in their mouth, but that non judgemental environment in here, like they are treated like human beings, like the way they should be treated, which unfortunately I don't think it's all, there's always the case everywhere. They're everywhere they go, you know?
Jeff : 17:55 No, and they're not. And you know, it's probably the first time in their lives to be honest with you there, where somebody sat down said, Nope, what do you want? Not me. What do you want with your addiction, your mental health, you know, and you know, they're your future. And sometimes it's just simple stuff. I want to connect with my family. Once again, I wanted to have a, a room that I can call my own. I want to continue to inject, but I wanted to be safe. Um, I don't want to die, you know, uh, these are, you know, things that we can achieve.
Kwadwo: 18:35 That's crazy. I, I mean, it's one thing I've been appreciating doing this, the show a bit. Like I just finished a show with a child psychologist and we did, we talked a lot about child like me increasing anxiety and depression we're seeing in kids. And what really stuck with me was early intervention. How much of an impact if we were to invest more early on in, in prevention, in sewing to her world, if we could have more resources to be able to either treat the kids or to have set up them in an environment for them to thrive. You know what I'm saying? And once again, this is the theme here too. You know, kids that are getting abused, kids that are in foster homes, it's, you know, it's, it's just so sad to hear that this is something that we could be doing better.
Jeff : 19:34 Yeah. And you have to ask yourself, why don't we do that? Or on those things, because we know financially the return on investment is enormous. Right? So it makes good financial sense if nothing more, you know, to invest into early childhood development, poverty reduction strategies for children, those types of education, you know, community building, stuff like that. Enormous return on investment. So it's not a financial issue. It's not, it's the right thing to do for communities.
Kwadwo: 20:06 Absolutely. But I mean this is a bit in your world, like you've been in some big wicked men positions. Like I know you're not like political, but what, what do you think it is? Like why, why aren't we going there? Like it's our kids, you know what I'm saying?
Jeff : 20:22 This is our future. These are our children. And so I, on the one hand, you know, there's an argument to do this for because as good for communities is the right thing to do financially, it's the right thing to do from a human rights perspective. Children, like any other citizen of this province deserves safety, education, housing, nutrition, you know, that's what we would expect of our for our children, all those entitlements. So why doesn't that happen? Um, as there, I think that we are paralyzed in that sense of, um, we can't move ahead. Um, because of the way our govern is structured and the, um, the lack of vision that some of our leaders have about doing what's the right thing. I sometimes in my darker moments, wonder about is there a sense of I don't want to help them because, you know, why do I want to be, have so much equity within our community when I'm a, an influential leader who's on the upper side of things? Um, but I do believe by and large, Canadians want to live in a more equitable society and they don't want to see people begging, um, on their streets or children dying of,
Kwadwo: 21:44 I don't know what the answer is too, but I just, I pray and I hope that it's not because they feel like their, their feed is already written on the wall, whatever the expression is. I hope that's not the, the, the, the concern cause it's clear from research, from, from experts that this is not the, this doesn't have to be, their faith
Jeff : 22:09 does not have to be their fate. However, I can tell you there is certainty that if you do not deal with this, their fate will be addiction, mental health in and out of the hospital, in and out of prisons, uh, on a regular basis. And the cost of that is something that we just cannot afford.
Kwadwo: 22:30 Yeah. And it's true. Like we talked a little bit about this yesterday in preparation. It's like even the fact that we put a lot of these, uh, I w I don't want to call them patients with these poor people in an environment where they're not gonna thrive. Like in prison, we've talked about this. You go to prison at a vulnerable age. In, you're in an environment where there are drugs that are violence. The, the idea of reforming their on papers, ridiculous.
Jeff : 23:03 We know that it's not very effective. But think of what we do in society. What we do is we take our most vulnerable populations, those populations that are in the greatest need. Um, in my circumstance it says the homeless, but it may not necessarily be the homeless, maybe our indigenous colleagues, whatever. But we, we as a society, we tend to isolate those individuals. We tend to put them into circumstances, out of sight, out of mind. For me, it's lower town. It might be the lower East side of Vancouver. It may be, you know, region park in Toronto or other places. Um, we put those people in. Those are particularly vulnerable. Um, there's high risk around them of drugs and violence, et cetera. So we take vulnerable people, put them in circumstances of higher risk. We deprive them of access to reasonable entitlements to help them get out of that circumstance. And then we're surprised that HIV rates, hepatitis C rates, mental health rates, addiction rates, trauma, suicide, all of that exceeds that of the developing world. And we're thinking that's odd. Well, our public health colleagues would say that's exactly what you would anticipate.
Kwadwo: 24:21 Absolutely. You know, I think, um, I want to ask you a bit about the opiate crisis, but just to that point too about, you know, um, the added resources and strain to a system related. Mostly I think to the opioid crisis. I work at more for hospitals, so close to venue and the amount of overdoses, complications from injections, uh, whether that's endocarditis or infection of the valve or bloodstream infections, cellulitis or infection of the skin has been like, I don't want the numbers in front of me, but they're crazy. Like if I even look in the last eight years. And so I wanted to get a sense from you. Are you feeling this? Like what are your, like today you were saying, you know, you're, you were going over about 300, just under 300 cases. If you were to compare this say to six years ago or whatnot, is there, has it been a dramatic change?
Jeff : 25:21 So our whole world changed in 2016, you know, when the opioid crisis hit, I used to say, you know, we were dealing with alcohol and non beverage alcohol, you know, from mouthwash and stuff like that. So this is pretty tough, you know, and then crack cocaine happened to us and I said, Oh, can never get worse than this. And then we had, you know, I would have a couple of people who are heroin addicts in a month, um, and maybe three overdoses, um, in a month, maybe longer. Well, uh, however, in 2016 in August we had a, we knew it was coming and we had 35 overdoses in August. Wow. We had 70 overdoses in September and we leveled off at five overdoses a day. And so what you're seeing in the emergency department, uh, the ma for the ICU, we don't send our people anymore by ambulance when they overdose.
Jeff : 26:33 Wow. We deal with them the last time. Often the ambulance is bring them to us for resuscitation, not to the hospital. So we have a modus, we have, you know, we, I can't think of the last time we asked an ambulance to come and pick up an overdose. Our staff are skilled at looking after it. Um, and we, um, we deal with all of that. We have a program called targeted engagement and diversion where we divert ambulances to us away from hospitals for addiction. You're drunk and disorderly. You've got other problems. The ambulances would pick that up, the person up normally and go to the hospital. But you know what would happen, we both know what would happen in the hospital. You would wait for offload. The person would slowly recover. Uh, they would probably never be seen. They would leave AMA and do it again and do it again. Um, sometimes hundreds of times in a, you know, six months, uh, that would happen. And so we divert those people to us now. And so we, at any one time in the evening, you'll see about three ambulances in a squad car outside of our unit. And those are people dropping off, not picking up. We divert 3,400 emergency visits to us every year away from the emergency department.
Kwadwo: 28:02 That is absolutely insane. Like, think about this, huh?
Jeff : 28:07 The hook and you go there. That is crazy. 11 or one in the morning. It is off the hook. Like we have 45 beds and they are all full every night.
Kwadwo: 28:18 So let me just summarize this and make sure I got this right. So as of three years ago plus the uh, because of the opioid epidemic, the volume of cases that you were seeing puts you in a situation where you are now having to or encouraging ambulance ambulances to, to see, to come to, to hear it for you guys to manage these patients and diverting. That meant you said 3,400
Jeff : 28:50 yeah. Ambulance visits per a year.
Kwadwo: 28:52 And, and y'all, you, you guys like your, what your wait times in the merchant long. Now imagine if these guys were coming in. That's a lot. That's like what is that 3,400 divided three so like 10 a day, almost 10 a day.
Jeff : 29:05 Oh, at least, remember we have 45 beds and so those are just ambulances. Then there's the walking wounded who come in and the police, um, OSSI transport. Now it's not all book. The opioid crisis is people who are dictated to alcohol, mental health crisis, et cetera. But it's been made worse by the opioid crisis. And so I think the, our world has changed dramatically with the opioid crisis. We have seen, you know, deaths and you know, complications you've described of heart infections, of skin infections and bone infections. And we deal with that every day. Uh, we probably have at any one time three people on intravenous six weeks of intravenous therapy for complicated infections as a result of injection drug use. Um, so the, the opioid, it's just turned a whole world upside down.
Kwadwo: 30:06 Yeah. I got to tell you to like, just to put a bit of context in this too, like we would see like you obviously got appreciation of the numbers, but in ICU, you know, we would see maybe one or two patients we would lose or would pass away, like opioid related or overdose related. You know, from knowing IB drug use or from complications thereof. And I can think of at least two cases in the last two months where people under the age of 41 was in the late, late twenties, early thirties. Once again, a mum, a parent, a brother, a sister, a loved one that is now deceased. It's, it's crazy and it's, and it's so sad and I, I just, I just can't believe the work yet. You guys do and I mean I might be ignorant cause I didn't know about these numbers and I F I don't know if this is well known throughout, you know, the city, but if not you, this needs to be praised because this is amazing work y'all are doing.
Jeff : 31:18 I always like to think of it as a, the problem is one that profoundly affects our community, where we come from and the solutions will come from our community and yes, we'll draw upon them. Our four hospital, the Ottawa hospital for support. Um, but by and large, they want their care as much as it can be done for them. [inaudible] to their intravenous therapy, whatever, to be provided to them on their terms, in their location. They don't do well in hospitals or in other institutional settings. They, so if we can do our best to provide that care, it's cheaper, it's better for them. We get better outcomes and our community is the better for it.
Kwadwo: 32:10 [inaudible] what I love about this is like you guys took it in your own hands, you took it in your own hands. This is a problem. You want the solution. And I think this is a model for a lot of people too, by the way, because we're in a town where a lot of people bitch and complain about and there's no action. You know what I'm saying? It's a lot of dah, dah, dah, dah, dah, dah, dah. And the thing that I, I will always be proud to associate with y'all. It is the fact that you saw the problem. You come up with a solution that works with the patient, with the, with, with the people, not something that you think is best. Not the model that you read them some textbook that says that or this model, this is the way we should approach this problem without booking the P the patient or the people in the eye and saying, what will work for you? You know what I'm saying?
Jeff : 33:03 Yeah. Then, but to do that, you know, our healthcare system and you know, to be given as credit is very good for the majority of people who use it services. You know, these are people like you and I. um, and I'm very proud of that. Very proud of our tertiary hospitals and our primary care. But for visit these people, the vulnerable, the disenfranchised, they just, it has to be on their terms and it won't be successful if we just say, you know, look, here's what's offered to you. Take it or leave it cause it'll be leave it. And we know the consequences of that. So if you actually sit in and listen to them and say, what would be the care that you need, how would that be delivered? On the one hand that is liberating because now you can start to think of ways that really are successful. You engage them, they start to trust you. Um, but on the other hand, it's very intimidating and very challenging. So what is appropriate for them? Um, you know, is it right for me to be doing chest taps, um, and giving Ivy therapy to somebody in a shelter environment? You know, and,
Kwadwo: 34:23 but you know, it's a shared decision. It's a shared decision. That's what's beautiful about it. Like, yeah, there's risk maybe of, you know, it's not the ideal environment, but you're two grown ass people saying like, these are what, this is the situation, these are the risks, this is how, you know, this is what our options are. Is this okay?
Jeff : 34:47 Yeah. And they invariably will accept the option of saying, I want you to provide the care that you think is the best for me on my terms. And you know, and you know, frankly, that's patient centered care. That's what, um, that's probably what we should be doing. And that's why we got trained as physicians to serve that community serve and to serve all, yeah. Not just the people. We kind of like who look like us, but more so to serve people who you know, just are so, you know, they're, they struggle so much.
Kwadwo: 35:26 You know, I, I want to get into a bit of some of these stories as well cause like you're talking to me yesterday about a lot about their, a lot of these, these uh, the patients you see because on the surface, you know, when you see some of these patients in hospital, because it's not an environment where they thrive, there's a lot of attitude, there's a lot of conflict. And so I think a lot of people get there. Whatever the expression is, guns up or backs up, the humanization is in the waste there. You know what I'm saying? And so can you think like what are some of the mindset that you find when once you make that connection, once you have that rapport, like where their head's at?
Jeff : 36:13 So I can only give you examples. And so just recently I was chatting with a young lady who would be in her twenties, early twenties, and, um, there was a lot of behavioral challenges that we had encountered with her. And, um, and we, she was a very profound opioid addict, defendable addict. And those behaviors were related to her addiction, either out there searching for the money to feed $150 a day habit, um, or the consequences of injecting and, um, being a fentanyl addict recovering from your injection. Um, and she just, I S chatting with her about, so opioid substitution and how we get better manage this and you know, this person who is at first standoffish and kind of hostile a little bit then just suddenly disintegrated. She was in her young 20s, early twenties, and she said, you know, I never thought this would be what my life was like.
Jeff : 37:25 I squat in housing, you know, out in a parking lot. Um, I'm assaulted on a regular daily basis. Um, I have no belongings. I don't connect with my family anymore. Um, four years ago I was in school and now I'm a street prostitute. Addicted to fentanyl, this is my life, you know, and you know, it's hard for me to sort of think about how terrible that would be. You know, I couldn't conceive of that for any of my children. And it's very hard to walk away from that and saying, you know, that's your problem. You made that decision. You know, her mental health, uh, she three or four years ago started to hear voices. That's what our mental health deteriorated and that's where it's led her. Um, so I think we have an obligation not to walk away from that person.
Kwadwo: 38:24 I'm really glad to hear this story because once again, you know, a lot of the people listening to this is our healthcare providers and you know, I've said it a couple times now, but they are human beings. Yeah. This poor girl did not want to be sleeping with people to make money so that she could pay for her addiction. Right. And, and like, and Jeff like maybe even illustrate like once you're addicted, what satellite? Like, you know, like we, we judge and say, Oh, they're just seeking more drugs or whatever. What's it like not to get that fentanyl.
