0:04

Welcome to the Skeptics

0:06

Guide to Emergency Medicine.

0:09

Meet them, Greet them,

0:11

treat them, and street

0:14

them. Today's date is

0:16

January 7th 2025 and

0:19

I'm your skeptical host

0:21

Ken Milne. The title of

0:24

today's podcast is This

0:26

is Our Fight Song.

0:28

Feminim 2.0. And we have

0:31

not one. Not two. But

0:33

three. guest skeptics for this

0:35

super S gem extra. So the first

0:37

guest skeptic is Dr. Dara

0:40

Cass. She is an emergency

0:42

medicine physician, public health leader

0:44

and advocate passionate about equity

0:46

and health care reform. She

0:48

founded Feminem, promoting gender

0:51

equity in emergency medicine and

0:53

champions organ donation reform after

0:56

donating part of her own

0:58

liver to her youngest son. Dr.

1:00

Cass is dedicated to expanding

1:03

reproductive health care access and

1:05

educating the public on health

1:07

care policy. A mother of

1:09

three, she combines her commitment

1:11

to medicine, advocacy, and equity

1:13

to create meaningful change. Welcome

1:16

back to the SGM, Dara. Thank

1:18

you for having me back, Dr. Milne.

1:20

Oh, oh, come on, Dara, it's Ken, and I

1:22

love having you on. I've had you on,

1:24

I think a couple of times. I mean,

1:26

it goes back like... to some of the

1:29

early days, it was 2017, when I came

1:31

out and I said, hey, there's this new

1:33

group coming up, feminine, and I looked into

1:35

it, and by December I'm like, you know

1:37

what, 2017 is the year of feminine. You

1:40

did declare that, and I think that we

1:42

did have a very good year that year.

1:44

I can't say it was because of you,

1:46

but I can certainly say they both happened

1:48

at the same. I don't want to over

1:50

interpret the data, but I would say that

1:53

we did have a good year in 2017.

1:55

Correlation is not causation right but

1:57

you were kind enough to invite me

2:00

to present at your 2019 female idea

2:02

exchange conference in New York City. So

2:04

that was 2019, Dr. Jen Gunter was

2:06

there, she was launching a book, my

2:08

wife Barb came down and it was

2:11

just an amazing trip to New York

2:13

City and to be in that room

2:15

with about five, no, I think it

2:17

was like 800 women and I've done

2:19

a lot of speaking, I must admit.

2:21

I was very nervous getting up on

2:23

that stage presenting in front of those

2:26

women talking about the evidence behind gender

2:28

inequity in the House of Medicine. It

2:30

was great to have you. I will

2:32

say that the feminine conferences and we'll

2:34

talk a little bit about them I

2:36

think as we go on were magic.

2:39

I still hold that they were one

2:41

of the most amazing things we did

2:43

and we hadn't expected to do them

2:45

year over year. Lots of reasons we'll

2:47

talk about why they stopped, but having

2:49

you there was very special. The feeling

2:52

of running those conferences and seeing the

2:54

interpersonal like dynamics and the speakers and

2:56

the participants and just the energy in

2:58

the room is something that I think

3:00

I still carry with me when I

3:02

have challenging days because it was just

3:05

magic as the only word we ever

3:07

use. It's always funny what you remember

3:09

from these things. I remember three things.

3:11

One, we arrived and Barb lost her

3:13

luggage. I shouldn't say Barb lost her

3:15

luggage, but the airline lost her luggage.

3:18

So we went on a shopping trip

3:20

through New York City, which was fabulous

3:22

for her. And then when I came

3:24

to present, I was really nervous, like

3:26

I said, and my bladder was like,

3:28

oh my God, I got a pee,

3:31

I got a pee, I got a

3:33

pee, I got a pee. And they

3:35

had changed all the bathrooms on that.

3:37

had to run down, oh my god

3:39

I'm on in five minutes, and I

3:41

had to run downstairs and use another

3:43

bathroom because all the bathrooms are changed.

3:46

So that was the second thing I

3:48

remember, again, weird. And the third thing

3:50

is we had all these capes, these

3:52

purple capes that said fix 19, and

3:54

all these presenters wearing these capes, looking

3:56

like superheroes of medicine. That was the

3:59

image that was left with me. I

4:01

loved it. So I will just say one

4:03

thing. The first conference we had, which

4:05

was fixed 17, we actually took all

4:07

the bathrooms in the venue and made

4:09

them gender neutral and was interesting because

4:11

we had about a dozen men joined

4:13

that first conference and there was no

4:16

man's bathroom. It was just gender neutral

4:18

bathrooms for everybody. And I remember that

4:20

that first day, one of the guys

4:22

that was at the conference and these

4:24

were all champions of gender equity, you

4:26

know, had thought about things from a

4:28

very equitable perspective. standing in line for

4:31

the bathroom behind 20 women because every

4:33

bathroom is gender neutral was one of

4:35

the first introductions into what it's like

4:37

to walk in the shoes of somebody

4:40

that you don't think about you know

4:42

having different experiences. So gender neutral bathrooms

4:44

are great at every conference. I'd advocate

4:46

for them across the board for lots

4:49

of reasons, but I would say turning

4:51

the bathrooms into gender neutral conferences at

4:53

the first conference was a really good

4:55

lesson in gender equity that I had

4:58

not anticipated teaching a few good men.

5:00

So much to learn. All right and

5:02

our next guest skeptic is Dr. Esther

5:04

Chu Now she just goes by a

5:06

single name because she is a rock

5:09

star We're just going to call her

5:11

Chu and I'm waiting for her evolution

5:13

to be like Prince. She'll be the

5:15

the the emergency physician formerly known as

5:18

Chu and she'll just be represented by

5:20

a symbol She is an emergency physician

5:22

and professor at the Oregon Health and

5:24

Science University. She's a popular science communicator

5:27

who has used social media to talk

5:29

about racism and Sexism in Health Care.

5:31

Welcome back to the S gem, Esther

5:34

Chu. Have I also been on the S

5:36

gem? Yes, you've been on twice.

5:38

I had you on once in 2019,

5:40

and the show was, she works hard

5:42

for the money. And the other one

5:45

was, an S gem extra about being

5:47

stronger together, and that was in 2017.

5:49

That sounds right. I think that's

5:51

when we did together. Well, it's

5:54

good to be back. And so our

5:56

third guest skeptic on this S

5:58

gem extra is Dr. Jenny Beck-Esmay.

6:00

She is an associate professor of

6:02

emergency medicine and assistant residency director

6:05

at Mount Sinai, Morningside, and Mount

6:07

Sinai West in New York City.

6:09

And she is passionate about emergency

6:11

medicine education and gender equity in

6:13

medicine and has proud to have

6:15

contributed content to numerous foam ed

6:18

resources like feminine, rebel EM and

6:20

EM docs. Welcome to the ESGEM

6:22

Jenny. Thank you. I'm so excited

6:24

to be here. Well, this is

6:26

your first time on the SJEM,

6:28

and I'm surprised that I'm saying

6:30

that, because we'll need to make

6:33

sure it's not your last time

6:35

on the SJEM. I'm a little

6:37

shocked as well. You and I

6:39

go way back now to some

6:41

of my earliest roots in the

6:43

FOMAD universe, and I'm surprised this

6:46

is my first time visiting you

6:48

in Canada. Well, we are going

6:50

to rectify that today, and moving

6:52

forward. Excellent! This is an SGM

6:54

Extra where we bring you special

6:56

episodes that highlight important topics in

6:58

emergency medicine. Today, we've invited these

7:01

three amazing people to discuss the

7:03

relaunch of females in emergency medicine

7:05

or feminine 2.0 initiative. And yeah,

7:07

it was it was a long

7:09

time ago that we spoke and

7:11

feminems was making waves about empowering

7:14

women emergency medicine and fostering this

7:16

conversation about gender equity. So let's

7:18

do a little time travel forward.

7:20

Do do, do, do, do, do,

7:22

do. Here we are in 2025

7:24

and feminine is back. better than

7:26

ever with a renewed energy and

7:29

a clear mission. So before we

7:31

dive into relaunching Feminim 2.0, what

7:33

the heck of you three been

7:35

up to over the last few

7:37

years because I'm sure there's some

7:39

interesting backstory. We'll start with you,

7:42

Dara. So what have I been

7:44

doing? Okay, well, the last time

7:46

we met in 2019 at the

7:48

conference, there was a virus that

7:50

circulated around the United States and

7:52

I hear it went through the

7:54

rest of the world as well.

7:57

I don't know. C

7:59

time before COVID. Seriously.

8:03

So obviously, all of

8:05

us got through the COVID experience

8:07

and in many different ways. And thank

8:09

God, most of us survived, although we do

8:11

need to remember that not everybody did. But

8:13

at the end of the day,

8:15

we all kind of kept working

8:17

in the ER and started thinking

8:19

about what was next. So

8:21

for me, the thing

8:24

I did in 2021 really

8:26

did also change the

8:28

course of Feminine, which was that

8:30

I went to go work for the Biden

8:32

-Harris Administration as a regional director in the

8:34

Department of Health and Human Services, which

8:36

was an incredible honor to be a presidential

8:38

appointee after especially the experience we had

8:40

with COVID. But also really gave me a

8:42

chance to integrate a lot of my

8:44

experiences as a clinical emergency physician and also

8:46

think about policy changes that had to

8:48

happen at the national level. The

8:50

really important factor for anybody

8:52

out there thinking about becoming

8:54

a presidential appointee, regardless of

8:56

the president, is you cannot

8:58

own or run a health

9:00

care organization if you work

9:03

for the administration as an

9:05

appointee. So as one of

9:07

the conditions of my employment, I

9:09

had to transfer ownership and all

9:12

activities of Feminine to Jenny, back

9:14

as May. She'll talk about

9:16

that in a second. But really,

9:18

that was the reason that

9:20

Feminine hibernated was that because of

9:22

my job in the federal

9:24

government, I could not either help

9:26

make decisions for Feminine, help

9:28

organize the conferences. And all of

9:30

us got very busy basically

9:32

keeping ourselves together. I also moved

9:34

from Brooklyn to Scarstale, which

9:36

is very exciting for me. Have

9:38

a new house, have fun

9:40

like that. And I have a couple

9:42

of kids. Actually, I have three. I need to

9:45

keep track of all of them. I have three

9:47

kids. And so now my daughter is about to

9:49

go to college. My son is a freshman in

9:51

high school and my other son is in seventh

9:53

grade. So it's busy times, but I am really

9:55

excited about the relaunch of Feminine and I'm really

9:57

excited to talk about what we're going to do

9:59

next. Isn't it amazing how

10:01

life just happens? So many life

10:03

events. I mean, you changed jobs,

10:05

you got through a pandemic, you

10:07

moved, I mean, wow. I mean,

10:10

I think there's a stress scale

10:12

out there about, you know, changing

10:14

jobs, health, you know, all of

10:16

those types of things. And you're

10:18

hitting a lot of the top

10:20

five right there. So good on

10:22

you for coming out of this

10:24

so successfully. But we need to

10:26

move on. Yeah, let's move on

10:28

to Esther because I want to

10:30

Esther, Well, it's a good question.

10:33

I'm not exactly sure what I

10:35

have been doing, but there was,

10:37

likewise, I also experience a pandemic,

10:39

strangely enough, and all the things

10:41

associated with that, a lot of

10:43

public health work, I would say.

10:45

And then in my day job,

10:47

other than being in the emergency

10:49

department, I am a health services

10:51

researcher. So I study health policy,

10:54

impact on health services of a

10:56

variety of things, but mostly focused

10:58

around opioid and cannabis use. And

11:00

so that. job has been very

11:02

busy and actually drifts a lot

11:04

over to what is happening in

11:06

health policy and health services related

11:08

to reproductive health. So I think

11:10

there's lots that's complementary and that

11:12

is what we're talking about today

11:15

because I think this is probably

11:17

the most significant and dramatic shift

11:19

in health care delivery that we've

11:21

seen in a while and understanding

11:23

its impact in emergency medicine. I

11:25

think is the first step, so

11:27

that we can best support our

11:29

workforce and know how to move

11:31

forward. Well, I'll have to make

11:33

a mental note about the opioid

11:35

use disorder stuff because our December,

11:38

hot off the press episode from

11:40

Academic Emergency Medicine, was about compassion

11:42

and the compassion that providers have.

11:44

and the perceived stigma that the

11:46

people with substance use disorder had.

11:48

And I thought it was a

11:50

really good topic and an excellent

11:52

discussion about the whole area of

11:54

substance use disorder and some of

11:56

the biases and stigma that we

11:59

can bring into that relationship. up

12:01

as providers and health care clinicians.

12:03

So I'm hoping I can pick

12:05

your brain later about it, but

12:07

that's about what we're here. Yeah, that'd

12:10

be great. Jenny, your turn. What

12:12

have you been up to for

12:14

the last five years? Of course,

12:16

besides doing CPR on feminine and

12:18

keeping it alive. I did keep

12:20

feminine on life support for

12:23

the last few years despite

12:25

Darrow's best efforts to kill it.

12:27

Did it have a DNR on it

12:29

or what a DNI? Yeah, you know I

12:31

every time I would try and give up

12:34

feminine to someone else or

12:36

consider selling it or consider

12:38

just you know putting it into a

12:41

grave, I thought back to all these

12:43

wonderful experiences that we had, including some

12:45

with you can at the feminine ID

12:47

exchange, and I just couldn't do it.

12:49

I just felt like there is something

12:51

there and I know that there will

12:53

be a time. later if it's my

12:55

if it's my time or dare is

12:58

time again where there's going to be

13:00

a reason for this to still exist

13:02

so I just kind of kept it

13:04

alive barely in the background because I

13:06

was quite busy you know as the

13:09

other two mentioned we did go through

13:11

this thing called a pandemic and

13:13

it took a lot of our time and

13:15

our energy and a lot of us had

13:17

to do a lot of self-care to get

13:20

through that in addition during that I had

13:22

a baby who's now three. And so I

13:24

have been doing all of the things

13:26

that come with early years of motherhood,

13:29

pregnancy and motherhood in the last few

13:31

years, well, feminine has been on life

13:33

support. So it's been a wonderful ride,

13:36

but I am very excited that now

13:38

that my kid is entering her preschool

13:40

years, feminine is back and I have

13:42

some time to spend with it again.

13:45

There's just something so special about

13:47

feminine. You could feel it back

13:49

2017, 2018, 2019. Something really great.

13:52

So I'm glad that you kept

13:54

it on life support and you

13:56

did not terminate or pull the

13:58

plug on it because... It's too

14:00

good. It's too good to give up on.

14:02

I just couldn't do it. You've brought us

14:05

up to speed. We're at 2025. I've

14:07

got my favorite number of questions

14:09

to ask you. That's right. Five.

14:11

And so each of you can respond

14:13

to any of the questions. You can

14:15

all respond. You can not respond. But

14:18

we're just going to go through this

14:20

list of five. And we're going to

14:22

start with the very first and most

14:24

obvious question. Why are you relaunching

14:27

feminine feminine? So I'll

14:29

start with that one. So when I

14:31

left the federal government and feminine was

14:33

hibernating, I really had to sit with

14:35

what was its purpose anymore and more

14:38

importantly, how is it going to exist?

14:40

So we don't always like to talk

14:42

about the financial viability of organizations and

14:44

the ability to support staff and time

14:46

and bookkeepers and accountants and all the

14:48

things, but. When feminine 1.0 existed,

14:50

we ran it very much like

14:53

a glass door model, which is

14:55

an employment-based model that where employers

14:58

supported the work we were doing

15:00

around the idea that a viable

15:02

workforce in emergency medicine was really

15:05

important to employers. The pandemic taught

15:07

us a lot and has really opened

15:10

a lot of our eyes into how

15:12

much of an investment certain groups and

15:14

certain organizations want to make in our

15:17

workforce. And it was clear to me

15:19

that that was not a strategy, a

15:21

fiscal strategy that would be at least

15:24

immediately possible, especially given the fact that,

15:26

you know, we were still dealing with

15:28

like, you know, COVID backlash. Our physicians

15:31

are overworked and underpaid. And so going

15:33

back to physician employers and asking them

15:35

to support an organization, while we know that

15:37

physician salaries are going down and we're working

15:40

harder than ever before, did not feel like

15:42

the right. strategy. So I kind of sat

15:44

with it for about six or eight months

15:46

and didn't know. And then as the reproductive

15:49

health care policies around the country started

15:51

really kind of getting embedded and we

15:54

realize that many physicians are practicing medicine

15:56

state by state in a way that

15:58

we've never seen before. No other practice

16:00

of medicine has seen this level of

16:03

disconnect. What happens in one state versus

16:05

a neighboring state? And Estrasees is almost

16:07

daily in Oregon versus Idaho. You know,

16:09

what does it look like to take

16:11

care of a patient? There is a

16:14

real need to galvanize and support the

16:16

emergency medicine community around the care of

16:18

reproductive health care patients and also still

16:20

support women physicians in emergency medicine. And

16:22

so it really kind of dawns on

16:25

me after doing some consulting work. for

16:27

six or eight months after I left

16:29

the federal government, that there was an

16:31

opportunity to marry those two missions, to

16:33

take the work we had done on

16:36

gender equity in the workplace, and also

16:38

as a nonprofit, right, which is not

16:40

how feminine had started because I was

16:42

using the revenue stream from employers to

16:44

facilitate the work we were doing, actually

16:47

to form it as a nonprofit and

16:49

have grant funding to support the care

16:51

of patients in emergency medicine. starting with

16:53

reproductive health care, but really expanding for

16:56

as much as we we find grants

16:58

and we think about the work we're

17:00

doing, because that is where the need

17:02

is, right? So one of the things

17:04

we've seen over the past couple of

17:07

years, and again, this is a very

17:09

American problem, but at the same time,

17:11

what happens on our doorstep leaves out

17:13

so many places, excuse my analogy, to

17:15

our neighboring countries and to our physicians

17:18

who go back and forth, it's really

17:20

important that we address the care of

17:22

patients in emergency medicine and the care

17:24

of the people who are taking care

17:26

of those patients. And so feminine gets

17:29

to do both in this new iteration.

17:31

We're going to launch with the same

17:33

website. So it's the same address, right?

17:35

It's still feminine.org, but it will be

17:37

a brand new website with a lot

17:40

deeper resources. So deeper resources on policies

17:42

and protocols on. employment for women in

17:44

medicine, but also on reproductive health care

17:46

delivery at topic pregnancy, you know, miscarriage

17:49

management. What does it look like to

17:51

start contraception? What does it look like?

17:53

to have a

17:55

library of resources so

17:57

making sure that

18:00

we have a well

18:02

curated research library

18:04

of important articles around

18:06

both gender equity and

18:08

medicine and professional development of women

18:10

and also the care of

18:13

patients in regards to reproductive health

18:15

care. So really serving as

18:17

a resource for our community and

18:19

bringing everybody back together

18:21

having some development programs on

18:23

women and medicine groups also state

18:25

-based policy groups so if you're

18:28

practicing emergency medicine in a

18:30

state like Idaho getting together all

18:32

of those physicians who care for

18:34

patients in Idaho not just women

18:36

physicians and making sure that we

18:38

share best practices and policies across

18:40

the state like Idaho or Tennessee

18:42

where it has become confusing sometimes

18:45

to practice emergency medicine especially with

18:47

things like the mtala decision

18:49

which you know we are speaking

18:51

a little bit freely about

18:53

but you know the mtala the

18:55

decision about where mtala applies

18:57

to emergency patients um is not

18:59

something that many of us

19:01

thought five years ago. Not

19:04

everybody will know what mtala is so if

19:06

you could just expand just a tiny

19:08

bit for our non -americans. Yeah

19:10

so mtala Escherche

19:12

why don't you take it from here? Do you

19:14

want to take it from here or do

19:16

you want me to keep going? No keep going

19:18

keep going because I'm I'm next and I'll

19:20

jump in as I need to. So mtala is

19:22

the Emergency Medicine Treatment and Labor Act was

19:24

passed in the 1980s to make sure that all

19:26

patients in American emergency departments got care at the

19:28

door stabilized regardless of their ability to

19:30

pay and what has happened and this

19:32

has been a real kind of foundation

19:34

of what emergency medicine is in the

19:37

United States we take care of patients

19:39

first and foremost we do not ask

19:41

them for their insurance or their checkbook

19:43

or their credit card at the door

19:45

it was obviously passed to take care

19:47

of the most vulnerable patients amongst us

19:49

these were originally low -income patients who

19:52

often were patients of trauma that were

19:54

being transferred from a private facility to

19:56

a public hospital and they were dying

19:58

on the way sometimes in a stretcher down

20:00

the block. And Emtala really is

20:02

the foundation of what it means

20:04

to take care of anyone, any

20:07

place, any time, regardless of their

20:09

ability to pay. And in the

20:11

United States right now, there is

20:13

a question about whether or not

20:15

the care that somebody might need

20:17

in an emergency, if it includes

20:19

a termination of a pregnancy, would

20:21

be protected under Emtala. And I

20:23

say that as we talk about

20:25

Idaho, Idaho, because it is the

20:27

Idaho solicitor general that brought this

20:29

to the United States Supreme Court.