Jeff : 39:05 So they will say, um, that they can't conceive of anything worse in their life, um, than to go without, um, one person just recently said, you know, if you gave me the choice of being hit by a car today and dying as a result of a motor vehicle accident or coming into hospital and withdrawing from fentanyl, I would choose any second the motor vehicle accident and death. Rather than that. That's how powerful and how terrifying withdrawal is for these people. You know, and you know, you'd say, Oh, well why do they inject? Well, they inject because of this terror of withdrawing. They inject because of the high. And when you talk to them about, you know, well, you just can't keep getting high all the time. Um, they look at you and they say, you know, you think I'm doing this to get high. I do this to get numb.
Jeff : 40:11 I just want one hour out of 24 when I don't have to be me. A person who is living on the streets, who has no family, poor, um, mental health, committing crime, things that, you know, they thought as they grew up, they would never ever do that would be somebody else. And now that's who they are. And for 23 hours a day, they have to be that person. But for one hour they get to be known and they have so much history of trauma, uh, throughout their life, um, that they're just trying to forget that for a very short period of time. So it's really not up to me to judge when they inject or not inject or it's only really up to me to better understand the circumstances.
Kwadwo: 41:06 Yeah. Even as a health professional, like I don't know if I fully appreciate how difficult withdrawing can be on, on our patients and like, cause I mean, like most of most things that we see, we've all had a family member of broken leg go through, have a deliver baby bursa or appendix or whatever. You know, not everyone's had a family member withdrawing fentanyl,
Kwadwo: 41:33 salt or hopefully not a clinician doing the same thing. But, uh, it's less, um, what's the word? Relatable maybe. And so like to hear stories like that I think can go a very long way. I got to ask you, because the work that you guys are doing once again to incredible is this unique to Ottawa, is this, uh, other places doing similar, similar activity.
Jeff : 42:04 So the like we provide sort of comprehensive health promotion, primary care, secondary care, some tertiary care, uh, even end of life care, um, for the homeless community. So, and we have shamelessly borrowed and stole from some of our colleagues when they have good ideas throughout the country and internationally. However, now we've sort of moved beyond that and some of the work that we're doing is almost every week we have somebody from another city, United States, Europe, um, um, Australasia just recently. So it is unique in terms of the overarching comprehensiveness of what we do, uh, that no other city does that. Um, however, um, some aspects of it have been reproduced in other jurisdictions for our managed alcohol program, um, is a program that has now been reproduced in all of the Netherlands. Wow. Um, yeah, we went to the Netherlands and looked at how they deal with opioid addiction, you know, so, um, it's a, it's a process of sharing internationally.
Kwadwo: 43:17 Yeah. Cause you know, one of the themes of our show is just promoting anything that's innovative that provides better care, that allows healthcare to be more sustainable. And just hearing this and, and, and hearing the work that you do, hearing the 45 beds and diverting all this, these cases from emerge, like it really, it really needs to be championed that I, I mean, I know every city's different and, and just like we talked about what each kind of clinical scenario you want to tailor it to the, to the city. But the bare bones of it I think is incredible.
Jeff : 44:00 The principle is one that I think people who are interested in health policy should really adhere to. The principle is moving care to where it's best applied based on the needs of that unique community and whether you're indigenous or frail, elderly or homeless. Um, the, the principle is the same. You know, your day is filled with looking after people who probably at the Ottawa hospital could be cared for just as well in another cheaper setting, 100% and so shouldn't we try and embrace that principle wherever we are now, I happen to have practiced that in a homeless setting and frankly, if you can do it in the shelters over here, and if you can give [inaudible] and oxygen and treat HIV and Hep C and seizures as well as addictions and mental health, and you can do that in a, an an environment of a shelter, you can probably do that anywhere. Wow.
Kwadwo: 45:06 That's a, that's a frigging powerful statement right there, man. Um, so many lessons there. What would you need to thrive even more than your thriving now?
Jeff : 45:20 So when we started this process, we started with what I'll call the front end. That's the stabilization initial treatment, et cetera. Um, so somebody's out of control because of their addiction, their mental health, living in a world of chaos. Um, it was, our hope is to be able to stabilize that person and get them frontline care for their HIV, their Hep C, their addiction and their mental health. And we did that and we continue to do that on a regular basis. But we never thought much about, you know, because we just weren't thinking, um, about the back end. Like after that they'd turned to us and said, so what? Now you've got me stable, now I want a garden and reconnecting with my kids and I want to, you know, cook for myself. And you know, that led us then to say, okay, well we now have to have a lot of what I'll call backend services.
Jeff : 46:24 So we've got residential housing programs, we have four sites or hotels now that we've taken over with individuals. But as we continue to stabilize people and move people out of this environment, which is toxic to them and dangerous and inappropriate for anybody, and we just need 40 hotels, not for, you know, we need to have supportive, subsidized housing where we can take these people and say, here's a place for yourself. Go and thrive. But we're onsite, we will continue to help you with your mental health. We will continue to look after addiction. We will continue to look after your HIV and Hep C and endocarditis, whatever it might be.
Kwadwo: 47:13 Wow. They have that support there. You know, the thing I think is so beautiful, and I think I might've said this already, but it's the nonjudgmental approach to treating these patients like the, you know, I still remember the days where somebody comes in with alcohol withdrawal. Okay. And you know, they're usually at rounds and they're, someone's talking about giving them more sedatives to try and keep them more calm and all that stuff. And I'll be, I'll be like, just give them some alcohol, give them a Labatt blue on ice. Okay. Uh, and this will fix everything. The withdraw stops. We don't have to give them an increasing level of sedation. So let me just walk you through what normally happens in real life. So if someone comes in with alcohol withdrawal, you treat them with normally a benzodiazepine, more like, uh, uh, Adavan for example, to try and manage their symptoms. Sometimes you need more. Sometimes their level of consciousness goes down. Sometimes they can't maintain their airway, so now they need to be intubated sometimes that they, uh, they might develop a pneumonia because of the deck, decreased level of consciousness. They're in ICU for four days. They cost the system probably about $15,000 at that point of ICU costs. And this solution could have been, they get their beer, they get their Brandy, get their alcoholic choice, and they'll be home in a day.
Jeff : 48:45 And often the solution was they came to you because of a pneumonia, which now because of the sedation that you give them is much worse. And they're going to stay for a longer period of time with complications. And now they've got a seizure as well because of the alcohol withdrawal. In fact, if you just gave the person antibiotics out in the community, they would never have come to you in the first place. I'm willing to have gotten better care. Exactly. And that's what you and I would have expected for a simple pneumonia. But for some reason we're going to put those people at huge, risked their lives, withdraw them, and you know, they're going to, it's enormously expensive to them, their own personal health and to us as a system
Kwadwo: 49:32 cause of it. It all comes down from judgment, from not having that patient centered focus. Get put your ego away. See, look at Charlie or what, or Chuck and say, what do you need now to get yourself out of this? Yeah.
Jeff : 49:50 Wow, man. And you know, when you sit down with Charlie or a Chuck, if I know this guy's an architect or this guy was the guy who designed the Welland canal, or this guy is an artist,
Kwadwo: 50:03 I got to tell you, that was the most mind-boggling thing, Eila. Call me an ignorant a screwball. But that month, that week I spent with you, that was the most touching humbling thing is that you would talk to the 65 year old guy that's dying, you know, and, and, and dying comfortably, thankfully because of the care that, uh, y'all were providing. But he lived a life. He had, he accomplished some things and he was, uh, uh, you know, a chartered accountant or, or work for the government and how to divorce, got to the bottle and, and that God, the better side of them got homeless, lost his money and had complications there of after, uh, related to that. And you just realize like, yes, these are, I keep saying it, they're human beings
Jeff : 51:02 and they, you know, frankly could be any one of us maybe of us a step away from those series of events, you know, that brought that person to that seat could be any of us or our families.
Kwadwo: 51:15 Absolutely. So just in summary, Jeff, where, how, how can we fix some of these, these major issues that could practically,
Jeff : 51:27 so I think there is something that everyone can do in this. It's not for healthcare providers or housing people or social workers. This is for our whole community and there's something that we can all do to contribute. Yes. If you want to fix it, um, work on some of those upstream social determinants. Um, but they're gonna take time. We've still got so many people who need care. Um, but communities can embrace these individuals. We can start to think of better ways of moving care out of the hospital environments, into the communities where we can do it much more effectively. We can listen to this community much more. Yes, we can invest in subsidized housing and we can do better with more addiction counseling and mental health services. All of those things are things we can certainly do. But at the same time, I would argue that we should be starting to seriously think about policy decisions.
Jeff : 52:34 Um, you know, how do we think it's right to fill our prisons with people with mental health and addictions? It shouldn't we be trying to deal with that as a, um, uh, an illness rather than, uh, some social aberration. Um, so couldn't we be thinking of more informed, um, drug policy, more informed, uh, social policy as we look to support these populations? Certainly our indigenous communities, certainly, uh, others who find themselves so disadvantaged, you know, shouldn't we be reaching out with, you know, or advocating for, you know, evidence informed policy decisions rather than, uh, what seems to be, you know, palatable to a population such as warm, you know, there's a war on drugs, which does not work.
Kwadwo: 53:33 I always liked to, you know, when we get to the end here, a story where you were proud of what you do. You, you got the sense that, you know, this is why I'm here.
Jeff : 53:46 You know. Um, I've always thought we spend the first half of our life trying to live up to the expectations of our parents and the second half of our lives living up to the expectation of our children. And I think that time that I feel the proudest of what I'm doing is when, um, my kids see what I'm doing and they just say, you know, what you're doing is a good thing and I just want you to keep doing it. And I think that makes all the, you know, the late nights, the on call, uh, you know, you know, times when I don't sleep, that makes it worthwhile. And so I think that that's probably the times when they're with them and they say with the homeless and they just say, you know, your dad's doing a good thing. Wow. That's what probably makes me the most proud.
Kwadwo: 54:44 I mean, I, I, I always, I got to tell you, the life has changed since bringing in some offspring in the world. But I where you're, where you're seeing reigns. True. Like I always say all myself, like in general, in life in general, how would the kids react when they're, if they saw dad in this situation, how would, how would dad want to react if dad was, what,
Jeff : 55:07 how would you like to be viewed by your children? What would they say about you when you know, you're 70, 80 or gone, but would they say, you know, yeah, you made it a whole bunch of money, you know, or he did the right thing.
Kwadwo: 55:26 Okay. And you know what, and that's what it comes down to. And this is another theme of this show is like, let's all try and do the right thing. Let's all be able to look at ourselves in the mirror at the end of the day and say, I did something good here. Yeah, I did something that my kids will be proud of. And, um, I just, I do feel like sometimes we need to say that more, you know?
Jeff : 55:53 Yeah. We have to think that our job, why we were here while we were put on this earth, while we were educated, why we were, you know, society put money into us was to serve. That's why we're here. And to serve a community no matter who they are, but those people in need and independent of their income and what they look like. So that's our job.
Kwadwo: 56:20 And, and to be honest with you, like not to get too philosophical on, on
Kwadwo: 56:24 your cats, but like in this era where we're a little bit where we're seeing more depression and mood disorders and everything, you want to be happier, surf. Yeah. You know, help others and I promise you, you will, you'll be more content. You'll find more fulfillment and um, you know, it's easier. I know for a lot of people it's easier said than done, but you know, I, I do truly believe you're moving towards that direction leads to a more fulfilled life.
Jeff : 56:58 How'd you too, I honestly agree that this concept of bringing meaning into your life, we do it many different ways. We can, you know, through children, through relationships. Um, but some of us have this great opportunity to bring meaning to our work and we're blessed and we shouldn't squander that.
Kwadwo: 57:22 Amen brother. I, I can't, I mean this was truly special for me, man. Like I, I've looked up to you for awhile. I, we didn't totally get into all the work that Jeff does cause we would be here for three hours and 47 minutes, but you know, how, how many hours do you sleep in a day? I'm not a big sleep. Last time I asked you that you said about four hours and uh, and uh, the amount of work you do, the amount of meaningful work you do, the impact you're having on so many lives. I am proud to know you already been a great fan of yours too. Thank you. Appreciate it. Thanks so much.
Kwadwo: 58:08 How amazing was that? Oh my God, I love Jeff. Um, so in terms of lessons from this episode, from an administrative level, we really need programs to support programs like Jeff's where we provide care in a setting where the homeless and the vulnerable patient population can thrive. Uh, I think it's, I think it's scalable. I think it's too important and um, we need to, we need more of that from a clinician point of view. Remember, these are human beings. Whatever we could do to support them in an environment that is optimal for them, I think we got to do our best to do that. So let's work with our homeless population. Let's work with, our drug addicts and, and, and provide them with care that will allow them to thrive. And then from a general population point of view, honestly, if you have time, volunteer your time, connect with these guys, provide some support. It truly is amazing. You will, you will get as much out of it as you are providing for them a promise you that. Okay. That's it for episode. So if you want to connect with us, we're on Twitter @kwadcast, we're on Facebook at kwadcast. If you have any comments at kwadcast99@gmail.com and thanks again everybody for tuning in and we'll see you in a week or two.
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Transcript for this episode:
Kwadwo: 00:37 Heather Bousada, welcome to the podcast. Thank you very much. Um, do you remember how we met? Gosh, that was a long time ago. Long time ago. Cause if you off the hook, I don't actually remember how we met, but I do remember how I met your husband. So to the listener, I was playing hockey game and he, he didn't know, he didn't know who I was and I, I approached him after the game after a hard fought game, which I think we won by the way. You guys were dirty. We were done. And I approached Chris and I said, Hey, I know your wife. And he's like, what did you just say to me? Oh I really know your wife.
Heather: 01:31 And then he did recognize you. Yeah. And that I explained that to everybody in the teleconference one. Yes. Unknowingly.
Kwadwo: 01:40 Well thanks for doing this Heather. It means a lot. And so maybe we could start off with what does a day in the life of the Heather Bousada look like, whether it's at the hospital doing what you do or in your work with grief.