20:32

And so when you are practicing

20:34

emergency medicine in Idaho, you may

20:36

be transferring patients out to a

20:38

neighboring state for emergency care. Yes,

20:40

sir. The L and M tala

20:42

stands for labor. And so reproductive

20:44

rights were already embedded in that

20:46

1980s law, correct? Yes, and so

20:48

the labor part of it included

20:50

active labor. So what it really

20:52

meant was that somebody that was

20:54

presenting to a private hospital in

20:56

active labor could not be shut

20:59

to a county hospital to deliver

21:01

their baby. What has happened because

21:03

of the term labor is that

21:05

there are a lot of people

21:07

that say that that means that

21:09

no pregnancy can be terminated under

21:11

EMTALA. And so there is actually

21:13

a lot of conversation about what

21:15

does it mean to take the

21:17

original intent of EMTALA and actually

21:19

apply it to the current state.

21:21

And again, the only reason that

21:24

this all comes up is to

21:26

say that this web of confusing

21:28

litigation or confusing laws. Married with

21:30

our existing best practices in medicine,

21:32

which actually haven't changed, is one

21:34

of the reasons why feminine 2.0

21:36

as a non-profit centered on gender

21:38

equity for physicians and the care

21:40

of our patients is so important.

21:42

Because if you think about the

21:44

moral injury to physicians, not just

21:46

women physicians, but the moral injury

21:49

to providers after a pandemic like

21:51

COVID, to come back and then

21:53

now work in a state which

21:55

has changed your practice capabilities. because

21:57

you are constantly concerned about being

21:59

in a court of law to

22:01

say, I practiced the right evidence

22:03

based care. But then you've been

22:05

charged with a crime, you have

22:07

had to hire a lawyer, you

22:09

maybe take time off of work.

22:12

And we know from the data

22:14

on litigation stress, what that does

22:16

to physicians and how many physicians

22:18

will practice then defensive medicine. in

22:20

anticipation of that risk? And

22:23

what does that mean for patients?

22:25

So again, like, I just want

22:27

to frame out, the reason why

22:30

we've decided to launch Feminem 2.0

22:32

is this is a, are we

22:34

allowed to curse on your podcast?

22:36

No, I'd lose my iTunes ratings

22:38

and as a Canadian, as a

22:40

Canadian, I'd have to say Sorrier.

22:42

F-ing mess, right? And so we

22:45

are here as a community to

22:47

hold hands with each other across

22:49

emergency medicine, across other specialties to

22:51

say to our colleagues in OBG-N

22:53

and family medicine and a lot

22:55

of our rural family practice doctors,

22:57

you know, we are in community,

22:59

we are heard together. And so

23:02

that's a very long answer to

23:04

your first question, which means this

23:06

is going to be a really

23:08

long podcast. Hey, the quality of the

23:10

podcast is not depend on the length.

23:12

Is it independent of the length? And

23:14

as long as we're getting this great

23:16

high quality content, we could go all

23:18

day. But if I could summarize some

23:20

of the stuff that I've heard is

23:22

you left the Fed. There's this thing called

23:25

a glass door, which I was not

23:27

familiar with, and I thought you were

23:29

trying to make some Freudian sort of

23:31

thing to a glass ceiling to connect

23:33

it to Faminem. And then you talked

23:35

about some of these key changes that

23:38

are to come, talking about reproductive rights,

23:40

employment equity for women physicians and beyond,

23:42

and also, you know, obviously my ear

23:44

perked up when you're talking about evidence-based

23:47

protocols and evidence-based policies, and so that

23:49

everyone, no matter who they are or

23:51

how they identify, gets the best care

23:53

based on the best evidence as a

23:56

as a resource. So you're going to

23:58

be some resource for some of these,

24:00

like a repository for some of

24:02

these best practices and best evidence.

24:04

And of course, being up in

24:07

Canada, when the U.S. gets a

24:09

cold, we come down with a

24:11

life-threatening septic pneumonia because you are

24:13

very influential. Right, Jenny, we've heard a

24:15

lot from Dara about the relaunch of

24:18

feminine. I'm just wondering, what are you

24:20

looking for? What do you think

24:22

the key change that's going to

24:24

come with this reimagination or feminine 2.

24:26

To me, the key thing is

24:29

really that we're taking feminine

24:31

from an organization whose mission

24:34

statement was the support of

24:36

women practicing emergency

24:39

medicine to expanding it to

24:41

encompassing all women in emergency

24:43

medicine. So that means the

24:45

people practicing it as well

24:47

as the patients that we're

24:50

taking care of. So in

24:52

my mind, we're now kind

24:54

of siphoning off two major

24:56

parts of our organization, the

24:58

previous part that was focused

25:01

on the professional development and

25:03

the support of the practitioners,

25:05

is not going anywhere. That's

25:07

going to be alive and

25:09

well and everyone can come to

25:11

that part for everything they've grown

25:14

to love. But we're expanding it

25:16

to include this much needed portion

25:18

of the care of women patients,

25:21

female identifying patients or

25:23

patients who have female

25:25

anatomy in the emergency department

25:27

which is a very crucial thing to

25:30

be done specifically at this juncture but

25:32

probably throughout history in emergency medicine. I

25:34

love it that you're heading towards

25:37

my world more of evidence-based medicine where

25:39

you have those three pillars and you

25:41

know those two of those pillars one

25:44

is the clinician which you've been talking

25:46

about and feminine has been working on

25:48

to improve the clinician and also the

25:51

literature so that's the the other pillar

25:53

the literature that informs those clinicians but

25:55

involving and inviting and engaging with patients

25:57

exactly and asking what they value and

26:00

what they prefer. And so you're bringing

26:02

that into the organization. Well done. I

26:04

like the change. Thank you. Chu, do you

26:07

want to add anything about what are

26:09

the key changes or where you see

26:11

this transition going to before we get

26:13

to the next question? No, I think

26:16

actually a lot of that feeds into

26:18

the next question if you want to

26:20

move ahead. So the second question is

26:22

about the new mission and

26:24

vision. And the new mission

26:26

statement from feminine focuses. on

26:28

advancing gender equity in emergency

26:30

medicine and improving reproductive health

26:32

care delivery in emergency departments.

26:34

So Chu, what strategies will

26:37

feminine use to achieve these

26:39

very specific goals? Yeah, I

26:41

think some of them dare already hit

26:43

on, but obviously we want to

26:45

strengthen the clinical care we already

26:47

provide. So this is not something new,

26:49

we already do reproductive health care, but

26:51

this is a time in history where

26:54

we need to bring our aid game.

26:56

We need to explore what kinds of

26:58

things we need to do to meet

27:00

emerging needs in a rapidly shifting political

27:02

landscape. And we need to figure out

27:04

what is the top of our license. And

27:06

this is what emergency medicine does all

27:08

the time when there's changing public health

27:11

needs. We meet it. So I think

27:13

20 years ago it would have been

27:15

unheard of to address, say, the substance

27:17

use disorder crisis, the opioid crisis, the

27:19

way that we do. I mean, people

27:21

would throw things in meeting if you

27:23

talk about screening for HIV. or for

27:25

substance use or for mental health conditions.

27:27

And we do a lot of those

27:29

things as a matter of course now.

27:31

So we are the most changing specialty,

27:33

I would say. We basically look around and

27:36

we say, what are the needs that need to

27:38

be met because we're the safety net and

27:40

after us comes no one. So I think

27:42

right now we need to be the reproductive

27:44

health safety net. There's no question. We just

27:47

cannot leave all of this to OB guy.

27:49

So a lot of what feminine will do

27:51

in this new launch is really think about.

27:53

What in what ways do we expand and

27:55

grow in response to what's happening around

27:57

us? And then, you know, some of these...

28:00

issues are medical but also medical legal

28:02

so how do we understand policy

28:04

and how much it can interfere

28:06

with our care and so how

28:08

do we address those things and

28:10

so that will be the quad

28:12

facto of good clinical resources education

28:14

and that is a very holistic

28:16

education it includes you know didactic

28:18

materials CME, better ultrasound training it

28:20

will be a research agenda both

28:22

understanding and making accessible existing research

28:24

and sponsoring and conducting some of

28:26

our own research and then I'll

28:28

be building community and I think

28:30

some of that will really build

28:32

off the infrastructure that feminine had

28:34

the four ways of gathering bringing

28:36

people together because this work is

28:38

so hard it is not to

28:40

be done in silos that is

28:42

incredibly inefficient and actually very hard

28:44

to do because things change so

28:46

fast and so where a lot

28:48

of what we're building in feminine

28:50

is how do we get people

28:52

to communicate well in their institutions,

28:54

in their states, in their regions

28:56

with people practicing in similar practice

28:58

settings and in counting the same

29:00

challenges and figuring out how we

29:03

create. the environment where people can

29:05

come together and move forward efficiently

29:07

and be stronger because they have

29:09

the wisdom of a dozen women,

29:11

a hundred women, rather than just

29:13

trying to make things up as

29:15

they go along. So there's a

29:17

lot embedded in each of those

29:19

things, but I think those are

29:21

the pillars of what we want

29:23

to do. And the only thing

29:25

I want to add is, you

29:27

know, gender equity is such a

29:29

key part of this. I mean,

29:31

we've had so much discussion about

29:33

Should we just focus on reproductive

29:35

health care or should we keep

29:37

going with this gender equity and

29:39

community building peace? But I think

29:41

because of everything, Dara said, because

29:43

we need to come together, and

29:45

because the fundamental problem we are

29:47

tackling here is gender inequity. I

29:49

mean, you cannot name another health

29:51

problem that is treated like this

29:53

for men. I mean, have you

29:55

ever felt that as a man,

29:57

you go to a hospital and

29:59

And the government is going to

30:01

step in and say where the

30:03

parameters of your care should be

30:05

or say that because of the

30:07

mancare you received, you may actually

30:09

have to face legal consequences or

30:11

lose your license or be brought

30:13

to court or be fined because

30:15

of the way that your man

30:17

issue was treated. I think they're

30:19

fundamentally at the root of this

30:21

entire reason we're together is gender

30:23

equity. And so there is a

30:25

higher purpose here as we need

30:27

to address some of the drivers.

30:29

of how we got here and

30:31

that needs to be done by,

30:33

you know, again, by community by

30:35

bringing women together and by addressing

30:37

these issues. But this is not

30:39

to the exclusion of women. Obviously,

30:41

Ken, you were first in the

30:43

door for feminine and we hope

30:45

to make sure that people understand

30:47

that the resources and opportunities we're

30:49

building are for everybody in emergency

30:51

medicine and for a gender issue

30:53

for the clinician per se, right?

30:56

Like it's not about my gender

30:58

necessarily with regards to the care.

31:00

And so I think it's gender

31:02

less. It affects every clinician who's

31:04

trying to provide care. I don't

31:06

know if your question was rhetorical

31:08

about have I had my medical

31:10

decisions restricted based on my chromosomes,

31:12

my fact that I am lacking

31:14

in X and that I have

31:16

a Y. The answer of course

31:18

is no. But also, you know,

31:20

and I'm careful not to come

31:22

across as a smug Canadian, but

31:24

it also doesn't affect women XX

31:26

or whatever, you know, like if

31:28

you want to get into chromosomes,

31:30

gender, all that, that's a confusing

31:32

sometimes longer. That's a whole other

31:34

podcast, we'll leave it that. But

31:36

reproductive rights and stuff like that

31:38

in Canada are much different than

31:40

in the US, and the US

31:42

has taken a significant change and

31:44

turn that will have material impact

31:46

on women's health. And so I

31:48

still think that... the question if

31:50

you asked a male physician in

31:52

the US or a male in

31:54

the US, I don't think that

31:56

there, maybe you guys can. confirm

31:58

their health care will not be

32:00

restricted or impaired or because of

32:02

that. Is that correct? It's still

32:04

the same in the US and

32:06

Canada if you're a man. That's

32:08

right. No, I think that's true.

32:10

And I think that's true. And I think

32:12

that also goes back to some of

32:15

the things about the mission and the

32:17

vision that I just want to add

32:19

to what Esther said, which is that

32:21

a, no organization can be everything to

32:23

everyone all the time. And so it

32:25

is going to be true that in

32:27

this iteration of feminine, we are very

32:29

transparent about some of the issues we're

32:31

going to face are exclusively American issues.

32:33

Some of them are going to be

32:35

exclusively childbearing issues. Some of them may

32:37

be exclusively female, I would say, gender

32:39

perception issues, right? So whereas a lot

32:41

of our policies and protocols, and the

32:43

work we're going to do is going

32:46

to apply to all female identifying people.

32:48

But some won't. Right. Some will only

32:50

apply to fertile female identifying people or

32:53

fertile people, you know, alone. Some will

32:55

apply to patients who take care of

32:57

everybody who can procreate. Right. So there's

33:00

so many different ways the work we're

33:02

going to do is going to impact

33:04

both patients and providers. And it I

33:07

think that sometimes I think I ask

33:09

for for myself, but I think we

33:11

have to ask for each other grace

33:13

in the idea that not every project

33:16

or every. or every program, every protocol

33:18

is going to be applicable to everybody.

33:20

And I also think that that, because

33:22

there's so much that has to be done,

33:25

right? And if we only did things that

33:27

were applicable to everybody all the time, we

33:29

would miss so much of the nuance, honestly,

33:31

the niche stuff that is even, for people

33:34

that are even more marginalized or less commonly

33:36

thought about because it doesn't apply to everybody

33:38

all the time. And so we hope to

33:40

do a lot of that work that is

33:42

being missed by other people. And I think

33:45

the other thing to say is that in

33:47

the iteration where feminine is a nonprofit that

33:49

has a deep bench and a broad

33:51

team, you know, last time we did

33:53

it, it was very in many ways

33:55

bootstrappy, right? Economically, I put a lot of

33:58

my own money behind it personally because because

34:00

I felt so strongly about getting it

34:02

going. It was an LLC, it had

34:04

a revenue stream, and as soon as

34:06

I got pulled out of the project,

34:08

the project didn't have enough. enough lift

34:10

to stay alive actually. Nobody could dedicate

34:12

that much time unpaid. Nobody could dedicate

34:14

that much energy and it became and

34:17

then obviously we had COVID and other

34:19

things were happening. But the reason I

34:21

say that is to say that the

34:23

goal for this iteration of feminine is

34:25

a non-profit. Feminim to point out is

34:27

that not a single person is the

34:29

core of what is going to happen.

34:31

Right. It will have grant funding, sustainable

34:33

funding, hopefully annualized grants. It will have

34:35

a large board of board of directors.

34:38

It will have a team of physician

34:40

of physician. who will own different parts

34:42

of it, will invest in more professional

34:44

development programs like Esther said that are

34:46

local, so that, you know, a lot

34:48

of these groups that survived in departments

34:50

and in cities, and, you know, even

34:52

all New York City or all LA,

34:54

that is where we're going to invest

34:56

a lot of our resources. So that

34:58

this is so much bigger than the

35:01

team at the, you know, that's spending

35:03

a lot of time doing it, but

35:05

it really is meeting the moment because

35:07

many of something was missing when a

35:09

feminine. sunset it, right? But it couldn't

35:11

come back until a core group of

35:13

people could dedicate this much time and

35:15

energy to bringing it back. But just

35:17

because a core group of people is

35:19

bringing it back, there needs to be

35:22

a huge team of people keeping it

35:24

alive because that is the only way

35:26

this thing survives for the next generation

35:28

of women in emergency medicine and honestly

35:30

the next generation of patients we take

35:32

care of. That's an important point because

35:34

sustainability for these types of initiatives is

35:36

so important and we've seen that Since

35:38

2012 with the rise of foam ed

35:40

the free open access to medical education

35:42

There is this sort of curve that

35:45

comes where you get this huge Increase

35:47

and everybody jumps on and people are

35:49

starting their own blog and podcast and

35:51

here we are 12 13 years later,

35:53

and there's been a bit of culling

35:55

of the herd There's not as many

35:57

blogs and podcasts in the foamed space

35:59

and the one that are sometimes aren't

36:01

as active. And so if you want

36:03

to create something that's going to last,

36:06

you've got to find some, I mean, I'm

36:08

just finishing my NBA, so some way to,

36:10

you know, like sustain it, you know, and

36:12

it really was, you champion feminine 1.0,

36:14

but now we're going to have feminine

36:17

2.0 where it's a much different

36:19

organization, it's non-profit, it's going to

36:22

have a board of directors, you

36:24

know, hopefully sustainable funding from grants

36:26

and things like that. God forbid

36:29

anything happens to any one individual.

36:31

It's the mission. It's the organization

36:33

that will continue with or without

36:36

some of those really important people,

36:38

but the organization and the mission

36:40

is above that is more important.

36:43

I did have one clarifying question

36:45

for you, Chu, and I heard

36:47

you talking and you mentioned something

36:49

about attending meetings where people were

36:51

throwing things at you. My mind

36:53

works this way, and so automatically

36:56

I go back to movies. And

36:58

I know it's a little outside

37:00

my era. It's from 1992,

37:02

a league of their own. And there's

37:04

no crying in baseball. There's

37:07

no throwing things in meetings.

37:09

Who are you inviting to meetings?

37:11

Where people are you inviting

37:14

to meetings? Where people are

37:16

throwing things in meetings? Who

37:18

are you inviting to meetings? People

37:20

would throw things. Not at me.

37:22

But there were actually meetings where

37:24

maybe throwing things is a little

37:26

dramatic, but I remember at the

37:28

beginning of my career when somebody

37:30

would come to a meeting and

37:32

introduce the idea of doing some of

37:35

these public health measures in the

37:37

emergency department. This was really at

37:39

the beginning of addressing public health

37:41

needs in the emergency department by

37:44

systematized screening for things like HIV,

37:46

Pepsi, opiate use disorders, you know,

37:48

so that we could then initiate

37:50

therapy or do. do referrals and warm handoffs

37:53

to make sure that people got their services because

37:55

they weren't showing up to primary care either. So

37:57

where could we capture people who had really high

37:59

public health? needs. That was in the

38:01

emergency department, but there were people,

38:03

and there still are, but much

38:05

more than, who were like, I

38:07

treat heart attacks, I treat trauma,

38:09

I treat strokes, and sepsis, and

38:11

anything else is for primary care.

38:13

And of course, you know, that

38:15

answer is not the right one,

38:17

especially in places like the United

38:19

States, where so many millions, tens

38:21

of millions of people don't have

38:23

ready access to primary care. Yeah,

38:25

the hair in the back of

38:27

my neck always goes up when

38:29

somebody says, it's not my job.

38:31

You know, it may not be

38:33

your job specifically to do that

38:35

specific care, but it is your

38:37

job to facilitate it if that

38:39

patient comes in and there's always

38:41

something you can do and help

38:44

them with. And that doesn't necessarily

38:46

mean you're going to be doing

38:48

that specific care. But like you

38:50

said, a warm handoff to make

38:52

sure that the people do get

38:54

the care they need. And one

38:56

of the things that... bothers me

38:58

sometimes about fellow emergency physicians is

39:00

that they do think that they're

39:02

only there for emergencies and I

39:04

view it slightly different. I think

39:06

we're there to assess everyone to

39:08

see if they have an emergency

39:10

and to pick the signal out

39:12

of the noise and that's where

39:14

our skill set is and the

39:16

patient defines whether they think this

39:18

is urgent or emergent and needs

39:20

to come in and I'm happy

39:22

that most of the time it

39:24

isn't. And then I can refer

39:26

them on to the appropriate individual

39:28

that can take care of them.

39:30

So we've heard about this new

39:32

mission and vision, Jenny. Can you

39:34

give me a little bit more

39:36

about the strategies that will be

39:38

used in feminine to achieve the

39:40

goals that they're trying to achieve

39:42

with this new mission and vision?

39:44

I think the really specific change

39:46

that people are going to see

39:48

within feminine is... a model that

39:50

now includes a lot more actual

39:52

CME content and actual protocols. And

39:54

this can be a place that

39:56

you can come for, even, you

39:58

know, tip of the finger knowledge.