Heather: 01:57 Yeah. Uh, well it's busy. It's very busy, but, uh, most of my time spent in the palliative care and the palliative care team and I also work in medicine and I've worked with you in ICU, but, uh, I, you know, my love and passion is palliative care and grief. So a lot of my days spent with the palliative care team, meeting families and patients and talking about terminal illness and impact it has on the family and their goals and their hopes and their dreams and basically what's happened to them and providing them support through that very difficult time
Kwadwo: 02:32 and crazy hours long days is that
Heather: 02:36 they're long days, they're long days. And sometimes I walk out of here pulling my hair and other times I'm like, wow, I feel like I was able to make a difference, you know? And that feels good. Yeah,
Kwadwo: 02:45 absolutely. One thing that I do appreciate that you guys do is, you know, I run into, I'll have a family meeting or two in the afternoon and I feel emotionally I'd, no, I actually just physically, emotionally and physically exhausted. You're doing this every day.
Heather: 03:05 Yeah. Well we all are in healthcare, aren't we? We're having really difficult conversations all the time. I don't think, I think, uh, one of my colleagues I was talks about if we only had a GoPro, I don't think people would believe what we go through in a day in terms of the conversations that we have. They're really detailed. Intimate people are at their worst times often, right? And trying to make really serious decisions, um, on, not sometimes for themselves, but oftentimes families are having to make that for their loved one and they, they're not sure what to do when they're feeling stressed and scared and they're not understanding how, or, you know, looking for support. And feeling in a world that's not part of their typical day. Right? Yeah.
Kwadwo: 03:49 Imagine you literally can't imagine being in the spots that and, right. Like, it's not something that you think about, dream about, it's just,
Heather: 03:58 well, people don't get practice at this right now, let's say to people like, it's not something you sign up for. And then all of a sudden you find yourself in the hospital having to have conversations about end of life, either for yourself or your family. And it's, it's a, it's, you don't get practice at it. Right? Yeah.
Kwadwo: 04:15 So we'll talk about some of the details of, you know, these difficult conversations in a bit, but you have a expertise in grief counseling and what are some of the things that you wish more people knew about the grieving process?
Heather: 04:34 Yeah, that's a, it's a huge topic. You know, it's, it is my passion and not only for patients and families, but expecially for health care providers. You know, one of my passions lately is that, uh, as healers, we need to be okay, right? We need to, we're doing some really serious work here. And if we're not understanding, you know, for having to go through our own grief and mourning through loss of a family member, you know, I see it all the time, I see at the hospital and people are coming to me and you know, oftentimes they feel like what is going on. You know, I used to be able to take care of five, 10 people. Now all of a sudden just taking care of one person, I feel like completely overwrought and I don't know what's going on with me. Right. And sometimes just having conversation about what it is and what's happening to them, to their body, to their mind, um, really kind of helps take off.
Heather: 05:21 Oh, OK. Cause we're not only a death denying culture, but we really, um, you know, there's that whole, whether it's implicit or explicit out there that you got to buck up, right? You got to buck up, you got to get on with it. Um, you know, have a stiff upper lip and you know, people are looked at as courageous if, Oh, they look so strong. They haven't even cried. Not everybody cries, but there's that sense of, you know, if you're only being strong, if you're, you know, just keep moving forward. But the interesting part about grief and mourning is it's not about moving forward. Everything we do in grief and mourning is about going backwards. So I mean, if you look at grief and mourning, and I think that's an important part, I, well one I want to start with a lot of my approach degree from morning is from dr Alan Wolfelt.
Heather: 06:06 He has a companion and approach and that's where my training is from. Um, as a social worker, I've also, I've gone down, there's a center for loss and life transitions and it's actually really a wonderful approach. And I, I heard dr Wolfville years ago and you know, just working in this field, I, when he talked about what grief and mourning as in going from the head to the heart, really it was what it's about. And it's that, um, that journey that we experienced that it just resonated with me, but it's throughout our system, right? So like if you look at brief families or the hospices, the Canadian military, the American military, they have also adopted this approach because it's a, it's meeting people not from the head and the intellect. It's meeting people with the heart, right? It's companioning somebody and companion is means to break bread and it's like sitting down with somebody and actually saying, you know what, I'm not necessarily the expert in what your relationship was with that person or what you went through, but I have some tools and I have an open, compassionate heart to be able to explore. What was that loss like for you? Right.
Kwadwo: 07:11 I feel like that's a big fear for a lot of people. It's like when you know somebody has experienced a loss, I can't count how many times people say, I do not know what to say to them. I do not know what to do. I don't know what to bring. I, you know, it's, it's awkward for awkward for some people, some people, and even as a palliative care doc that in certain circumstances where it's like, you know, I literally, I'm not sure what to tell this person.
Heather: 07:41 Yeah. And there's actually, we can talk about that a little bit later, but I think it's important to start off with like, you know, there's a lot of jargon out there, you know, brave man grief, mourning, like people throw out the words, right? But it's really, it's important to understand what the concepts mean, right? So that you can make some sense of it. So when you're looking at at, for instance, bereavement, it's a loss of a loved one. But what, what's really fascinating about the word is it actually means that the Latin root word of it means to be torn apart. So, um, you know, it's amazing whether it's here or people would call me when I was doing my private practice with grief counseling and in some shape or form, they would be describing that their world has been blown apart. Right. Um, and that's basically what it is, is that your world's been torn apart.
Heather: 08:28 But the, the, the grief is important cause it's the grief is there are internal thoughts and feelings. So unless you're a sociopath, you're gonna feel that loss, right? When you love somebody, I mean, grief and love are the flip side of the same coin, right? Cause if you love somebody, you're gonna feel that loss. So it's the thoughts and feelings. But where we get stuck is people just have that feeling, right? They have that feeling, but they're not sure. So they're not sure how to process it. Right? And we don't get taught that and everybody's teaching them to, Oh, just move on. Right? But where the real work is in the morning, right? And that's the part that, um, that I tried to help people understand and, and how to kind of go about doing that. Like the morning is the outward expression of that grief.
Heather: 09:11 So emotions need motion. Um, so the more that you, it's a social, a shared response to loss. Sometimes it can be specific to one's culture or rituals that you might do. But unless you're sharing that loss and expressing it and um, and I see it all the time with patients and families, once you get them to start talking about that relationship and who that person was, you can see the movement, right? It's a natural unfolding. You know, people think of it as like mental health. It's grief and mourning is a natural thing that we all go through, right? Unfortunately we like to avoid pain and suffering, but we will experience it and it can't get people around it. You got to go through it. But in that journey is as a really kind of beauty in it in terms of recognizing what you've experienced and how you then integrate it. I mean, grief is, if you really look at it, it's, it's moving from one of physical presence, um, to one of memory. That's the ultimate shift that what you're doing in the morning work, right? So again, you're moving that from physical presence to one American memory and you're integrating that into your new life, right? There is no new norm. There's a new normal now, right? You can't go back to the old normal as a new normal. So you're integrating that.
Kwadwo: 10:28 Wow. So there's a lot there. So one thing actually, so Heather maybe talk a bit about what to expect when you're going through that process. Yeah. Obviously there's going to be a lot of distraught pain, you know, there's that new normal as you described, but what are some of the things that people might expect?
Heather: 10:57 Yeah. Like for yourself and other people. Yeah, and that's what I find fascinating is um, people don't understand, like people think, assume it's a, it's just an emotional response, right? But it's the totality of your whole being, right? It affects you physically, cognitively, socially as spiritual ritually. And especially if, if I make reference to the healthcare workers, we need to be game on, right? So like as yourself, as an ICU doctor, you need to be there. You need to be present. But if you're going through a lot, us, you are, um, not only physically your body, you get extreme fatigue. Uh, you exhausted your appetite. You know, 80% of people lose their appetite, 10% gain another 10% that are neutral sleep disturbance. You know, so often people will tell me, you know, they're quick to go to bed to sleep cause they're so exhausted, but they wake up frequently, right?
Heather: 11:53 Um, so you're not getting a lot of sleep. Your immune system's down, right? Cause you're in this critical state, like you're in this hyper arousal because you've got this in either an impending loss or a loss, right? So, um, physically it's affecting you emotionally. You've got like multitude. There's no, you can find many different feelings at once and it comes in waves, right? Um, and cognitive is, it was interesting part, especially with healthcare is that healthcare workers is you, you know, we multitask, right? We're constantly multitasking and, and life and death. Like you're making life and death decisions. Um, and you all of a sudden you're, and it's, there's a lot of research on it and uh, people will start to, uh, you'll find it's difficult to concentrate. Um, it more irritable. Uh, the multitasking often goes right out the window. Um, so all of a sudden you're like, wow, you know what's, and that's where people often in healthcare come to me and say, I don't know what's going on, but you know, I was used to, I would could do this with my eyes closed.
Heather: 12:54 Now I can't even, um, you know, concentrate on, on two patients that I have. Um, I mean I, for a personal example, I remember I've been in palliative care like for 19 years and I remember when my own mom was, um, uh, terminally ill and she was in the hospital and I went with my team to go meet a patient and the doctor and the nurse and myself when we sat down. And sometimes you're not aware of it, right? Cause you're so in grossed and what's happening that you're not really aware of how difficult it is for you. So I remember sitting there listening to the nurse and the doctor talked to the patient a conversation I have every day and I couldn't even process what they were saying. At least I had the wherewithal to go, wow, I shouldn't be here. Yeah, I need to step back.
Heather: 13:42 And, and I did, I stepped back. I mean it cause it's cognitive that couldn't wrap my brain around it. Like what was going on, what was being said. Um, yeah. And this was fairly recent. Oh, about four years ago. Yeah. Um, and uh, recently with my dad. But uh, yeah, it, it, uh, it's, it's good to recognize it. Right? It's important for, uh, for people in general, but especially for healthcare workers that they're not doing a bad job. That there's nothing wrong with them. They're going to the natural processes of grieving. Right. Yeah. We talked a bit about this beforehand. It's a very unique scenario for health care providers to try and take care of others. Yeah. You definitely, yeah. You know, like for the reasons you mentioned prior about how unique it is for health care workers, you're literally taking care of people. You're seeing death and dying every, yeah.
Kwadwo: 14:52 And then when they experienced the loss, when they're not able to think as clearly when they see that emotional tie to their dad or their mom or whoever might have experienced loss, you know, I don't know if we talk about that enough. I don't know if we support each other enough.
Heather: 15:12 And I don't think, I mean, I don't think it's through bad intention. It's, again, it's a, it's a S a social, cultural Mileah of, of Western society in general. We don't tend to talk about pain and suffering. Dewey, you know, we talk about being happy, being independent and um, eh, so to talk about pain and suffering, we don't, when we don't often teach our children about it either. Right? So I'm often talking to families about how do you help children through the loss or the are about to lose someone important to them because we're not taught. Right? So all of a sudden when we're faced with it, we don't know what to do. And as health care providers in general, um, you know, whether your community or in a hospital, uh, we want to take it on. But if we're not understanding, we should be the very role models and understanding because we're going to be out there trying to heal others and if we are not healed ourself are not going to be up to speed. Right. Yeah.
Kwadwo: 16:06 It's, it's very much that cause the culture in medicine. Like I try not to get too personal, but you know, when I, I found out my dad passed away, it was a Thursday while I was on ICU and it didn't even occur to me to get somebody to cover, you know, it was just sort of ingrained in me like that plug away. And I didn't even tell anybody. Okay. I told them one person actually TP, just a just thing. So I just want it to have that kind of, um, security in case things became overwhelming during that time period. But, uh, yeah, it's for whatever reason, it's that culture, it's that talk about it, let's grind away at what we're doing. Even, you know, healthcare aside, even had a conversation with somebody that, that recently relatively recently experienced a loss, you know, and it was kinda like you alluded to at the beginning where it's like, I just want to do a bunch of stuff that keeps my mind off it and all I think about this and maybe it's worth diving into more, what are the consequences of not letting things sink in of always running?
Heather: 17:34 Well, I mean, when you look at, um, the six central needs of mourning, like through the companioning model, one of the things is, um, acknowledging, um, the reality of the death, right? And they're not stages, right? You can come back and forth, back and forth, but primarily initially you're trying to acknowledge the reality of the death, right? And depending on the circumstances, um, that may take weeks, right? So like for instance, if people don't actually get to see the body, you know, say somebody died overseas and they regret it, that acknowledging the reality, the reality of what that the person is gone. Again, remember, grief is about one of physical presence to one a memory. So you haven't actually been there to see it. It's hard to integrate it into ourselves. Right? So, um, and then, you know, and then we start to identify or start to, um, embrace the pain of the loss, right?
Heather: 18:31 And our body and our mind has this wonderful ability to be able to do that. So like it's about encountering innovating. So it's okay. Like our mind can't take it all in at once. Right? So our mind has a guy call it nature's anesthetic. So when we need initially have the loss of somebody, we, our body has this way of kind of numbing us a little bit and it's just because it otherwise it's too overwhelming and it ends as that numbing starts to kind of wear off a little bit and the reality of that person gone starts to set in that the pain really comes out. And that's actually the hard part. Like that's actually when I would find, I would get calls for grief counseling was around that stage. So, you know, somebody passed on, they have all this family and friends coming to provide them with support.
Heather: 19:19 Um, and their new normal hasn't really introduced themselves yet, right? Because they're still living in that world of that person being there. Cause everybody's around, right. And then as people start to go back to their normal day lives and people that are the person, the bereaved person's left and they just looking around going, Whoa, what happened? You know, where is that person? I'm, you know, I'm used to getting up every day and having a coffee and then we head off to work and then we come home and we do this. That's not, that's not there anymore. So then the pain starts to come in. And that's when people would call me and they'd say, I don't know what's going on. Like I thought it was doing okay, what? Now I'm just like, this is awful. This really is painful. And, and, and that's when I'd say, well, I can't get you around it, but you know what?