40:00

on shift. Famnam didn't used to

40:02

have that kind of clinical focus.

40:04

It had much more of this

40:06

professional development focus. And I think

40:09

now this is going to be

40:11

a website and a resource that

40:13

people use on shift to get

40:15

access to information that they need,

40:17

as well as off shift to

40:19

get continuing medical education in this

40:22

area of medical care. I think

40:24

this brings up the next question very

40:26

nicely Ken. Okay, so number three, see

40:28

how she directed me there. So number

40:30

three is addressing reproductive health care challenges.

40:32

One of the standout components, because we've

40:34

been talking about some of the key

40:36

changes and stuff, one of the standout

40:38

components of this relaunch of feminine. is

40:40

the focus on reproductive health care

40:43

emergencies. So I'm looking for you

40:45

to elaborate on the evidence-based protocols

40:47

and resources feminine 2.0 plans to

40:50

implement and how they will impact

40:52

patient outcomes. So the reason why

40:54

I wanted to bridge those two conversations

40:57

is that a lot of the the

40:59

evidence-based protocols that we're going to talk

41:01

about. Some people sit without the outside

41:03

of the wheelhouse of what they traditionally

41:05

thought was their job in emergency medicine.

41:08

So for the last six or eight

41:10

months, I was consulting for an organization

41:12

called Access Bridge, so was Esther. And

41:14

so we have been working with

41:16

a team to work on these

41:18

protocols that basically create a diagnostic

41:20

algorithm around the evidence-based care for

41:23

patients having reproductive health care emergencies

41:25

specifically in the first trimester. So

41:27

thinking about things like ectopic pregnancy

41:29

decision making or management of a

41:31

miscarriage, but also putting into context

41:33

some of the changing landscape of access

41:35

and opportunity that patients may have in

41:38

states with new restrictions on abortion access,

41:40

which again, plenty of people will tell

41:42

us. that abortion restrictions have nothing to

41:44

do with decision making around miscarriage management.

41:46

And then I will remind them that

41:48

three of the articles we heard from

41:50

Pro Public of this year were women

41:52

who were having miscarriages who died because

41:54

the care they needed was not delivered

41:56

and the state they lived in had

41:59

an abortion ban. can tell me

42:01

that correlation is not causation and

42:03

this time I'm going to say

42:05

you're wrong because in states that

42:07

are restricting abortion access we are

42:10

seeing collateral damage to patients around

42:12

the delivery of care in non-elective

42:14

terminations in places like that are

42:16

the diagnostic decision-making and treatment for

42:18

ectopic pregnancies or miscarriages and the

42:21

protocols that we've developed will help

42:23

neutralize the concern that you're making

42:25

a decision in a moment for

42:27

a patient rather than following best

42:30

practices. So we've scored the evidence

42:32

of the articles around, let's say,

42:34

decision-making on a topic pregnancy. And

42:36

we know that the decision-making on

42:38

a topic pregnancy when informed by

42:41

the patient's condition and ultrasound findings

42:43

and the beta HCG level can...

42:45

present a opportunity to advise the

42:47

patient on whether or not they

42:50

want to have methotrexate for a

42:52

obvious ectopic pregnancy without a fetal

42:54

pole or maybe a presumed ectopic

42:56

pregnancy with a beta HCG that's

42:59

high enough to make that decision.

43:01

But most importantly that a physician

43:03

in a state where they are

43:05

concerned that they have to have

43:07

diagnostic certainty, they can then look

43:10

at the protocol and say actually.

43:12

This is my ultrasound, this is

43:14

my patient, this is my beta

43:16

HCG, this is my path, I'm

43:19

calling GYN and I am having

43:21

a conversation about, you know, offering

43:23

this patient methotrexate because their beta

43:25

HCG is 4,000 and my ultrasound

43:28

officially does not show an interuter

43:30

in pregnancy. Those protocols are are

43:32

very central to empowering physicians to

43:34

practice evidence-based medicine when there are

43:36

lots of noise around them and

43:39

concern that they may be criminalized

43:41

or charged with a crime or

43:43

even questioned after the fact. And

43:45

that's one of the things that

43:48

for us, we are reminding emergency

43:50

physicians that even though you may

43:52

not yourself be seeing this practice

43:54

change in your ER on the

43:56

day you worked, the field is

43:59

saying that there are issues. Estrand

44:01

I did some research on this

44:03

and found that emergency medicine physicians

44:05

across the country were changing their

44:08

practice around ectopic pregnancy decision-making to

44:10

be more certain to have another ultrasound

44:12

to have a higher beta HCG in

44:14

order to go down that diet the

44:17

treatment algorithm for ectopic pregnancy and the

44:19

same thing is obviously true for miscarriage

44:21

management to ensure that patients are getting

44:24

the best evidence in 2018. the American

44:26

College of Obstetricians and

44:29

Gynecologists. Again, we think the

44:31

Canadian College probably says the same thing,

44:33

but I can't speak for the

44:35

Canadians, but ACOG put out

44:37

its best practices policy statement,

44:39

which says that patients should

44:41

be offered medication management. which

44:43

includes Miffa Pristone for miscarriage

44:45

2018. This is prior to

44:47

the Dobbs decision, it has

44:49

nothing to do with the

44:51

elective termination of pregnancy, and

44:53

yet we're seeing states like

44:55

Louisiana change access and availability

44:58

to Miffa Pristone, and that

45:00

changes whether or not a physician feels

45:02

comfortable necessarily writing that

45:04

prescription, again, having nothing

45:07

to do with electraformation.

45:09

So. we will provide resources to

45:11

teach physicians how to have myfopristone

45:13

on formulary and how to be

45:15

certified to prescribe myfopristone

45:17

for miscarriage. Again, in other states

45:19

like in New York and California

45:22

and Oregon where Esther and I

45:24

practice in work, you may decide

45:26

as a provider to understand more

45:28

about medication abortion administration and your

45:31

emergency department and that is an opportunity

45:33

that people should have. We're seeing very

45:35

successful data come out of California. Another

45:37

one of our teammates, if you will,

45:40

in the work we did at Access Bridge,

45:42

Monica Sixenna published very successful data showing

45:44

that you can prescribe Mifurpristone

45:46

from the emergency department for

45:48

the elective termination of a

45:50

pregnancy and have really success in

45:52

patient outcomes insofar as the patient is

45:55

getting the care that they're looking for.

45:57

And as physicians who take care of whole

45:59

patients. and really try to deliver patient-centered

46:01

care that is equitable and accessible. It's

46:04

really important that we create access points

46:06

for all care across the board, but

46:08

it is. And it's foundation important

46:10

that we as emergency physicians know how

46:13

to take best care of our patients.

46:15

And when the system is falling

46:17

apart around us, and that system could

46:19

be as simple as decreased number of

46:22

OBGY plans in your community, changes

46:24

in access in community pharmacies, patients losing

46:26

access to insurance because your state

46:28

Medicaid laws are changing under federal government

46:30

changes. Like there's a lot of things

46:33

that are about to happen. again,

46:35

in the United States patient access, that

46:37

we as emergency physicians will be holding

46:39

the ball, if you will, you

46:42

know, Esther. That's, yeah. And that's why

46:44

we can't sit back and say let

46:46

it all play out with Obie

46:48

Guines or out in the community, because

46:51

it's hard to imagine a circumstance in

46:53

which it doesn't start to impact

46:55

our care. I mean, I think over

46:57

the past decade, there was a recent

47:00

Jama paper that said over the

47:02

past decade. something like 500 rural hospitals,

47:04

predominantly rural hospitals lost their maternal

47:06

care presence, meaning that where does that

47:08

care fall then? So you lost your

47:11

person and your department in the

47:13

hospital that you're going to call with

47:15

some of these maternal reproductive care emergencies

47:17

and so more falls to the

47:19

emergency department. We're seeing that trainees are

47:22

making different decisions about where they train

47:24

and where they stay after training

47:26

and that is. widening the maternal care

47:28

gaps that are already quite wide across

47:31

the country, where it is back

47:33

careful, back to the emergency department. It

47:35

means that we have fewer closed follow-up

47:37

options and we just want to

47:39

discharge and have them follow-up, and it

47:42

means that people will bounce back

47:44

to us instead of going to an

47:46

accessible clinic in their community. And so

47:48

there is no circumstance where we

47:50

can dodge these kind of issues, and

47:53

so we can either face it and

47:55

prepare, or we can have some

47:57

really bad shifts in the emergency department.

47:59

and then to where we're reliable for

48:02

poor care. And we talk about this

48:04

a lot, like it's the same,

48:06

like contraception initiation, right? Again, this

48:08

is something that sounds, you know,

48:10

we get a lot of pushback

48:12

when we have this conversation socially

48:14

about whether or not contraception should

48:16

be initiated in the emergency department.

48:18

And look, there's over the counter

48:20

contraception contraception. We do not talk

48:22

about motrin initiation has shown us

48:25

that this kind of. this medication,

48:27

it is available without a prescription.

48:29

So let's kind of talk about

48:31

our barriers to access. But having

48:33

just the conversation about whether or not

48:35

a patient wants to be pregnant or

48:37

wants to know more about contraception, plenty

48:39

of people take contraception and use contraception

48:42

not just to avoid pregnancy, right? But

48:44

it is really important and Esther and

48:46

I have talked a lot about. you

48:48

know, she'll text me after a shift

48:50

and be like, guess what I did

48:53

yesterday? You know, it's patients that are

48:55

ours, like it's patients that are undamissiled,

48:57

right, who want to be on contraception,

48:59

but they want to be on long

49:01

acting contraception because they know that getting

49:04

pregnant as a person without a home

49:06

is a not great plan and they

49:08

want to be empowered to, you know,

49:10

whatever it is, and being able to

49:13

offer them long acting contraception contraception in

49:15

the ED. is a, I mean, I don't think it's a

49:17

miracle, but it's a big deal. I mean,

49:19

Esther, do you want to speak to that?

49:21

I mean, no, I think it's true. Again, I mean,

49:23

a lot of people will say, and we

49:25

just did a survey study of clinician

49:28

attitudes towards something like contraception

49:30

provision or counseling and emergency

49:33

department, and it's a survey

49:35

because we need to ask people how

49:37

they feel, because this would be an

49:39

extension of the care we provide. And

49:42

there's certainly a lot of comments like.

49:44

This is not in our wheelhouse. Can't we send

49:46

them to primary care? Which they don't have, by

49:48

the way. And why do we need to ever

49:50

expand what emergency medicine does? But the problem is

49:53

everybody in the system is saying it's not their

49:55

issue. So talking with a colleague in Obie Guine

49:57

here, she's like, you know, the number of people.

50:00

We see who have been for 10

50:02

or 15 years on a teratogenic medication

50:04

without their prescribing physician ever talking to

50:06

them about what their plan is for

50:08

if they want to get pregnant, when

50:10

they want to get pregnant, what birth

50:13

control are on? And they are unaware.

50:15

No one has had this conversation. Do

50:17

you know that if you get pregnant

50:19

on this medication you need to stop

50:21

it? And it may be critical for

50:23

you to control your symptoms of whatever

50:26

rheumatologic disease they have, or you should

50:28

be on a contraception straight through, and

50:30

nobody has had that conversation. And you

50:32

know, for OB down, they're like, okay,

50:34

so their primary care wasn't having that

50:36

conversation. The rheumatologist is not having that

50:39

conversation. They don't have a women's health

50:41

provider, and they're showing up in your

50:43

ED, like who here can help us.

50:45

no more than a few minutes to

50:47

address. I mean, we, you know, I

50:49

think it's very obvious to care providers

50:52

that we are a source of medication

50:54

refills, right? I mean, that's not a

50:56

surprise. I'm sure that happens in, I

50:58

assume it's not a US problem, but

51:00

it also happens in Canada. They may

51:02

come in for something else and then

51:04

say, I also need some medical med

51:07

refills because I've run out and I'm

51:09

not going to see my primary care

51:11

for several months. And we generally like

51:13

refill those as a matter of those

51:15

as a matter of course. But we

51:17

carve a hole around contraception because we

51:20

feel like, oh, that needs a specialist.

51:22

When actually it has, it's a very

51:24

common and safe medication that's way more

51:26

common than the alternative, which is an

51:28

unplanned pregnancy. And yet we feel like

51:30

there's some special magic that needs to

51:33

happen in an opium clinic six months

51:35

from now. It doesn't make sense. It's

51:37

very interesting how we'll have these over-the-counter

51:39

medicines, like you were saying ibuprofen, and

51:41

talking about those types of things. you

51:43

know, we don't have those, oh, we've

51:46

got to have an informed consent decision,

51:48

whatever, and yet we shy away from

51:50

anything involving sex. And maybe that's the

51:52

difference. Maybe that's the correlation, Dara. Yes,

51:54

sex, gender, and all of it. And

51:56

I think that, I guess, these six.

51:59

a lot of this and saying, this

52:01

is health care. And that's why it's

52:03

an important thing for us to

52:05

address as evidence-based people, at people

52:07

who practice evidence-based medicine, let's kind

52:09

of incorporate that into our care

52:12

and not let other people redefine

52:14

our language around it. Well, I

52:16

like that Chu brought up the whole

52:18

idea of rural practices because that's an

52:21

area that I advocate for greatly. I

52:23

grew up on an apple farm. Apples

52:25

are a doctor's kryptonite. It's supposed to

52:27

lead. keep you away, but it didn't

52:30

keep me away having four or five

52:32

thousand apple trees. I went into medicine

52:34

anyways, but this whole idea of

52:36

rural medicine and my position

52:38

is that access to care should be

52:41

based on your need, not on your

52:43

postal code. Now I can translate that

52:45

for our American listeners, not based on

52:48

your zip code. So your zip code

52:50

shouldn't determine your access to care that

52:52

is necessary, right? And everybody should have

52:55

timely access and appropriate access to emergency

52:57

care. And that doesn't mean we have

52:59

a neurosurge in every rural town, but

53:02

we should have the setup that those

53:04

people can be assessed, stabilized, treated, and

53:06

transferred appropriately to definitive level of care

53:09

that may be outside the scope of

53:11

what can be done in a rural.

53:13

facility. And for you, Dara, when it

53:15

talks, when you talk about evidence-based medicine,

53:17

you know, it is hard to practice

53:19

medicine. The practice of medicine is

53:21

difficult, and the evidence-based medicine model

53:24

looks for the best evidence, which

53:26

means the least biased. So we're

53:28

looking for the best evidence, the

53:31

best literature, but we apply our

53:33

clinical judgment. And then, of course,

53:35

we ask the patients about their

53:37

values and preferences, and that's that

53:39

then diagram of the three pillars.

53:41

is politics and that would just

53:43

make it so much more complicated.

53:45

It's already very complicated, but that

53:47

adds a whole other layer. So

53:50

I'd really like just to get

53:52

back to that ethos, that philosophy

53:54

of evidence-based medicine and giving patients

53:56

the best care based on the

53:58

best evidence. Jenny back in... question

54:00

one you were talking about you

54:02

know key changes and inviting and

54:05

engaging with patients and women about

54:07

their health care and that was

54:09

a going to be a key

54:11

change with the relaunch of feminine

54:14

what's the impact that you think

54:16

that this will have with regards

54:18

to the patient outcomes when addressing

54:20

reproductive health care? Well I think

54:23

the Chu, who is on this

54:25

call, Chu is going to be

54:27

the one who's probably going to

54:29

do all the research who tells

54:32

us exactly what impact this has,

54:34

because that's her wheelhouse. But, you

54:36

know, in short, Ken, people are

54:38

dying. You know, you've heard stories

54:41

today about patients who are dying

54:43

in our emergency departments, in our

54:45

wards, because care is not happening

54:47

at home, because they're scared to

54:49

get the care that they need.

54:52

And that is unacceptable. It is

54:54

absolutely unacceptable. People are literally dying

54:56

for health care. For health care.

54:58

Right. For care that is not

55:01

hard and not complicated and not

55:03

controversial, it shouldn't be. Well, the

55:05

health care component part of it

55:07

isn't. Right. The medicine, the thing

55:10

that a doctor and a nurse

55:12

can do for a patient is

55:14

not. that is the impact and

55:16

and she will study it at

55:19

length I'm sure and give us

55:21

all the numbers but the main

55:23

thing is that nobody should be

55:25

dying for this. But we need

55:28

to keep moving along here and

55:30

so we're coming up to number

55:32

four and this one's an important

55:34

one this is about mentorship and

55:36

career development and I have to

55:39

tell you mentors were very important

55:41

to me and I'm sure you

55:43

had many mentors but when we're

55:45

talking about mentors for me and

55:48

education and leadership You know, the

55:50

legend of emergency medicine is Diane

55:52

Brumbomer. Dr. Brumbomer is just a

55:54

rock star who has helped me

55:57

out so much as an educator.

55:59

And I see that mentorship

56:01

and career development, you know, it's

56:04

always been a cornerstone of the

56:06

feminine, but I want to know

56:08

how new mentorship programs are going

56:10

to be designed to support women

56:12

in emergency medicine and what role

56:14

do they play in addressing issues

56:17

like burnout or moral injury and

56:19

also career development. Cheer,

56:21

you got to break some news here. Can I,

56:23

can I talk about it? I mean, I think

56:25

you can. It's

56:32

just funny to us that you

56:34

mentioned Diane because she will

56:36

be serving on the board

56:38

of directors of feminine and

56:40

because she is the legendary

56:42

mentor to countless people in

56:44

emergency medicine. She will be so influential

56:46

in how we develop this out for

56:48

many years to come. I mean, because

56:50

as you say, we're now changing as

56:52

an organization. I think some of this,

56:54

I mean, we know what we want

56:56

to do right now, but some of

56:58

this will evolve for the new times

57:01

and we really have to think about

57:03

what does mentorship mean in this new

57:05

era and how do we best support

57:07

people in doing very specific things and

57:09

implementing new models of care where they

57:11

are. And I think what you need

57:13

really depends on, it is like, you know,

57:15

kind of this big. and mentor model and

57:17

will lean on Diane a lot for

57:19

that and how we build community across

57:21

and gross across. our whole membership, but

57:23

mentorship in this area is a funny

57:25

thing because the best mentor to you

57:27

may be the closest person who practices

57:29

in a similar practice setting. And some

57:31

of those connections are not obvious. For

57:33

example, you can practice in the same

57:35

state and you have three other friends

57:37

who are interested in advanced and reproductive

57:39

care, but one of you works at

57:41

the VA Medical Center, you know, the

57:43

government run medical center, one of you

57:45

works in a public county hospital, and

57:48

one of you works in a Catholic

57:50

hospital. And the challenges that you face...

57:52

and the limits of what you can

57:54

do and the language you need to

57:56

learn and need to use and the

57:58

allies that you need. to implement care

58:01

changes are completely different. And so

58:03

we're really thinking about who is

58:05

the best person to meet your

58:07

needs institutionally when you're trying to

58:09

advance some of these topics and

58:12

have faced the same hardships you

58:14

have. And so that's part of

58:16

the exciting thing about feminine 2.0

58:18

is that we're, we've got a

58:21

lot of challenges and exciting challenges

58:23

and opportunities to try to match

58:25

people with the support they need.

58:27

And I think that one of the,

58:29

One of the things that we learned

58:32

last time and also one of the

58:34

things we're investing in is this kind

58:36

of deep broad and personalizable connectedness in

58:38

emergency medicine for people. I think that,

58:40

you know, again, if you are really

58:43

honest about where we are as a

58:45

specialty from five years ago, the level

58:47

of moral injury we have survived is

58:49

overwhelming. And it's not getting better every

58:51

day at all. And I don't even

58:54

know who's trying to make it better.

58:56

I think that a lot of our

58:58

clinical practice environments are with boarding and,

59:00

you know, violence and, you know, resource

59:02

issues not related to reproductive health care.

59:05

I mean, obviously, if you add in

59:07

legislative overreach to that, it's even worse.