Heather: 20:07 There's a way to go through it. Right. And that's where the remembering that, you know, the morning comes in remembering the person who's died, right? And it's that work. And I see it not only in grief like a post-death, but I see in palliative care, it's really kind of that wonderful transition, you know, where you see families initially like, wow, I can't believe this is happening. No, it can't be in there in crisis. Right? And they're questioning the diagnosis and the prognosis and what's going on and they're in this state of helplessness. Right? Um, and then as you develop this kind of, um, time to give them space, uh, to answer their questions, provide education and support and of honor the process that's going on. It's this beautiful movement that you see, right? As they shift from the head to the heart and acknowledging that person's about to pass. And I love that, you know, after like a while, and you walk in the room and they're all sitting around the bedside and they're sitting vigil and they're sharing stories and they're laughing and they're crying. You see that morning work coming in, right? And that starts there. And it's really quite a beautiful process. And it's not that they want their loved ones to pass, but they're, they're acknowledging it, right? And they're giving honor to that person. And that's a really wonderful thing to be doing.
Kwadwo: 21:23 Yeah. And I mean, I could speak also from the clinical side. I think you would agree with me on this being part of that, being in that privileged part of being, of watching them go navigate through these tough times. And the very reason I got into palliative care was those moments and the life where you're sitting with the family, you're talking about uncle Gus funny jokes at Christmas and that funny outfit he wore at Halloween and you're laughing and you're crying in here and you're just, you're being present.
Heather: 22:05 Yeah. You're honoring the joy. The love. Yeah. Yeah, yeah. No, it's, it's incredible. I know. Cause people haven't say, well, how can you work in palliative care? It's, I'm not, it's not about the dead, it's about the living, right. It's about honoring the living and uh, it's that, it's that it's life, it's life affirming. Right. And it's really quite life affirming. Yeah.
Kwadwo: 22:26 So maybe we could speak to what to do to help our fellow employee, our fellow nurse or a fellow loved one, navigate through this process. Cause once again, come like I alluded to at the beginning, sometimes a lot of people just don't know what to do. They want to say to, you know, send them a song. Do you, you know, I can write a Paul, what do you do? What's the best advice that we could give people listening.
Heather: 22:58 Yeah. Well, you know, whether you're talking to a colleague or families that are going through it is it's important just to meet them where they're at, right? That's the first step. Um, because again, like grief is about, I'm going backwards before going forwards. It's about saying hello before you ever say goodbye. And what we tend to do is in our society in general, we tend to want to move things forward, right? Sometimes that's because it makes us feel better. But really that person, like when you're working in healthcare, people will often notice that, uh, families will keep going back to questions and keep going back. Well, why did that happen? And did, did we do the right thing? And, and it can be frustrating sometimes cause you think, Oh my God, I've told them how many times. Right. But it's because mourning there actually. And that's where I say, okay, you know, just take a moment because they're going backwards.
Heather: 23:51 I just had a family recently and lovely daughter's sitting vigil by the bedside and they kept going back and I kept going back. And then finally I just sat down and I said, can I describe a little bit about grief and mourning to you? And I did. I sat down and I talked about what is grief, what is mourning and what we need to do in that process. Um, and uh, I said a lot of it is about going backwards. And I said, and that's what you're doing. So I'm going to honor that and I'm gonna answer your questions, but I want you to know that that's what you're doing right now. And they just kind of went, Oh, okay. I see. Okay. Cause otherwise they think, well, why I'm going crazy. These questions are driving me nuts, you know? Yeah.
Kwadwo: 24:30 That really is enlightening because I got to tell you, without knowing this as a clinician sometimes I'm like, I've answered this question three times. I'm like, what's happening? And I always related it to being in shock because of all the things I going through, which is totally understandable. But what you're saying makes a lot of sense. We James downer, he's initiating an ICU study actually on bereavement and this was quite eye opening for me. Like ICU. A lot of the families have tons of questions after they leave us and you know, not being on that side, like I've never had a loved one in ICU and I wouldn't know what it would be like to hear that information on, you know, your loved ones dying and trying to process all that, you know, and in that time frame. But hearing James speak to the matter, it's like a lot of these people are, have questions after they have all these kind of, uh, concerns that, you know, there's no real process to, to help navigate and, and my whole, I mean, the whole point of doing this podcast, the whole point of doing what we do is to help others and to help them reduce their pain.
Kwadwo: 25:55 And so, you know, it's, I hope this is at least helpful also too, a lot of the clinicians out there hearing these things and, you know, it really comes down to being, making time, being present, not giving the bullshit answer of like, all you'll get through it and we'll move through this, you know, your warrior move forward. But to sit with them, you know, sit with them and hear them out and we don't need to give a rah rah speech every time we see them. It's just being present, acknowledging it's hard.
Heather: 26:27 Yeah. It's especially difficult in ICU because the unexpectedness often, right. Right. So that's another flavor entirely around it. So, um, again, so they're in that unexpectedness and so moving from the head to the heart, it's not about what, you know, it's what you feel right in grief. So when you've got somebody in a try, usually a tragic situation in ICU and uh, that, that kind of reality of the loss is going to take them a little bit more time. Right. It's, you know, it's gone from zero to a hundred and like one minute of their lives often. Right. So, yeah, that's a whole other flavor as well. Um, and trying to, to help them through that. So yeah, they're going to have a lot of questions cause they're trying to kind of, their mind is trying to connect with their heart in terms of what just happened and just then trying to acknowledge that person. Right. So hadn't how that's transformed and transition for them. So sext or work for sure. Yeah.
Kwadwo: 27:34 You've experienced loss in your life. You lost your both parents relatively recently, especially your dad was just December, December, coming up and coming up here and I want to know how it's affected you as a grief counselor or a social worker in hospital. Do you feel
Heather: 28:00 it's changed?
Heather: 28:03 Um, well, typical social worker is going to redirect it back to you, but uh, yeah, of course it does. It, it, uh, you know, that's when I talk about the beauty and grief and mourning, people go, wow, was she talking about, um, but when you've had a loss yourself, like we can all kind of relate to it, right? You know, there's empathy and sympathy, you know, sympathy is, you know, I feel sorry for you. Empathy is, let me understand what you're going through. And the big buzz word now is compassion is meeting somebody heart to heart. You know what? Suffering is a shared risk. We all go through it, right? We all so when you've gone through a loss, and if you don't mind me saying, so quad Joe, I remember in your Facebook after your, I think your dad's anniversary. Okay. To talk about, um, I loved what you wrote because you said, um, that it made you a better doctor.
Heather: 29:00 And it's not like you're going to sit with your families and patients and like whale and cry, but you know what it is to be human and you know, what loss means and how painful it can be and that we all are in that together. You know, the world's a mystery. Do I have all the answers to everything? No. Do you know, but we, we recognize in our fellow man that that sense of pain and suffering and, you know, when I'd have like the F the patients or clients that I had in grief counseling, I think almost everyone said to me something along the lines of, you know, I never really understood it, you know, um, until I felt it myself and I feel more for other people. Yeah. I can relate to their pain more. Like one lady had said to me, uh, you know, so-and-so lost their mom recently at work and last year I would've probably thought, Oh, whatever, just hurry up and get back to work. Yeah. But she said, you know what, now I look at her and I, I go over and I give her a hug. And I said, wow, this is hard, isn't it? Yeah. You know, welcome to the club kind of thing. You know, the shared human existence. And uh, that's the beauty I'm talking about. Right. And to connect again to say, wow, you know, this is how we, this is what we go through. Right?
Kwadwo: 30:20 Yeah. I, I gotta tell you the, after going through it, the way I see people that are now going through a loss is, I want to say it's a completely different, but I am, I'm there, I understand more where they're coming from until the empathy and the compassion. It's inevitable. And one thing that I did totally appreciate is you take it almost tell by how someone hugs you if they've experienced lost themselves recently or not. Like the like meaningful bear hug would usually come from people that like, I know what's going down, I know how you feel around. Um, but yeah, it's amazing. Like I that did give me personally a lot of solace knowing that you can make good out of the bad situation. I mean, it sounds cheesy, but I truly believe I'm a more compassionate, compassionate, dark. Now. I think I'm more present when someone's telling me about loss and now I give less of a damn too. I'm like, I don't think I'd be doing this show if it wasn't for experiencing loss and knowing how, you know, like can just be done. And so let's live now
Heather: 31:45 for [inaudible]. You did the, you, you took the time to do the morning work. Right? And that, that's where sometimes people get stuck because they don't know what it is. They understand they're feeling this awfulness but they don't know how to move it. Right. And what you did learn about that and you shared, you had a social response to it, right? You share to everybody what it was like for you and you worked with your family and you started to move in that process. And it's not that it wasn't painful, but in, in some respects you were able to move, right? You moved from that physical presence of your dad to want a memory. Cause I mean, death ends a life. It doesn't end a relationship.
Kwadwo: 32:24 Interesting.
Heather: 32:25 And yeah, that's, that's really powerful. And because it does it, you will forever have a relationship with that person. It's integrating into that your new normal and your new identity that they're not there in your life anymore physically. But they're still really powerfully there all the time. I mean, I know with your dad and even with my mom, as I get older, I can look back at my mom and go, Oh wow. Yeah, she's just, we're all just human beings trying to do the best we can. Right. You know, and as you evolve and you go through your own life transitions, you go back to that relationship, right. And you see it differently. It evolves just like as you evolve.
Kwadwo: 33:05 Yeah, no, it's, it's true. This is why I want to do on the show. I like, I'm a bio to care doc. I'm an ICU doc. I see death all the time. And after experiencing it at a, with my father, it was, I didn't know all this stuff. I didn't expect all this physical, spiritual, mental difficulties that were to, uh, that I experience. And so I really think it's important to share this with people, to be able to be open, to be there for their fellow man or woman and be less of a denying culture. And I really think we will go a lot further if we approach this with open arms.
Heather: 33:58 Yeah, absolutely. And by not only the, you know, the public, but especially as healthcare workers, we need to kind of honor that. What that happens to each other and to be, do we all have to be grief counselors? No, but do we all have a responsibility and maybe, uh, to be more aware so that when we see our fellow colleagues who would go, Hey, yeah, okay, I get it. I get it. Okay. They're not just being lazy or they're just, they're just self-pitying. There's actually something going on in there. Like, even like people just sitting vigil, like when they're sitting with their loved ones dying, I will say to them, you know, I talk a lot about self care to them because even though you're just sitting there, you're running a mini marathon inside, right? Because so much is going on and processing and there.
Heather: 34:45 So I remind them, I said, you know, you're mint, your body's physically running a mini marathon. Make sure you drink, make sure you get some rest. You gotta be good to yourself. Um, and it's the same thing when we're grieving, right? There's a lot like it's, so if I, if you had a broken leg, I wouldn't be expecting you to be running around the hospital. Just, you can't see it. You can't see when somebody's grieving. Right? So, but I, it's what dr Wolfelt says, he actually gives out pins. I love it. It says, uh, if you're in grief, you put a pin called under construction. Yeah. And it just gets your mankind to say, Hey, you know, I'm slower right now. Be patient with me. There's a lot going on in here and you can't see it. But it's there. Right.
Kwadwo: 35:26 So you, you even brought up a point too when we were talking earlier about the house, just some cultures, like, you know, they're grieving based on attire. So it's like part of the culture to
Heather: 35:38 be able to whether visual or, um, take time with the loved ones. But that's part of, yeah. Well that's a fascinating part is that we've, we've moved away from that, right? People used to die in the home, you know, grandma and grandpa lived with us or extended family and uh, they didn't tend to die in the hospitals. Like what 70% of people die in the hospitals now it's often removed. So it's often away from us. So, um, you know, before people would die, the was a national part of life, right? And now it's kind of removed from us. Um, and before like, like maybe what, 80, a hundred years ago, uh, if you're a widow, do, you'd be wearing black and you'd be walking around. But what's wonderful about that is you'd be walking around in your black attire and you would start to do the morning work. Cause people would stop you and say, Hey, you know who passed away?
Heather: 36:34 Was it George, your husband? Yeah, I did. And he started talking about George, right? And then you're that shared response to loss. It starts to evolve and you get to talk about that person. And so it's a wonderful thing, right? But we've moved away from, we're not supposed to talk about it, so I'm comfortable. Um, and that's healing. It's incredibly healing. That's incredibly healing. And you know, people often have, you know, just a little tidbit, like people are afraid to say, Oh, I saw so and so when I don't want to say anything. Uh, I know they just lost their mom, but, uh, I don't want to remind them of the death. Well, I'll tell you what, they know that person's died, but when you say something to them, what you're doing is you're reminding them that person lived and that's the part that really needs to be done.
Heather: 37:21 I remember recently actually a shout out to cam on a five and medicine. Um, yeah, as I said, my dad passed away in December. And is this a, this is part of what I'm talking about is she did this, and I don't even think she knows, maybe she does now. Um, but I was sitting at the five nursing station just charting and uh, she came over to me and I forgot that she taken care of, both of my parents were in their hospital and then she started talking to me about travel or something and then she started to say, Oh yeah, your dad's from Scotland and you told me about this. And he said this. And he, she started sharing stories and I was like, wow, that's my dad. He was like, wow, he is in the room for a moment. It's like, I got a piece of my dad.
Heather: 38:03 And I was like, wow. She just did some amazing morning work and she didn't even realize it. That's, uh, that's the funny part is when I talked to nurses or other healthcare providers about grief and mourning, it's just sometimes as simple as like going into the room of somebody who's, you know, terminally ill and picking up the photo frame and saying to the husband, Oh, I love this photo. What's going on here? And then you see that kind of often stiff and often I've, I don't think I've ever remembered anybody not wanting to share. Right. And then they start talking about that person and um, they're, they're moving, they're, you know, they're trans and that's what we, it's so important. So vital.
Kwadwo: 38:41 Wow. I think, I hope it serves a little bit as a inspiration to a lot of people seeing patients out there like take that time. It doesn't, it's a little like, you think I'm learning about doing, we shows and so far it's like they really is a little things like literally looking up that picture and saying, wow, look at that. Look are from a few years back.
Heather: 39:08 Yeah. Oh yeah. Do you see the smile on their faces when you do that? Yeah. Well, it's kind of like, you know, people don't really want to know what you have to say unless they know you care. And like more like for physicians that's really important, right? Cause you're sitting down giving really bad news and you're making recommendations and if you're doing it from a, you know, intellectual kind of, this is what it is and people aren't going to respond as well. But if you sit down and say, Hey, you know, this is tough, tell me a little bit about whoever it is in the bed and then start to work from there and say, okay, well this is what's going on. And they feel like that person's in the room, that they're not just a number and just another person to take up a bed. But they're real, that they mean a lot to them. Right.
Kwadwo: 39:53 Wow. Some good shit. Yo, I hope you all are buying in. Um, last couple of things, uh, while I have you have there. Okay. So just to give some context, Heather's got like, I don't know how many guardian angel things on our, on our, uh, [inaudible] lanyard on your land planning yard when you're, yeah, she got about seven guardian angels on her lanyard, which is like weighing her down actually. She actually walks with a limp. It's crazy. Um, so just to give you a sense of how giving and how much love she gets at the Ottawa hospital, but can you share a story where, you know, you've been appreciated because we, you know, we appreciate you all every day, but like,
Heather: 40:47 yeah. Um, yeah, I'm so bad at names, but I never forget a story. Like I almost remember stories when people tell me them, well, I guess recent, like I always, if somebody passed at the hospital, I always make a point of giving them a followup call because it's not part of my protocol, but I think it's essential because all of a sudden you've got all this support at the hospital, people are coming in and talking to you, and then your loved one dies and then boom, you totally disconnected. Right. And they may have questions and worries. So I always generally give them a call after. So,
Heather: 41:24 and I love to hear about how they're doing. But I think recently I had a family. Um, if father husband was dying, two older sons and a lovely family, just, just beautiful the salt of the earth. And you can see how much they loved this man and you could see it walking in the room. And that, that journey I talked about where it was like, Oh my God, what's going on? Can't we do this? Can't we do that? You know, that like that helpless. I think one of my favorite quotes in grief is, uh, by C S Lewis, he wrote Narnia. I used to have it in my grief office. Um, no one ever told me that grief felt so much like fear. Wow. Cause it is, it's, it's absolute like, it's, uh, an insult to your identity. It's an insult to your safety and security. And it's an insult.
Heather: 42:13 Well, men, since [inaudible] insults a strong word but affects your sense of meaning, right? So much unknown. People are terrified and you see that and there's no where in this world where you feel more helpless when you're not able to stop what's happening and you're watching this deterioration. So I S I witnessed this family, um, in that state and then as we evolved and we talked and we shared and they have some education and understanding of our own what's happening, that really cool family just kind of sat in this tight two bedroom in the hospital. But I would open up the curtain and I would just go, wow, this is so much sacredness right here. Wow. You guys haven't nailed. Like even though it was in a tight, awful kind of setting, they made it beautiful, you know, just that honor. And you could hear the stories and the children were coming and um, we actually, I got the kids to do a hug blanket, which is something I love doing with the kids.
Heather: 43:11 So, you know, if the kids can't be there all the time or they need to feel part of it, you know, you're old enough to love your old enough degree. Right. That's very important. So I've got the kids do a hug blanket where they kind of draw their arms on it and write all over the blanket and then they put it over the grandfather. So they had done that. And so you walk in there and you'd see this beautiful blanket and all the kids riding on it and everybody just loving this man, you know? So when I called afterwards and I spoke to the family, uh, they had sat Shivah and they had brought out the hug blanket. So when people would come over and, you know, people come over and pay their respects and all that, they would bring out the blanket and they'd share about it.
Heather: 43:50 I was so touched. I was like, wow, that's beautiful. Like that was really, uh, that just, yeah, that was really beautiful. Wow. Eh, before ending, I know there was another, speaking of about some pretty cool initiatives at a conference you went to recently. Yeah. The normal, if you want to mention that. Yeah. Well, grief and mourning in general is really misunderstood and it's, um, in a lot of myths and misconceptions about it. And oftentimes when you just really trying to sit and tell people about it, they really feel more understanding about what's happening. Um, and it's been kind of one of my, um, ones I want to bring more forward to the healthcare community cause we're supposed to be at, man, we're supposed to be the mentors. We're supposed to know what this is all about. This is what we deal with every day. But yet there is a loss in that.
Heather: 44:45 There's, there's not a lot of understanding around it for, um, you know, especially for each other. Right. And we really need to bring that forward, um, to support each other as we go through these really difficult times. Right. Um, and not to feel that what's wrong with us and I'm going to lose my job and you know, we need to be supported and no matter where we are, what other, what agency or what company we work for, we all need to feel that way. Um, but when I went to recently the Canadian hospice palliative care, or did I have to say that Canadian hospice palliative care association, they had a conference recently here in Ottawa and, uh, because it's been one of my babies about, and, and I think it's partly because people like you and other doctors and nurses and managers have come to me because they are like, what is going on with me?
Heather: 45:31 I don't understand this. Like, wow, like something I just assume everybody knows go. No, it's really not understood. And then we start to beat ourselves up. You know, what's wrong with me that I'm not moving on. And, um, so I wanted to bring this more to our workplace. Right. How can we help other, each other cause, and so part of this conference there was, I went to one of the workshops and I was really excited. Uh, it was a lady, uh, just spoke to her, Karen Brownrigg. Actually, I did ask her if it's okay to say her name on this. She said, yeah. So under the Canadian hospice palliative care association, they have something called Canadian compassionate companies. So they recognize that this grief and taking, you know, the stress of caring for somebody who's terminally ill, it's a chronic condition. So the policies and procedures that are in most institutions in places of work are behind the times because they're not aligned with how things are now in society.
Heather: 46:28 Um, you know, modern technology, advancement of science. I mean, you see it all the time, how we people are living longer and often living longer though with chronic illnesses and often debilitating States, right? So not only are you, uh, trying to, uh, attend to your family member, your loved one, um, but this can be an ongoing issue, right? And our policies aren't in place to help support that. Um, and if you show you support your employers during those times, you're gonna have more retention of them. Uh, you're going to have, um, attract more people with, uh, good qualifications to want to be working there. When you maintain that good, healthy work life balance, people are happier. And when you happier employee employees, you're gonna have better care. Right? So it's, it's actually so the Canadian compassionate companies, I'm just learning about it, but um, they can actually come to the HR and start to educate and bring in policies to workers who are going through this. So when you have, when you have a policies and procedures around it, the culture starts to change, right? Because then it's normalized and validated that, yeah, this is hard. You know, I care about your psychological safety cause if you're safe, everybody else here is safe. Right. And that's important not just for our colleagues but for our patients and families. Right. So I was really excited about it and like that. Yeah.
Kwadwo: 47:52 I think it's definitely worth mentioning because it's, I want to say innovative. It's, it's, I wouldn't say this is common practice in areas amongst companies and amongst healthcare providers. So anything that's going to help people get through these tough times and provide better, ultimately provide better care we should embrace.
Heather: 48:14 Absolutely. Absolutely. Yeah. So yes.
Kwadwo: 48:21 Been a dream. I really, I can't express the work that you do and how meaningful it is that we see it day to day. I'm going to speak for, you know, like my ICU colleagues, my palliative care colleagues, my medicine colleagues, the work that you guys do, it's underappreciated, undervalued, and it goes in. It's one of the most important things we provide. And I just want to say that you do amazing work and whatever we could do to get the word out to how important these things are, including grieving, we need to do it. And I hope this is just a hopeless, I hope this helps.
Heather: 49:08 I hope so. I hope it moves things forward. Yeah, that would be great. And I'm there to help it out as much as I can and vice versa. It's been so great working with you, Kwadwo over the years. Yeah. Yeah. Right. Thanks so much. .
Medical Scribes of Canada is the company Dr. Hickling uses: http://www.medicalscribesofcanada.ca/
Systematic Review on medical scribes: https://www.jabfm.org/content/28/3/371.long
Resource Optimization Network website: https://www.resourceoptimizationnetwork.com/
Follow us on twitter: @Kwadcast
Please send your comments/feedback to kwadcast99@gmail.com
Link to the Dr. Eapen's TVO appearance:
https://www.facebook.com/TheAgenda/videos/rethinking-anxiety-meds/441849536384456/
Resource Optimization Network website: https://www.resourceoptimizationnetwork.com/
Follow us on twitter: @Kwadcast
Please send your comments/feedback to kwadcast99@gmail.com
Association Between Immigrant Status and End-of-Life Care in Ontario, Canada: https://jamanetwork.com/journals/jama/fullarticle/2656223
Brain death case: https://blg.com/en/News-And-Publications/Publication_5338
Resource Optimization Network website: https://www.resourceoptimizationnetwork.com/
Follow us on twitter: @Kwadcast
Please send your comments/feedback to kwadcast99@gmail.com
Episode transcript:
Kwadwo: 00:01 Welcome to solving healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of resource optimization network. We are on a mission to transform healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better healthcare system, best more cost effective, dignified and just for everyone involved.
Kwadwo: 00:37 Thanks everybody for joining us on solving healthcare. It's your host Kwadwo Kyeremanteng. Before joining our second part of the conversation I had with Dr. Gianni D'Egidio, I just wanted to talk about a couple of things. Number one, I have been extremely overwhelmed and grateful for the feedback I've received about part one. It's been mostly from nurses within critical care and, and what they've fed back to us is how meaningful it's been that somebody has been advocating for their concerns. And I gotta tell ya, you know, it really does come from the heart when you see how hard these these guys work to try and improve Karen and get their patients better and functional. And I had this moment a couple days ago. Uh, working in the ICU is like three in the morning and brought down a fairly sick patient and watching everybody moved together and working together to get that patient comfortable, to get that patient set up, to provide speedy, efficient and honestly love and care it, it is truly was magical and sometimes you take for granted what people do.
Kwadwo: 02:17 And I, I just wanna I wanted to mention again, these guys are my mini heroes, how hard they work, how excellent they are at their job and it can't be, can't be overstated. Um, so I just wanted to mention that real quick. The other thing, uh, was going to mention in terms of any feedback, you could send an email@quadcastninenineatgmail.com and you could follow us @Kwadcast on Twitter. Okay. So part two of our conversation with Gianni D'Egidio it's a good one. I won't lie to you. We talk about how culture can impact the level of care that is requested. We talk about Gianni's ability to discharge patients efficiently. We talk about the dangers of dr Google. We all know dr Google seems to know everything, but does he or she, we talk about the perception the media gives on medical care and the villainized nation of physicians. And then we talk about these recent brain death cases. So, so just to clarify, these are cases where patients are declared dead cause they're brain dead and the family has questioned that diagnosis and and have appealed to the courts for judgment. So without further ado, dr Gianni D'Egidio
Gianni: 03:59 I'll answer it again. The drive to address these issues to confront families I the dry, where's it coming from? It is an absolute, I'm absolutely infuriated with the, I guess absurdity of these cases when if you, a rational objective individual would look at this and say this does not make sense. And this brings us into the topic of what is driving this from the substitute decision maker side of things. And these are my comments and some of it supported by evidence. Some of it supported by just my anecdote. The of these 12 individuals in my study, only one was born in Canada. The vast majority of individuals, 11 out of the 12 were not born in Canada. And there was always a religious argument to their, um, request for therapy. And this is similar, not exactly the same, but to a Dr. Fowler study from Toronto looking at individuals who are recent immigrants to Canada.
Gianni: 05:06 We'll re, we'll demand, well not demand, but will undergo sociology. Yeah. It's associated with more aggressive care towards end of life. Right? So there's a religious cultural factor to it and I'm not being demeaning about that or whatever else, but this brings us into a bigger societal issue of the inability of, of religion to appropriately deal with death. I find, um, if we're going to, uh, say that physicians are not properly educated and cannot deal with death, I would have to make the exact same argument for religion. Um, there is this consistent argument that life at all costs and despite every single religion saying, Hey, when you die, you're actually going to go to whatever it may be, let's say heaven and better place, whatever else. Um, and there's this consistent argument, which again, if you speak to religious leaders from every associated faith, there'll be a disagreement about how aggressive to be towards end of life. And I've had that because we're fortunate that at our institution has spiritual care services and some very well respected members of the religious community of all different types of faith who will, who I've had the opportunity to discuss this with. And they agree that yes, we don't need to be this aggressive towards end of life. So that brings up a whole other, like you could do a whole other podcast on, on that. And I'm not gonna get into the sides that
Kwadwo: 06:28 that is a, a monster topic. Um, so one thing we haven't touched on is like how exactly are we going to fix these issues? So we've identified that, you know, culturally we, it's hard to accept death. Uh, we, we see that we could be better communicators, better, better at dealing with advanced care planning, goals of care discussions and so forth. We talked about how conflict manage, like we're not taught how to manage conflict in medical school and in residency. And fellowship or as even staff really. So where do, where's the biggest bang for your buck? Where should we, how do we fix this business?
Gianni: 07:17 Um, I guess I'll, I'll go back to the points I made earlier about, um, lack of education and then the fear component. Uh, tying it back to those two things in terms of education, we need to be educated on how to confidently propose a treatment plan. And you can't teach confidence, but you have to be able to reassure individuals. And I try to tell my med students and residents this, that yes, getting sued or getting a complaint absolutely sucks. If you follow the ethical, legal and medical framework of proposing an appropriate treatment plan, you will be absolutely fine. Yes, it's gonna suck. You'll get a college complaint, you might get sued, that's gonna take years of potentially of your life. But there are methods to deal with that. And the vast majority of the time, I think, at least from what I know, you're going to be absolutely fine in the end, but you have to deal with that.