59:09

But if you are just practicing emergency

59:11

medicine in a rural New York City

59:13

hospital, I mean, at an urban New

59:16

York City hospital like I am, you

59:18

know, it's not always that great. You

59:20

know, it's like, you know, Esther and

59:22

I talk about, compare notes about how

59:24

many patients were being held or how

59:27

much boarding there was or you know

59:29

how many patients you know stayed for

59:31

what period of time and we're hearing

59:33

this across the border from all emergency

59:36

professional you know emergency medicine providers regardless

59:38

of where they work and so I

59:40

think that there's a lot of the

59:42

practice of emergency medicine again that it's

59:44

not only related to women in medicine

59:47

but when you are a woman in

59:49

medicine and you are balancing so many

59:51

different things and you are thinking about

59:53

you know being a lead parent in

59:55

your house or all the other things

59:58

that we've balanced and you know we

1:00:00

see so many more issues now with

1:00:02

care response. is being shared amongst parents

1:00:04

because one of the benefits of the

1:00:06

pandemic, if you can say it that

1:00:09

way, is that a lot of people

1:00:11

resented their life to be more present

1:00:13

in their families. They did think about

1:00:15

what it was like to be a

1:00:17

present parent or present child or whatever

1:00:20

it is and prioritize whatever is important

1:00:22

to you. And that does require the

1:00:24

workplace to accommodate, you know, and to

1:00:26

create a flexibility that many people in

1:00:28

the world work from home, the aftermath

1:00:31

of COVID and not for us. But

1:00:33

it is a little bit for us,

1:00:35

right? How much conference is done virtually

1:00:37

now? How much, you know, how many

1:00:39

people are working from home to do

1:00:42

at least their research? There is a

1:00:44

level of acceptance that way. So I

1:00:46

guess when it comes to our mentorship

1:00:48

and career development, it will lead into

1:00:50

this new normal of emergency medicine that

1:00:53

is both worse and better and figure

1:00:55

out what does that mean for the

1:00:57

career development of? women physicians going forward,

1:00:59

again, not related to reproductive health care.

1:01:02

Although again, if you live in a

1:01:04

state as a person who can get

1:01:06

pregnant and thinking about your course as

1:01:08

a pregnant person, while you're also a

1:01:10

physician, that may inform your personal life,

1:01:13

not just your professional life as well.

1:01:15

Well, I mention how Diane Bernbomer is

1:01:17

one of my mentors and she is

1:01:19

a Legend

1:01:22

of emergency medicine. Jenny, do you

1:01:24

have any mentors? You want to

1:01:26

give a shout out too? Well,

1:01:29

I would be remiss if I

1:01:31

didn't say to Ann Burnbummer, but

1:01:33

I would also be remiss if

1:01:35

I didn't just say to other

1:01:37

people on this call. I mean,

1:01:39

it's as the not much younger,

1:01:41

but more junior in career member

1:01:43

of this team. these two women,

1:01:45

Dr. Dair Cass and Esther Chu,

1:01:47

are the two who got me

1:01:49

involved in this work in the

1:01:51

first place and have taken me

1:01:53

hand in hand through everything I've

1:01:55

learned about it and I am

1:01:57

forever grateful to them. Honestly, it's...

1:01:59

It's literally too hard to pick

1:02:01

anybody specific because, you know, I

1:02:04

have a role in resident education.

1:02:06

And so I do a lot

1:02:08

of work with just so many

1:02:10

young and enthusiastic and brilliant people. And

1:02:12

so if I started naming names, I

1:02:14

would forget names and I would just

1:02:17

feel bad. So what I want to

1:02:19

say is I have had these amazing

1:02:21

residents and I have had even just,

1:02:23

you know, one off mentorship meetings with

1:02:26

people who come to me for a

1:02:28

specific goal. One of the things I'm

1:02:30

really excited about with feminine 2.0

1:02:32

is that all of these people

1:02:34

that over the last few years

1:02:36

I have had these little relationships

1:02:38

with or longer relationships with are

1:02:40

going to find a home again

1:02:42

in a bigger tent where they're

1:02:44

going to learn from each other,

1:02:46

grow from each other, find new

1:02:49

mentors, find longer term mentorship, then

1:02:51

I have been able to provide

1:02:53

on my own while feminine was

1:02:55

on life support. this is going to

1:02:57

be a major catalyst for good and for

1:02:59

change in our specialty. I think it's really

1:03:01

smart about some of the educational

1:03:03

programs that we're putting in place too.

1:03:05

And this will lead next to your

1:03:07

next question because we're about to talk

1:03:09

about champions of change. But one thing

1:03:11

that program is doing that I think

1:03:13

is so savvy is they're not just

1:03:15

measuring what do you learn in these

1:03:18

medical student educational programs, but also

1:03:20

what impact does it have? on your

1:03:22

well-being as a professional and on

1:03:24

your burnout scores? Because obviously we're

1:03:26

one of the top burnout specialties,

1:03:28

at least here in the emergency

1:03:30

department. Is it the same? I'm

1:03:32

here in the US. Is this

1:03:34

the same in Canada? Are you

1:03:36

also the top? It's the third year in

1:03:38

a row for emergency physicians to report some

1:03:41

level of burnout. compared to all other specialties

1:03:43

and Canada is also very high. I don't

1:03:45

know if they're the number one, but you're

1:03:47

number one down in the US. We're number

1:03:49

one. Yeah, and I think a lot of

1:03:51

it has to do with our problems are

1:03:54

ones that we're told that we can do

1:03:56

nothing about. You know, at least that's what,

1:03:58

you know, constantly we're told nothing. can be

1:04:00

done about the burning issue, about the

1:04:02

boarding issue, nothing can be done about

1:04:04

the lack of resources and things like

1:04:06

that. But when we give people something

1:04:09

that is meaningful, that actually promises to

1:04:11

move the specialty and provide better care

1:04:13

for patients, what does that do to

1:04:15

that actually to your mental health and

1:04:17

to the course of your entire career?

1:04:19

That's actually the kind of ambitious goals

1:04:21

we have with our... educational programs, but

1:04:23

I'll leave that for dare to explain

1:04:25

a little bit more. Yeah, I mean,

1:04:27

you're like, we're both taking Ken's questions

1:04:30

from him. So basically we ask you,

1:04:32

Ken. Do you have any other questions

1:04:34

for us? I was just going to

1:04:36

make a comment that, you know, you

1:04:38

can't keep the world warm by setting

1:04:40

yourself on fire, and that's something I

1:04:42

had to learn. And so from a

1:04:44

burnout perspective, that was a good friend

1:04:46

of mine from the UK told me

1:04:49

that. Question number five, and this is

1:04:51

about Champions of Change, I would make

1:04:53

a friendly amendment and tell you to

1:04:55

call it Super Shiroz, but Champions of

1:04:57

Change is the program that you're going

1:04:59

to do. It's an exciting initiative targeting

1:05:01

medical students. So how do you envision

1:05:03

this program shaping the next generation, the

1:05:05

future, the people that are going to

1:05:08

be taking care of me as I

1:05:10

approach 60 here, you know, and advocate

1:05:12

for systemic change? So this actually, so

1:05:14

it's still going to be called Champions

1:05:16

of Change. We take your suggestion kindly

1:05:18

and we, it's under advisement, okay. But

1:05:20

the whole idea of this program, I

1:05:22

think, it grew out of the idea

1:05:24

that, you know, it's, and again, like,

1:05:27

it's launching January 20th, and I don't

1:05:29

know how much you know about what

1:05:31

that date will mean in the domestic

1:05:33

architecture, but here in the United States,

1:05:35

we're hitting into a time where a

1:05:37

lot of people are going to feel

1:05:39

disempowered as empowered as building future public

1:05:41

health and medical students, a lot of

1:05:43

them are going to really need a

1:05:46

place to land to think about how

1:05:48

do I understand how to make a

1:05:50

system better. And so one of our

1:05:52

colleagues, again, like there's a big team

1:05:54

in Emory, had been on the board

1:05:56

of medical students for choice for a

1:05:58

long time and knew a lot about

1:06:00

medical student, change management, but really felt

1:06:02

that there was a gap in the

1:06:05

landscape of access to teaching medical students

1:06:07

about how to be change agents at

1:06:09

their institution and what does it mean

1:06:11

to know how to change medical school,

1:06:13

a curriculum, you know, to be part

1:06:15

of policy change, to understand health systems

1:06:17

at your state level, federally, whatever it

1:06:19

is. And so she envisioned this program

1:06:21

for medical students that's a curriculum that's

1:06:24

six months long. It's open to any

1:06:26

medical student in, you know. domestically or

1:06:28

internationally inferior, although I think we're going

1:06:30

to focus on domestic to start because

1:06:32

again, you can't be everything to everyone

1:06:34

all the time, but Canadian medical students

1:06:37

we might make an exception for. That's

1:06:39

for you, Ken. But it's really, it's open

1:06:41

curriculum, it's an open program and it's basically

1:06:43

rooted in the idea that before you get

1:06:45

frustrated at the system that you cannot change, let's

1:06:47

teach you how to be an agent of change.

1:06:49

And we're going to talk a little bit about

1:06:51

reproductive health care, like that's going to be the

1:06:54

case. base that we're going to use for this

1:06:56

conversation. But it can be used on anything, right?

1:06:58

So if you find, if you're somebody that wants

1:07:00

to change public health in another way, so let's

1:07:02

say you want to be a substance use disorder,

1:07:05

or you want to worry about gun violence, or

1:07:07

if you want to talk about, you know, operations,

1:07:09

or whatever it is, you will learn those skills

1:07:11

in this. in this course and it's open to

1:07:13

medical students. It will start January 20th. It

1:07:16

will run for six months. There

1:07:18

will be a curriculum of lectures

1:07:20

that are virtual and then there

1:07:22

will be group organization and research

1:07:24

mentorship and the goal is really

1:07:26

to catch medical students before they're

1:07:28

falling and figure out if being

1:07:31

in a community of change makers

1:07:33

and learning skills that then allow

1:07:35

you to move forward with purpose

1:07:37

will. buffer the anxiety and burnout that

1:07:39

we are already seeing with both

1:07:41

medical students, obviously residents and physicians,

1:07:43

but getting to get them early.

1:07:46

So, you know, the idea of

1:07:48

a career development program that does

1:07:50

use reproductive health care knowledge as

1:07:52

its clinical case, but really is

1:07:54

about the longevity for medical students,

1:07:56

not only for women medical students,

1:07:58

for all medical students. kind

1:08:00

of exactly where we want to be

1:08:02

in feminine 2.0, right? So it was

1:08:04

this wonderful program to launch the day

1:08:06

the website goes live. So remember, feminine.org

1:08:09

will go live January 20th. It won't

1:08:11

be perfect. It's been a quick turnaround.