Gianni: 08:12 Um, and I'm not trying to minimize these issues, but you, you're going to have to deal with that. And that gets into a system or of a system type of, of issue is why is it as physicians, when we try to do the right thing in these certain cases that we are absolutely going to get punished for it. There has got to be some either new legislation and new policy that will allow us to constrain the treatment options available to an individual and at the same time guarantee that this not, this does not get dragged through the courts or result in complaints or whatever else it may be. Now these are for the extreme cases. Um, but there has to be some sort of change in legislation. And this brings us back to the study that the, about the ethical failings of, of the CPS policy and the health care consent act, those, those two things need to change and they need to be more supportive of other ethical principles. And I'll be Frank, need to be more supportive of the healthcare teams that are involved because with changing technology and changing, um, demands from the public, this is only gonna get worse unless those two pieces of policy and legislation change.
Kwadwo: 09:18 Yeah. I mean like you look at it, you're going to have more, less engagement by a care teams and less people are gonna want to do this for a living. The longevity of our nurses, allied health decreasing, you're seeing more physician burnout, you're seeing more and more physician issues in terms of mental health, wellness and so forth. And then, I don't want to keep harboring this, but like the financial impact, when you look at the decreasing labor force, when you look at providing care, like it really is defensive medicine. You're providing care because you're afraid of the consequences of, of the complaint of you ha or you're afraid of the consequences of, of being sued. Like it's a lot, you know, and like, and then in our current environment we end up cutting services that are often most beneficial like social work, physio-therapy spiritual care, like all that stuff is being cut.
Kwadwo: 10:17 Meanwhile, we're just flogging people with care that they don't even want. It's insane what you, when we were talking offline a couple of days ago, you were talking about the backlog of, of the system because of all these issues and not being able to provide, for example, care at home, you know, especially near end of life because of the lack of resources I wanted to do to talk about your experience. Like you had, um, your mother-in-law, she passed away at home and maybe you could speak to that experience in and counteract that with what we see most often. Yep. So the,
Gianni: 11:05 I'll, I'll speak on my personal experience with, with my mother-in-law and then I'll speak on the, I guess my professional experience with occasionally delivering end of life care at people's homes. Um, so for instance, with my, well not only my mother in law, but my, my grandmother in law as well, both, uh, end of life care, both received end of life care at home, um, surrounded by family members in a quiet, peaceful environment, um, with access to physicians, nurses, caregivers. Now the bias in that or the caveat to explain to that as I am a physician obviously and I know what I'm doing when it comes to end of life care and patient care and there are family members of mine who are involved in health care as well, who know how to deal with these things and we're young and able bodied and able to supplement or give some of the care ourselves as well.
Gianni: 12:04 So not everybody's going to be able to do that. And that's completely understandable. However, the experience at home, you can argue, and you and I have, I've gone through the literature on this. The vast majority of Canadians want to be at home when it comes to end of life. So the biggest barriers to that are physicians and qualified health care, other qualified healthcare professionals deliver end of life care at home. The equipment that can be set up, the medications can be delivered, all of that can be taken care of. But the access to a physician, the access to that healthcare team that has to provide that end of life care is going to be limited. Right. Especially if you look at other individuals who are not capable of delivering that care of themselves, whether it be from a lack of knowledge or lack of the able bodies to do that.
Gianni: 12:46 Um, those two experiences at home I felt went very well. Um, and the, from a professional aspect, occasionally I've been involved with delivering end of life care at people's homes at their request. Um, and I've, I've delivered and I feel that I am capable in delivering palliative care in the hospital setting and in these situations, um, patients and or their loved ones asked me to be involved at home because there was no physician available. Um, actually during the summer, most of the time was during summertime months. When are extremely overworked and wonderful community palliative care physicians are on vacation, not available. Um, so I agreed to do end of life care at home in those individuals home. And it went, I think, again, based on the feedback I received from family members and my own sort of interpretation of it went very, very well. Um, compared to a hospital setting where, let's be honest, the hospital setting is loud, incredibly loud, incredibly disturbing.
Gianni: 13:47 Um, you've got overhead announcements almost constantly. The fire alarm goes off, what would you say? Every day, every two days there's a fire alarm going off almost every day. There's some sort of of alarm going off and it's cold. It is unfamiliar and unfortunately, because of how backlog the system in is, you are sharing a room with other individuals who are potentially screaming, agitated, noisy because of no fault of their own, again, because of their medical condition, in my opinion. That's just my opinion. That is a very, very poor way to spend your last few days of life. Um, and the, because of our hospital system, the, there's complete lack of private rooms now, ideally when we build our new hospital that that will not be an issue. But the dying in, in a ward room with three other patients beside you, I, especially when they're, when they're profoundly agitated is I think just terrible. So that's my sort of professional and personal use of, of end of life care at home.
Kwadwo: 14:53 Yeah. And, um, I mean obviously as a palliative care doc, I, I've seen all sides. I couldn't agree more like that experience at home surrounded by loved ones in their own environment compared to that potentially dis disruptive environment in hospital. Like it's still good but it just could be better. Once again, kind of switching gears a little bit, I don't like to give you too many compliments for obvious reasons, but we both know I look incredibly sexy. Do not know you guys. Gotta listen to this. He is wearing everything tight. Okay. And the reason I'm not drinking or eating anything is because I don't want you all to hear me vomit on air. Okay. Um, I'm very uncomfortable in this car. Terrible by the way. Terrible. Thank you so much. Um, so getting back to the real deal, you are talented. Maybe that's the wrong word.
Kwadwo: 15:59 You seem to have an ability, you have an ability to see, to discharge patients probably quicker or more efficiently than some of your colleagues. And I want you to speak to like what are you doing that others aren't? Because I think this is another thing that could be scaled in terms of like improving the backlog of patients in emerge. Like when I got off a couple of days ago at the hospital I was at, I think there was about 20 inpatients in occupying a merge bets. You know what I'm saying? So like what is the, what's the ticket? What are you doing that so that people aren't doing
Gianni: 16:41 [inaudible] three things. One is, um, I think my colleagues or our healthcare teams don't understand that the vast majority of tests and care can be delivered as an outpatient would be the first point. The second point would be that, again, a lot of people don't understand that long term care facilities can actually deliver very good and um, can deliver antibiotics and oxygen. So that will prevent an admission or ongoing admission for, um, residents of longterm care facilities. And third, and I'll get into this, I give out my cell phone number, which sounds crazy and we'll talk about that in a sec. It is crazy. First getting back to, um, triage of tests. I can't tell you how many times I've had patients that I'll take over a team and my residents or someone will be like, they're waiting for a CT scan for their chest before they can be discharged home.
Gianni: 17:39 Yet patient is walking around eating, talking perfectly fine, but are waiting three or four days on hospital for a test when they can get that test in five or six days as an outpatient or a week or two from now and won't change the ultimate outcome. So I think an example like that is less. Same thing with ultrasonography, a blood work, whatever it may be. It can be managed as an outpatient. And more importantly, especially if set individual has a family physician communication with that family physician and ensuring the appropriate followup tests can be done. But it takes a tremendous amount of work to do it as far easier to keep someone in hospital and just do it yourself than it is to coordinate all the care as an outpatient, which again gets us, gets into a system. Issue number two, the long term care facility, uh, issue or, um, lack of knowledge of what they can provide.
Gianni: 18:30 Oxygen can be provided at longterm care facilities more times than not. The classic example is I get, uh, an elderly individual from a longterm care facility who presents with a pneumonia. They're on two, three liters of oxygen. You take off the oxygen, they de saturate to 85% or 80% or whatever it may be. And the team overnight has admitted this patient because they require oxygen. While the team overnight doesn't realize that that long term care facility they came from can actually provide oxygen. They can actually provide intravenous antibiotics through coordination if it's even required. And the vast majority of time, intravenous antibiotics are actually not required. So you can get away with an oral antibiotic. You can get away again with an, seems a little bit cruel, but an intramuscular antibiotic if an intravenous route is truly needed. And this brings me into the whole point of what we were talking about earlier, is the whole goals of care conversation as well.
Gianni: 19:17 Um, so an individual advanced age with multiple comorbidities who comes from a longterm care facility. The first thing I will do is have a discussion with the substitute decision makers about where are we headed with this care and what are their expectations and what are the treatment goals in this situation and I can't tell you how many times that the substitute decision maker when I approached them with a treatment plan of palliative care or no further transfer to hospital basically tells me thank you for having that conversation with us. We've been thinking that the whole time, but we just haven't had that opportunity to discuss this and thank you. And then I established that we're going to send them back to their long term care facility with a different type of treatment plan. Fair enough. So that, that's point number two. Point number three again, in terms of coordination of followup tests and whatever else, I give my phone number to individuals to call me when their tests are done or to ensure that their tests have been scheduled and whatever else. And you're kind of looking at me like I'm [inaudible].
Kwadwo: 20:13 I do think you're crazy. There was zero chance I would give a patient or family member, my Sally, you know what I mean? Just like I get even from friends alone, I get text message or their kids P to see what would this a asking me to figure out what's going on with this. And I can't imagine giving my cell phone to all the patients that we see. And the, the amount of over use I guess in terms of this is nothing not supported by any evidence
Gianni: 20:48 except my own anecdote and my own experience in that 10 years or so, 10 or so years that I've been doing this, I've only had to tell one individual to stop calling me a because the calls were, were inappropriate. Uh, video was me. So, um, I will, I will say that the, even when I give the instruction, I will tell them face to face. I'll write down the instruction and their discharge plan to call me on Tuesday or Wednesday or whatever day it may be to follow up on how they're doing. I will say a good 75% do not follow those instructions. So the vast majority people don't even call me. Um, those 25% who do call me great. I followup on their blood work and I would say about five to 10% of the time we actually catch something or require that they be readmitted to hospital or something needed to be done.
Gianni: 21:38 Um, so that has helped, uh, tremendously, uh, in coordinating their care. Whether it prevents hospital admissions, I'm not entirely certain. I think it does. Um, what I would say is it probably prevents emergency room visits, especially in the individual who doesn't have a family doctor. Um, cause they can call me with followup tests and whatever else. I mean, where you're throwing down make sense like you've ever thought about doing your office number or you problem with office number is completely inefficient. Right. So, um, they'll call my office, my admin assistant may not be there or they may give the, they'll leave a voicemail and the phone number or the name is hard to decipher, um, or they're going to be calling after hours. Right. Um, something may be going on at seven or eight o'clock at night and yes, I'll have my cell phone on there.
Gianni: 22:26 Yes. Uh, with me, uh, yes, I will answer it the vast majority of the time, but it cuts down on all that. Um, I guess phone tag, which I find can be very infuriating sometimes. Um, so from an office perspective, again, everybody's practice is a little bit different. I would prefer they just call me directly, um, because spelling of names, phone numbers that they leave, whatever it may be and that my admin assistance, there's no way they know of all the patients that I'm dealing with. That's not how my practice is set up so. Well, Gianni,
Gianni: 22:59 anything else you wanted to add or comment on in terms of whether that's solutions or problems that you're, that you've been exposed to? [inaudible] I'll make these comments and sort of a, a analogy, a passenger on an airplane would never tell a pilot how to do his job. Even if they had all the information available. Let's say you were in the cockpit, the door was open and whatever else and you could look into the cockpit and you have all this information from you and you had direct access to a pilot. You would never tell the pilot, I want you to fly this way cause I want to get there faster or I want you to land over here or whatever it may be. Okay.
Speaker 5: 22:59
Gianni: 23:39 you can argue that medicine and not to put down pilots, but medicine is far more um, challenging and requires far more training than a pilot. Okay. Yet every single day that I am in the intensive care unit or on my internal medicine wards, I have a family member telling me what to do.
Kwadwo: 23:58 Where is this coming from? I mean obviously I'm experiencing the same thing and it is draining because yes, I don't mind being questioned. I don't mind asking people asking me for further explanation in terms of why my treatment plan is the way it is. But the amount of time spent to explain why what you're suggesting is not beneficial
Gianni: 24:25 or even nonsensical is like getting worse with time. Like it's like half my day. You have to, again, this, this, we'll start going on rants here, but this is the problem. They are receiving their medical education from television, movies and Google. So if you type into Google, um, or let's, let's use the example of CPR. I can't tell you how many times I've been screaming at the television watching Grey's anatomy or Chicago hope or ER or whatever. Toby, lot of Grey's anatomy watch tons of it. Yeah. So the or any movie for instance that someone is getting operated on. I saw a guy in one show, I can't remember which show, who has a ruptured aortic aneurysm, who's being operated on from a surgeon who's not even a vascular surgeon. And that individual is not even intubated. They don't even have a breathing tube in.
Gianni: 25:19 So I've got news for you people, if you're going to have major abdominal or vascular surgery, you would require a breathing tube inserted in your mouth. This is a subtle thing that a physician would pick up on, but it's completely, completely unrealistic. That patient would be dead. That would never happen. Right? That. So people are getting their information from, like I said, from television, that is completely unrealistic. And Google has now allowed you to access a wealth of information. However, the ability to tease down that wealth of information to what is credible and what is not credible. That's where your training comes in. I had a patient asked me the other day, I want STEM cells for my loved one to repair his brain. I read it on the internet. I read it on Google. I'm not kidding. This is not made up. I want STEM cells to cure his massive stroke. I Googled it. It exists. I want it. That was literally the conversation.
Kwadwo: 26:17 Yeah. And it's, and it's not going anywhere. It's gonna get worse. And this is the thing that I'm, I don't know how to deal with this in any other way except for constant education, constant conversations, explaining why. And to be honest with you, even sometimes that doesn't work. No. They'll still insist on you ordering that pet or whatever tests is not indicated. And it comes down to like we're, for lack of a better word, that coward or cowardliness of of of physicians, we will, lot of us will order the tests and it comes down to being defensive because we don't want to be named in that complaint. We don't want to, if we point 0.006% chance that they might be right, you know you're, you're too fearful.
Gianni: 27:12 No they will. They won't be. I'll, I'll challenge you on that. They're not going to be right. These are situations where we all know we can do another CT scan, we can do another MRI. It is not going to change a single thing. All it is done is allowed you as that as that treatment physician that the, or excuse me, attending physician to avoid that difficult conversation which would take half an hour to an hour to do, let's be honest, it take half an hour to an hour of your time. It's going to be emotionally exhausting in order to explain why I'm not doing an MRI. It is far easier and takes five seconds to do on my computer right now to order an MRI for that patient. It is way easier to do that than to have that conversation to say, no, I am not doing the MRI. I've explained it to you time and time again, I'm not explaining it again and I know this sounds cold and it sounds callous, but I have spent hours and hours with substitute decision makers explaining why we will not do something and the information will not sink in and you cannot tell me that I'm not communicating clearly because there are other members of the healthcare team there.
Gianni: 28:12 There are social workers, there are nurses, there are residents, there are med students who have all had this conversation and like I said, I've had this conversation
Kwadwo: 28:21 five or six times previously
Gianni: 28:23 and eventually we just have to say no and it might result in a complaint. It might result in whatever it may be, but we just have to live with it. The right thing to do for everyone's sake, other patients, society, that patient, that substitute decision maker is to say no. In those situations.
Kwadwo: 28:38 I mean, just think about the potential consequences. Even like think about the MRI example in our world, they might need to be sedated for it. They might need to be having a endotracheal tube put in place to have the procedure done. You might have a false positive, you might get a result which is, which looks like it's something, but it's essentially not that you then have to chase down. Meanwhile that is, that's cost. The system will say one to $2,000 literally for nothing because, uh, because of, uh, dr Google because of curiosity, because of anxiety, it has all these downstream effects and it's, it's got to stop. And I actually think we've talked about this on offline a bit in medical school. Think about how valuable it would be to have, whether it's conflict, uh, what's the term? Conflict management, uh, conflict resolution, resolution training to have like expert advice in terms of how to deal with these circumstances.
Kwadwo: 29:43 This would go such a long way and it's like that little nudge that would have so many downstream implications and an improvement. Like you said, you're getting this advice from usually your, your colleagues and who knows how good they are at managing this. So yeah, man, like it's, and it's, I don't think it's that hard. You know what I mean? I, I know we get offered conflict resolution training through a R like Canadian medical association, but really if we're talking about creating some legit change, you know, investing that that little bit of investment could have such incredible downstream improvement.
Gianni: 30:28 And I mean, if I can make one last point about getting into what are some of the problems out there, and again, this is ranting, but in all the cases that I've been involved in that have gone to either that I've been named or indirectly referred to in the media, the vast, all the stories that have been written about these cases have been inaccurate. And that is another source of, I think, what the public will read and take into things. And there's almost this recently I would say, and this again is my opinion a villainization of the healthcare teams. It's crazy. Doctor wants to pull a plug, doctor wants to do this. Um, my loved one is a fighter they're gonna pull through with the doctor, said they were going to die, blah, blah blah. And they're, I think one of the things that we need to get better at as physicians and hospitals is actually commenting on these cases once it's been brought into the public Ave.
Gianni: 31:20 not again disclosing any personal health information, but we can comment on such things as why we are doing what we are doing. Um, and I can't tell you how many times we work in an intensive care unit. Patient critically injured in car accident. Well, no, the patient isn't critically injured. I'm in the intensive care unit right now. I've got news for you. I've been working in the quadrant or any tertiary or excuse me, quaternary trauma unit or intensive care unit. That patient is not in the intensive care unit. In fact, that patient is, I would want to say perfectly fine, but from a relative perspective of being critically injured, they're not, they are actually perfectly fine in the trauma unit or not even in the trauma unit. So there's just a small example of the sensei, slight sensationalization in the media and it's incorrect. That label is incorrect. They're not critically injured.
Kwadwo: 32:07 Yeah. I don't know where this Ville villainization is coming from. And I spoke to this a little bit earlier, like we got into this game to help people get better. We don't have agendas, we don't have, we just want to get that patient back to where they were and there is this insane amount of this doctor acts, he's making too much money. This doctor X wants to pull the plug. Even like some of these cases, the brain death patients,
Gianni: 32:40 I dunno, I, I mean I'll full disclosure didn't read the articles that while I've read, I've read all of them. Should we even get into this? We don't want have to, this is five minutes, five minutes on the [inaudible]
Kwadwo: 32:49 brain does stuff cat getting back to like the, you know, in terms of like dr Google or like an unrealistic expectations, these brain death cases, I don't know what to say. I feel like it's insane what's going on.
Gianni: 33:08 And again, this is a, it falls into education where someone cannot understand that a brain is dead, but the rest of the body is working for a physician. This is very straightforward. Your heart is basically autonomous. It really, for the lack of better purpose doesn't really depend on your brain, right? Right. Your sinus node is going to generate an electrical current that is going to make your heartbeat, doesn't require a living circulating blood in your brain. Um, whereas the public doesn't understand that public thinks death is K my heart is stopped. I am dead at that point. Uh, they cannot understand the concept that there is zero blood flow to the brain and that entire brain is dead based on imaging. Uh, we can prove it through, you know, of all the tests that we can do through the clinical exam that we can do.
Gianni: 33:57 And yet, um, they cannot, um, deal with that fact first of all, understand that fact. And then if they do understand that fact, they don't want to deal with the fact, um, that, um, that patient is dead. And in all of these cases there has been the, again going back to the religious concept of it, uh, they will say that our religion dictates that this patient is not dead until their heart stops. That is a very dangerous Avenue to go down. Would the same religion deny or claim that while I don't believe they have metastatic lung cancer, our religion dictates that. I don't believe they have metastatic lung cancer. It's the same diagnosis. The diagnosis is a diagnosis. It's medically proven. How we can allow a religion to dictate death or a diagnosis is a very, very dangerous concept and something that needs to be dealt with at a legislative level, at a government level where there has to be clear legislation that this is death. This is medically proven, it is there. This will not be debated. This is required.
Kwadwo: 35:00 It's time like the resources, the stream on the, on the healthcare team, and actually I would argue the stranger putting the family through to like, I don't know, even if they're saying this stuff, they're going to go through some emotional roller coaster thinking that loved one acts is not dead. They're just, whether it's a care team,
Gianni: 35:21 I will have to say trust or whatever. Shame on the, on the legal system for even entertaining this. And someone will argue, while this has no public health ramifications, of course it does. The cost associated with this, and this was mentioned, the reasons for decision and then the kitty case, the associated with this is tremendous. That is a public health concern right there because there is no way in our society that we would allow our religion to dictate whether or not you have pulmonary tuberculosis. We would isolate you, quarantine you, treat you despite what your religious views may be because of the public health concern that is there. And again, people will, some people may hear this and say, well, doctor the GTO, he's, he's an extremist. Um, and these are, these are insane views. They're not insane views in the eyes of, of the health care consent act.
Gianni: 36:06 A treatment is a treatment or a diagnosis is a diagnosis. It does not change. It cannot be influenced by religious beliefs, right? So that that needs to be dealt with and needs to be dealt with quickly. Uh, however it will not be. This will take I suspect, years to resolve. Yeah. And it's, it really is too bad. Listen, I want to thank you for joining the podcast who was, uh, this was the inaugural one and, uh, I couldn't think of a better person kinda to, to join me and, and to talk about these things and I really appreciate that. And uh, how do people get ahold of you if they want to get a hold of you? My cell phone. I'm just no way.
Speaker 6: 36:46 Yeah. One 900. Um, but yeah, no, seriously, thanks for joining us and uh, and thanks for doing this anytime. My pleasure.
Kwadwo: 36:59 Once again, thanks so much for listening to our conversation with Gianni. Did Judaeo in terms of takeaways from a system level or from an administrative level, lawmakers need to provide clinicians with that safety or the tools to be able to do the right thing, to feel safe, to say no to care. That is not beneficial from a clinician perspective. Address goals of care early. Don't shy away from these conversations and suggest a treatment plan that you feel is appropriate. And in terms of the general public, what, what can you do? Don't shy away from those conversations about end of life. You know, we're all gonna die one day. And to have those conversations and to plan ahead and to know what your loved one will want will go a long way. I promise you that. All right, for those once again, don't want to leave some comments. You could email us at kwadcast99@gmail.com that's kwadcast99@gmail.com you can follow us on Twitter @kwadcast and a subscribe today cause it could be more goodness to come freshness all around y'all. All right, talk to you soon.
Why should you listen to this? How's this host with a crazy name? In this episode, we'll have an overview of the direction of Solving Healthcare, how it came to be and what you're going to gain. Enjoy!
Here's our links to some of the studies we refer to.
Ethical failings of CPSO policy and the health care consent act: case review.
https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0357-y
Outcomes and Cost of Patients With Terminal Cancer Admitted to Acute Care in the Final 2 Weeks of Life: A Retrospective Chart Review
https://journals.sagepub.com/doi/abs/10.1177/1049909119843285?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003𝔯_id=ori%3Arid%3Acrossref.org&journalCode=ajhb
Resource Optimization Network website: https://www.resourceoptimizationnetwork.com/
Follow us on twitter: @Kwadcast
Episode transcripts:
Kwadwo: 00:01 Welcome to solving healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of resource optimization network. We are on a mission to transform healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better healthcare system that's more cost effective, dignified, and just for everyone involved.
Kwadwo: 00:37 For our very first podcast, I'd like to introduce dr Gianni D'Egidio. He is first off, a very good friend of mine who does critical care and general internal medicine at the Ottawa hospital. In this episode we'll talk about the impact of providing inappropriate care to patients and also discuss how to manage conflict in these circumstances. Gianni D'Egidio. Thanks for joining us. My pleasure. Um, first of all, I'd like to thank you for coming, considering that I completely dominated you in an arm wrestle not that long ago in front of many people in Clearwater, Florida. So I'm very grateful for you to be appearing on the show today. Thank you. Well, I see this podcast is going to be full of lies today. All right, we're off with a bang. Okay. So as an intensivist, as a general internist, where do you see the problems in our healthcare system?
Kwadwo: 01:36 I would have to say from my perspective, the biggest problem has to do with our lack or inability to correctly have an end of life care discussion or goals of care discussion. Now these terms are going to be interchangeable. Let's just say, uh, the term I'll use is, is proposing an adequate treatment plan to people. Okay. And the reason that is important, uh, is because what it results in is basically what you see right now in our entire healthcare system is a tremendous backlog. Everything is full. Uh, the hospitals are full, longterm care facilities are full. And I think one of the biggest problems we have is an inability to deal with these issues, namely having inappropriate, uh, discussion with substitute decision makers or patients about their overall prognosis and their overall care.
Kwadwo: 02:25 So, okay. So that's the problem. And where do you see this bottlenecking? Is this within family practices? Are we doing this within a tertiary care centers? Like where do you see this mostly being a problem?
Gianni: 02:38 Tickets from a continuum of starting with family practice? I think it can start there. It is rare that a family physician will have a well-informed, uh, advanced care planning session with their patients. And that then results in potentially, uh, an inappropriate admission to, and then when that admission to hospital comes, now let's take it into the acute phase where there is also probably an either ill informed or inappropriate conversation during the admission process, either through the emergency physician or the admitting physician. And then that progresses to further potential deescalate or excuse me, worsening of the patient in hospital and then results in a intensive care unit admission. Okay. Without giving a co like a exact patients scenario, walk us through exactly like what this could look like. So for instance, let's use one of our studies as an example. Okay. We looked at people presenting to the emergency department who subsequently died in the last, they were basically in the last two weeks of their life.
Gianni: 03:45 Uh, these were people with advanced cancers, metastatic cancer who present to the emergency department and subsequently died within two weeks. 71% of those individuals who clearly had end stage disease, 71% of those individuals did not have any discussion regarding end of life or advanced care planning. So there's a typical example of our system of a failure of our system. And this is not to put blame on oncologists or a family physicians or intensivists. This is to say that the vast majority of people or the vast majority of physicians are either uncomfortable with having that discussion or are improperly educated about how to have that discussion. Interesting. So obviously we do the same line of work. We see this problem all the time. And what do you think, you kind of answered the question, but what do you think is the problem? Like if we know it's an issue with addressing goals of care, why isn't it happening?
Gianni: 04:45 I would boil it down to two major issues. One is education amongst not only patients and substitute decision makers, but amongst physicians. And the second problem is fear. Um, or uncomfort or whatever you wanna label it as I would label it as fear and on the aspect or on the side of physicians especially that they are fearful of having these conversations, especially when the conversation is going to be fraught with emotion or conflict. So let's get back to 2.1 if I may about education when I, this is just anecdote, when I pull the medical students and residents that are in a lecture and I give many talks on end of life care, advanced care planning or proposing a treatment plan, I pull them on. I ask how many of you have had any education whatsoever in medical school about how to deal with conflict or how to have an appropriate end of life care discussion or advanced care planning discussion.
Gianni: 05:43 The vast majority raise their hand and say, we have not had that type of education. If we had had that education, it's only been for an hour or one lecture and that is it. So here are these medical students now residency. And then I asked the residents the same question and again the vast majority lack that education or that formal teaching on it. They say they pick it up from their attendings. Well I've got news for everybody. If your attending is not very good at having that conversation and they are going to be your role model or your source of education for that a topic, I've got news for you, your end of life care discussion or advanced care planning discussions are also going to be quite poor. So education is tremendously lacking and then that results I think in point number two which is fear.
Gianni: 06:31 We as physicians I think are, I as mentioned uneducated when it comes to having discussions that results in fear of having the discussions or avoidance of having these discussions. Let's look at the small percentage of conversations or families or substitute decision makers that are quote unquote difficult and we know they're going to be difficult. Physicians are fearful of having those conversations completely fearful and that we'll use the term almost cowardly. Um, when it comes to having those conversations, especially when they substitute decision maker or family member is threatening with a lawsuit or threatening to go to the media or whatever it may be that they're using. Um, physicians will avoid that conversation and if they're not avoiding the conversation, the conversation will basically allow the substitute decision maker to guide the treatment at that point. Like I couldn't agree more. And one of the things that people don't appreciate is the downstream consequences of these lack of conversations.