1:08:13

So it will have been less than

1:08:15

six weeks from the time we decided

1:08:17

to do this to time the website

1:08:19

will go live. And if you know

1:08:21

anything about website design, that's a really,

1:08:24

even just for that project, it's very

1:08:26

quick. It's very quick. But. The website

1:08:28

will go live. There will be resources

1:08:30

on it. There will be ways to

1:08:32

engage. You'll understand more about, you know,

1:08:34

how do you want to be part

1:08:37

of the group that works on programmatic

1:08:39

development? Or do you want to be

1:08:41

part of the group that works on

1:08:43

the best practices for women in medicine

1:08:45

and the employment best practices? Do you

1:08:47

want to help decide what? search criteria,

1:08:50

would you want to look for in

1:08:52

a job, right? So if you're looking

1:08:54

for a new job, would you want

1:08:56

to know more about flexible scheduling or

1:08:58

the night's policy or a differential for

1:09:00

nocturnists or the local school district or

1:09:03

maybe you want to know about the

1:09:05

night life? Like I don't want to

1:09:07

tell people what they want to know.

1:09:09

I just want to know what they

1:09:11

want to know. And so how do

1:09:13

you want to engage with this team

1:09:15

to inform the work that we're doing

1:09:18

going forward? Stay tuned, I guess, is

1:09:20

what it comes down to, because I

1:09:22

think that we're very excited to be

1:09:24

doing this. If you had asked me

1:09:26

six months ago, if this is how

1:09:28

I'd be opening 2025, true, I would

1:09:31

have told, if you had told me,

1:09:33

right, I would have said, you're crazy.

1:09:35

This is not how I expected to

1:09:37

open 2025. That's a surprise, for sure.

1:09:39

to live in interesting times. I really

1:09:41

wish there was that champions of change

1:09:44

program. When I was a medical student,

1:09:46

I could have learned so much because

1:09:48

for the longest time I'm like, oh

1:09:50

well, here's a paper, therefore, right? And

1:09:52

that's not how change happens. And I've

1:09:54

had to learn that out in the

1:09:56

field. And certainly my NBA has helped

1:09:59

me with that. I think that is

1:10:01

so important for medical students to learn

1:10:03

how to navigate the system and

1:10:05

nudge it and change it for

1:10:07

the better and for the better

1:10:09

both for the health care they're

1:10:11

providing patients but also for their

1:10:13

own longevity and practice and things

1:10:15

like that. And I'm just going

1:10:17

to come out and say it.

1:10:19

You guys. the two of you

1:10:21

have been real champions to me

1:10:23

and I've learned so much from

1:10:25

being associated with this program in

1:10:27

the periphery and you know I

1:10:29

follow the content and I listen

1:10:31

to you because you've taught me so

1:10:34

much so I really appreciate

1:10:36

it and again we really

1:10:38

we want to remind anyone

1:10:40

listening that we're getting old like I

1:10:42

mean it I'm the oldest one on

1:10:44

this call I know but like

1:10:46

you know It's really important that

1:10:49

this new, this new iteration, whatever,

1:10:51

feminine point 2.0, it has a

1:10:53

generational lift. It is bringing in

1:10:55

more voices that are younger, it

1:10:57

is inclusive, it is dynamic, it

1:10:59

is better than it was. I

1:11:01

mean, the lessons we've learned from

1:11:03

the first time are real, and

1:11:05

they're a little painful, to be honest.

1:11:07

I mean, you do the best you can,

1:11:09

and then you admit when you weren't

1:11:11

perfect. I feel like that has to

1:11:13

be part of this, like we are

1:11:16

learning too. And there are things that

1:11:18

I look back on and say, I

1:11:20

don't want to say I would have

1:11:22

moved slower, but I definitely could have,

1:11:24

there are definitely times that we could

1:11:26

have done things differently or, and so

1:11:28

I think that the gap in time

1:11:30

was good for us, right, because it

1:11:32

gave us a chance to like look

1:11:34

back and take a deep breath and

1:11:36

kind of learn from what we did.

1:11:38

And yet we're going to make mistakes

1:11:40

again. But I don't I hope nobody's looking

1:11:43

for perfection because if they are then

1:11:45

they're suffering from a potential nirvana fallacy

1:11:47

And unless it's perfect we can't do

1:11:49

it and it doesn't need to be

1:11:51

perfect It needs to be sufficient. It

1:11:53

needs to be enough and we can

1:11:55

have that iterative open mindset that we're

1:11:57

constantly changing and improving for the better

1:11:59

So I'm not going to sit there

1:12:02

and go on feminine.org on January 20th

1:12:04

and start criticizing parts of the website

1:12:06

that may not be perfect. I'm just

1:12:08

happy that you're relaunching it because it's

1:12:10

clear that feminine 2.0 is more than

1:12:13

just a relaunch. It's a movement towards

1:12:15

lasting change in our world of emergency

1:12:17

medicine and in the House of Medicine.

1:12:19

And so I really want to thank

1:12:21

you for sharing your journey with us

1:12:24

before we wrap up though. You know,

1:12:26

it's always good to have a call

1:12:28

to action at the end of something.

1:12:30

And so there's three of you. I'm

1:12:32

going to ask each one of you

1:12:35

to give me one call to action.

1:12:37

So I'll start with Dara. What's your

1:12:39

call to action? My call to action

1:12:41

is to go to the website on

1:12:43

January 20th and look at it and

1:12:46

take in what's there and feel free

1:12:48

to send us notes and feedback, sign

1:12:50

up for the newsletter again, be part

1:12:52

of the community. This only will work

1:12:54

if we do it. really just like

1:12:57

share it, amplify it, be part of

1:12:59

this, all the things because again, like,

1:13:01

the thing that's magic is the number

1:13:03

of people that have done this with

1:13:05

us in the past, that have done

1:13:08

it together in the past. Honestly, part

1:13:10

of the magic is how much of

1:13:12

it stayed alive when we stopped, right?

1:13:14

How many women in medicine organizations were

1:13:16

called to them? And how many times

1:13:19

you posted in the Facebook group? I

1:13:21

was like, Ken's still out there, Ken

1:13:23

still doing it. I'm still. you know

1:13:25

in the bureaucracy of the federal government

1:13:27

I can't do anything but on the

1:13:29

Facebook group I got a notification Ken

1:13:32

posted again and so I just want

1:13:34

to say like you know there's a

1:13:36

the energy and the vitality that we

1:13:38

gave to each other and again not

1:13:40

we like we the real royal way

1:13:43

That is the first thing that I

1:13:45

think we want to capture is bringing

1:13:47

everyone back in. We put up a

1:13:49

form randomly in one Facebook group and

1:13:51

we have like 200 people that wrote

1:13:54

in saying they want to be part

1:13:56

of whatever is going on. But that's

1:13:58

a fraction of who's out there, right?

1:14:00

So like please just like share it,

1:14:02

show it, think about it, feedback. say

1:14:05

what's missing, tell what you want to

1:14:07

do, but be part of this because

1:14:09

that's the only way that it is

1:14:11

what it needs to be, which is

1:14:13

something. Please engage as best as you

1:14:16

can. That's my big call to action.

1:14:18

Dr. Chu, what would you like to

1:14:20

see? I mean, mine will be a

1:14:22

little bit about researching data, but I

1:14:24

think we are really committed to filling

1:14:27

in the blanks for people, whether there

1:14:29

are clinical gaps, understanding about policies and

1:14:31

law, or just the scope. of what

1:14:33

we're facing. And I think, I mean,

1:14:35

from a, you know, from a policy

1:14:38

and health services landscape. So I think

1:14:40

the best thing we can ask of

1:14:42

people is their curiosity. You know, so

1:14:44

if you come to the website, take

1:14:46

a look at things or just engage

1:14:49

with this topic at all questions that

1:14:51

have to do with reproductive health care

1:14:53

and emergency medicine, simple emails. or messages

1:14:55

through the website. Those are things that

1:14:57

we really absorb and think about. And

1:15:00

it's kind of like a lot like

1:15:02

calling your Congressperson, so they know what

1:15:04

matters to their constituency. It's like every

1:15:06

message we get helps drive our mission,

1:15:08

our vision, and the work that we

1:15:11

do. So I think just any sort

1:15:13

of reach out and sharing what's on

1:15:15

your mind and what you wonder about

1:15:17

is super helpful to us. So your

1:15:19

call to action then would be to

1:15:22

be curious and then have that curiosity

1:15:24

Sent to you through the website so

1:15:26

that loud. Yes. Yes. Be curious out

1:15:28

loud not just sit there and stare

1:15:30

at your naval and say I'm really

1:15:33

curious about this How how should I

1:15:35

go about answering this question? Go to

1:15:37

the website go to feminine.org and start

1:15:39

asking questions and stuff like that and

1:15:41

Jenny. What's your call to action? I

1:15:44

think for me it would be to

1:15:46

make sure you tell your friends. I

1:15:48

think that there are women in medicine

1:15:50

groups and groups under the auspices of

1:15:52

a feminine group in emergency medicine residences

1:15:55

and medical schools all across at least

1:15:57

this country and maybe other countries. And

1:15:59

you need to spread the word that

1:16:01

things are coming back. We are back,

1:16:03

we are back with a newer, bolder,

1:16:06

broader mission statement and we want everybody

1:16:08

involved, no matter what your gender identity.

1:16:10

So you're like putting the

1:16:12

band back together and going

1:16:14

on a road tour? That is

1:16:16

exactly what it felt like on

1:16:18

our first group call. I was like,

1:16:20

the band is back together. Well,

1:16:23

it's clear to me that Faminem 2.0

1:16:25

is your fight song. Yes, it is

1:16:27

your fight song. So, um... Great, the

1:16:29

SGM will be back next episode with

1:16:32

a structured critical appraisal of a recent

1:16:34

publication. We here at the SGM will

1:16:36

continue to try to cut the KT

1:16:38

window down. That's the knowledge translation window

1:16:41

down from over 10 years to less

1:16:43

than one year using the power of

1:16:45

social media. And ultimately we want to

1:16:47

see patients get the best care based

1:16:49

on the best evidence. To finish the show,

1:16:52

and because I have three guest skeptics, I'm

1:16:54

going to ask each one of you

1:16:56

to read part. of the S gem

1:16:58

tagline. It'll go, Dara Esther Jenny.

1:17:00

You're ready? What's the tagline?

1:17:02

Remember to be skeptical of

1:17:05

anything you learn. Even if

1:17:07

you heard it on the,

1:17:09

Skeptic's Guide to Emergency Medicine.

1:17:11

Talk to everyone next week.