Kwadwo: 07:32 So yes, the patient gets admitted to an inpatient or into the intensive care unit, they get all this treatment, which people don't realize how, how much of a strain it is for the family member, for the patient, for the care team, for, you know, having that moral distress of giving, like providing care to someone that's not going to benefit. So you've been involved in several cases where there's been conflict with the treating team and the family or substitute decision makers. I'm wondering if you could talk about that process a little bit and, and maybe even describe what the experience has been like for the patient. The family, the care team and yourself. So the, for those that are listening that don't know what the consent capacity board is, the consent and capacity board or the CCB is an independent quasi judicial tribunal. I'm appointed by the province to basically adjudicate what is in the best interests of a patient, especially when there is a conflict or dispute between what the treatment team feels is in the patient's best interest compared to what the substitute decision makers feel is in the best interests of their loved one.
Gianni: 08:55 Um, Ivan and involved, uh, in six consent and capacity board cases and also been involved indirectly in multiple other cases. And I'll talk about, uh, our study a little bit later on. So regarding the CCB, um, the CCB as mentioned as closer judicial, it's basically a, uh, court like, um, a system or court like, um, process where me as the, uh, treating physician will file an application with a consent capacity board to basically, um, challenge whether or not the substitute decision maker is abiding by the principles of substitute decision making, which is section 21 of the health care consent act. And what that section 21 looks at is as mentioned, the principles of substitute decision making and a substitute decision maker. If I can make one clear point on this podcast today and what I do during my lectures as well, a substitute decision maker is only there to consent to the treatment plan that physicians propose and they have to do so based on number one previously expressed wishes of their loved one and if there's no previously expressed wishes, then they have to act on best interests.
Gianni: 10:01 A which considers values and beliefs substitute decision makers are not there to demand therapy, they cannot demand therapy and they are only there to consent. Like I said to the treatment plan that we propose and this goes back to our education and our inability to appropriately propose a treatment plan. So in terms of their demand of therapy, we as physicians are not obliged to offer, propose or initiate any therapy that has not been started or that will not benefit the patient in our opinion. Okay. That's what we forget all the time on our side. Substitute decision makers like me, like I mentioned have to act on previously expressed wishes and if not best interest and the consent capacity board will basically adjudicate, um, solely based on law and solely based on the section 21 of the health care consent act. So I filed a six applications.
Gianni: 10:59 I've been involved in five consent and capacity board hearings. Um, they are the consent capacity board. I guess the pearls of the consent and capacity board are that it is heard more end of life cases than any other court's combined in Canada. It is supposed to be rapid in the sense that once I file an application you're supposed to hear, there's supposed to be a pre hearing within one week of filing of that application and it's supposed to be much faster than the court system. Ideally you're having a pre hearing within a week and then ideally you're having the hearings within a month or two. Unfortunately that has been changing over time and I'll get into that maybe a little bit later on. So getting back to the pro, it's supposed to be fast. And more importantly when the hearing is done, you get your reasons for decision within 24 hours, which is unheard of compared to any other court Lake system.
Gianni: 11:49 Um, the cons of the consent capacity are that the decision is solely based on law. It does not factor in the ethics, the opportunity costs, the medical standard of care or whatever else physicians would deem important. When it comes to proposing a treatment plan or it comes to the care of a patient, it's solely based on, like I said again this subsection 21 of the health care consent act. Um, my experience with the CCB has been mixed. I would say, um, lately the from filing of application to decision has been three to four months, which albeit is still faster than the court system. However, it is still, uh, quite arduous in terms of the amount of preparation that requires and the amount of time in spent in hearings. So the latest case that I've done, basically it was a seven day process, uh, not to mention the multiple pre hearings beforehand.
Gianni: 12:47 So it can be quite labor intensive. And the reason I mention all this is because the vast majority of physicians will not proceed with a consent capacity board case. Um, I have done six, I know of in Ottawa at least, there's only been basically two other physicians who have filed a form G application, which deals with end of life care issues at the consent capacity board level. Um, so the vast majority of physicians will avoid it. And another factor is even if the reasons of decision, um, I hate to use a term but are favorable for the physician, let's say they find that the consent capacity or the, excuse me, that the substitute decision makers have not acted in the best interest of their loved ones that can be appealed. And then the appeal process will take another five to six months. And, uh, only adding to the workload and time for said physician involved.
Gianni: 13:37 In that case, not only is there the workload or the never ending aspect of the consent capacity board cases, but it can also potentially result in litigation. So you can understand why the vast majority of physicians will not want to pursue this Avenue. Then getting into your point about the effect it has on families, a more substitute decision makers. While you can say goodbye to the therapeutic relationship that's essentially over, once you file that form G application or start mentioning courts and lawyers and whatever else. So the therapeutic relationship completely breaks down there is going to be most likely an associated costs for the substitute decision maker because they will have to retain legal counsel. If they can afford legal counsel then great. Yes they will. They will have to basically a fork out their own money for that process. If they can't afford it then they can get legal representation through legal aid.
Gianni: 14:29 Um, so you have not only the financial burden for substitute decision makers, you have the therapeutic relationship breaking down and there is no doubt is a stressful for substitute decision makers as well. Right. Going through court is not a fun process for anyone involved. So you got into the technical aspect which fine, but like why are you doing it? Like are you seeing that is driving you to want to go through this process? Like give us a sense of what a patient is going through at the time where you, you, you decide I'm going to go through this process again, this comes at um, you have to remember that consent capacity board cases are open to the public and the reasons for decision are available to everyone. So what I am disclosing, I'm not disclosing any personal health information or anything like that and I have written about this.
Gianni: 15:22 I have also used these experiences in the consent capacity board but that there is no doubt in my mind and no doubt, um, in the eyes of any of the healthcare team involved that the patient is absolutely suffering. And I will use extreme examples from cases, um, where basically there are profound ulcerations of the skin because of immobility and despite how good our nurses and our healthcare team is with moving patients, repositioning them, whatever else. Those are absolutely unavoidable. In these situations, you are dealing with an individual who is completely basically comatose who is now in one case was on months and months of vasopressin. I've got news for people. If you put someone on months of vasal pressers, you are basically, their skin has zero flow, it will have very, very poor blood flow. You combine that with pressure and the next step is profound ulceration to the point of sloughing of skin in multiple areas.
Gianni: 16:25 And in one instance basically a complete degloving of a scalp from simple, um, bedside combing of the hair, um, that has happened, that has been documented. Um, and the same process will happen with any indwelling tube, uh, and breakdown. So for instance, rectal tubes, rectal tubes will result in the complete destruction of the rectum if it is unbelievable to see what will happen to these individuals. Um, so first and foremost it comes down to the suffering of a patient. And second, it comes down to just the injustice and uh, ethical dilemma that it presents to physicians. And that results in me basically bottom line, full disclosure being absolutely angry about the entire process. I could feel the anger in the room right now. But yeah, I gotta say I've seen you in and around a couple of cases and this is not easy getting back to like the reasons to do this. So I couldn't agree more that the cases that we see in the ICU have these prolonged uh, treatments where the patients aren't benefiting and it's been driven by the families, the amount of sufferings, insane. And one thing that goes under appreciated is the work our nurses are a allied health team members go through to to provide care. Like I'll never, when I was a fellow,
Kwadwo: 17:50 we were rounding on one of these patients that weren't going anywhere and the nurse was crying in the corner, like trying to hide that she was getting emotional. I'm like what's the matter? Like what's going on? And she's like, every time I walk into that room I feel like I'm torturing that patient. I'm like 12 hours of torturing this poor guy. And it was actually a huge epiphany for me because like when we get involved, we're involved for like five to 15 minutes, right? To do our assessments or whatnot and they're at the bedside for 12 hours doing this. You know, it comes down to for me, you know, in terms of the justice point of view, like people don't realize also about the financial burden that is being put into this. Like into cases that people aren't benefiting in. You know, 1% of your gross domestic product goes into treating people in the ICU.
Kwadwo: 18:51 A reasonable percentage of these, those people aren't benefiting. And we need to think about some of the opportunity costs. A colleague of ours, Michael Harwich, he was talking to us about his kid who has a, I think there's a breakfast program at his school where they, for underprivileged kids, they provide food for, uh, to ensure that they get nourished and they had to cut the program cause they were short money. And I'm like, this is insane. We are flogging some people that would never want cake, would never want treatment and we can't feed kids like, you know, get all that is.
Gianni: 19:30 So let's, let's, that's a perfect segue into the next study that, uh, I or we are doing and will be presented at the Canadian critical care forum. Uh, in November there were 12 patients. Uh, let's, this is a case series of 12 patients that I've been directly involved in. And just off the top of my head, picked 12 patients that have been these, let's say drastic cases or extreme cases, but these 12 patients had a median age of 83 years old. They were meeting median age of all 83.5. So let's round up to 84. Let's just do that. Fair enough. They had an average length of stay in hospital of 263 days. Okay. That is absolutely I think incredible. And their average ICU length of state was 109 days. All 12 of these patients died. All 12 of these patients had extreme cognitive impairment, either the vast majority through dementia.
Gianni: 20:25 And three, if I remember off the top of my head, three out of the 12 cases due to a severe interest cerebral, um, incident. Um, so as mentioned, all of these folks, unfortunately, well I should say all of these patients, I shouldn't use the term folks. All of these patients pass away the average cost of these 12 patients to our system, not including physician costs or any other, these are just indirect and direct costs. Nearly $8 million for these 12 patients. One patient spent 704 days in hospital. Now you cannot tell me that this is a wise use of our resources when we talk about opportunity costs. Now let's talk about the things this study didn't capture. Multiple nurses have quit and I know that directly, uh, multiple nurses have sought sick leave because of this. Um, we have had, um, there, there has been a tremendous um, decrease in the sort of wellbeing of our health care team.
Gianni: 21:26 When these cases happen or even after the fact, you could feel it. Yes, yeah. Yes. And it has scarred certain individuals, scarred individuals to the point where they have quit. They have left their position. And these are not junior nurses. These are nurses in mid career who have decided I have seen enough. This is this case in particular has pushed me over the edge. I will not, I will no longer be an intensive care unit nurse. And you know what's insane? It's like their whole mantra of their whole job is to like, I want to make people better. I want to help heal people. I want to help them get their function back and they get shat on to get verbally abused. They get inundated with all this. They have the moral distress and they often feel powerless. Yes. You know what I mean? And it's like we need to do some shit about this.
Gianni: 22:20 So this is, this brings us into another part of the bigger problem, which is as physicians in a healthcare team, besides the roots of the consent capacity board, the odds are stacked against the healthcare team right now. And if I may use the analogy of, of the pendulum, the pendulum has swung far too much towards the principle of autonomy. And I will refer people to the study that we recently published as well about the ethical failings of the end of life care or CPSO end of life care policy. And the health care consent act, which are completely favoring autonomy and they completely disregard other ethical principles such as distributive judge justice, non-maleficence and beneficent, excuse me. Um, and the reason that is our policies and law are completely stacked against um, those ethical principles and completely favor autonomy. For instance, the CPSO end of life care policy, which basically just to summarize, basically says you need consent not to perform CPR.
Gianni: 23:22 This is the only treatment that I am aware of that has ever been or deemed by the college or any, uh, professional body to be uh, universally indicated in everyone. And as I point out, again, when I lecture my med students and residents, there is no treatment that is universally indicated in any one. I use the simple things like water and oxygen. Oxygen is not universally indicated and everyone, in fact, oxygen can be harmful when not indicated. Water is not universally indicated in everyone. For instance, in the hyponatremic patient, there is no way that CPR is universally indicated in every single individual. They are going to be clear cases where CPR will never benefit in an individual and should not be offered. I mean you and I both know how insane that that statement was. Like just to be clear for the listener, like you could have a patient with end stage cancer.
Kwadwo: 24:13 You have a patient that is having end stage renal function. I, he needs dialysis and the treatment, the treating team says like this patient is not a, uh, is not a candidate for further chemo. They're not a candidate for further dialysis. They're not tolerating it. This ruling would still say that if they die you would need consent not to do CPR. Correct. Which is insane. Now, one of the things we as physicians, and this gets back to again, the uh, topic that I've been focusing in on is our proposal of treatment plans is very poor. And as I mentioned earlier, we do not need to offer any treatment or propose any treatment or begin any treatment that has not already been initiated or that's not going to be beneficial to an individual. However, that requires that the entire treatment team be on the same page.
Gianni: 25:06 And you have to remember our healthcare system or the way we operate in intensive care unit, I don't want to call it fragmented, but we have a most responsible physician or attending physician every week. Right. And to get consensus for let's say 20 individuals, 20 physicians who are going to be looking after this patient, there's going to be a different level of comfort amongst those attending physicians about what they're gonna offer and not offer for fear of reprimand because of a lawsuit, a college complaint or whatever else it may be. Even though said physician completely agrees that this treatment should not be offered, but they are fearful of the consequences of saying I am not going to offer dialysis. I am not going to offer peg tube feeding. But they are fearful of the consequences of that. I mean is because of the process. Like just to be the devil, the process.
Kwadwo: 25:52 Once you get a complaint, you get named in a lawsuit. That's years of your life. Yes. You know what I'm saying? And, um, so there is a lot of unfortunate the deterrent to be able to stand up and do what's right. But I think at the end of the day, all of us gotta look ourselves in the mirror, yo. And full disclosure, I have had a college of physicians and surgeons complaint, um, which took 15 months to basically resolve. I have had complaints to the chief of staff of the hospital to the CEO of the hospital, to my member of parliament as well. So these are, and I'm willing to deal with those. Uh, but again, I don't, I can't blame my colleagues for saying I don't want any of that. Especially if there is something else going on in their life that has providing them stress in their personal life or their academic career, whatever it may be. Right. They're going to completely avoid that. And part of me can't blame them.