Sharp Conversations With Gabe Charbonneau, MD

Hello, viewers and listeners! This week's episode of Sharp Conversations is ready for you. This week we got to hear from Gabe Charbonneau, MD to discuss Medicine Forward, a grassroots physician group fighting to reclaim the soul of medicine. Gabe Charbonneau is a family medicine physician and co-founder of Medicine Forward. He joins our series to talk about how Medicine Forward is helping him and his colleagues bring joy back to medicine. Thank you for watching or listening to this episode of the Sharp Conversations! Find more episodes at anchor.fm/sharp-conversations or wherever else you get your podcasts. If you liked it, share it with your friends and family or on social media with the hashtag #SharpConvos. Let us know if you have requests on topics or who you think we should interview next!

Let’s Dive In!

Janae Sharp: Hi, I'm Janae from the Sharp Index and I'm excited to sit down for our inaugural Sharp Conversations. I'm really looking forward to this discussion because I talk to a lot of people about healthcare IT. We have a toolkit for people who want their electronic health record (EHR) to be better, because, across the board, people don't think they're fantastic. And you're both experts in both realms. So, can you introduce yourselves?  

Subha Airan-Javia, MD, FAMIA: I'm Subha. I am a hospitalist at Penn Medicine. I am also an informaticist, founder, and CEO of CareAlign, which is really a labor of love and passion over the last 15 years since I spun out of the company a few years ago. So really excited to be here and talk about these really important points and topics. 

Gabe Charbonneau, MD: I'm Gabe Charbonneau. I'm a family practice doctor in rural Montana. But I have sort of myself taken a back seat from the building tech. I think you guys both know, I have gotten into the grassroots doctors organizing. So what my main work now is, my time when I'm not practicing medicine is with Medicine Forward, which is a grassroots Physicians Network. We're working on a project for this summer, hopefully in June, collaborating with ACP on really raising awareness and disrupting what's wrong with prior authorization. 

Subha Airan-Javia, MD, FAMIA: I have a question. I would love to hear about how you started Fight Burnout and Medicine Forward? 

Gabe Charbonneau, MD: Yes. I really felt this focus on how the system is really not working. Overall, most people inside of healthcare are good people, there are a ton of really good people trying to do good work, trying to make a positive difference. I just started journaling about it and I was reflecting on my own day job and family practice, and decided that when you can't solve problems in a tactical way, what if there was a symbolic way to show that I have hope that I believe that people can overcome these things? So that's where this came from. If you've seen the shirt, it's essentially the rod of Asclepius, the rod of medicine with the snake around it being symbolic of medicine, and the people in medicine, and then a Phoenix raising that out of flames below as this symbol of hope. It also has the words 'fight burnout'. We're trying to help reverse this trend of everyone being ground into the ground from working in the EMR and feeling like they had less autonomy than ever, and that their jobs were just exhausting. Burnout started to emerge as a trend that was as really important. And I thought, "what can you do with burnout? Well, I'm going to create a symbolic gesture showing that I believe in the future of humanity, overcoming burnout", so then it becomes Fight Burnout. Also, I'll throw it in there, speaking of things I like to watch, I love Harry Potter, which I think you guys might both already know. the Phoenix imagery was partly inspired by that. 

Janae Sharp: It is a good image. That's something that actually was one of my first impressions of you, because I thought, "this is a good image, who made that?". 

Gabe Charbonneau, MD: My subconscious, I can't really take credit for it. It was like the Phoenix was more intuitive than anything. It was just something that I liked. I didn't know it was going to work. Actually, when I first made it, I just made this shirt for myself. I'm like, "I don't really care. This is important to me. I'm going to make this shirt for myself. And I'm going to make it like the nicest shirt that I can like really good material. I'm going to have it printed at this local shop that makes great shirts." because I had made one before from there and, yeah, it just blossomed into something that was bigger. But the thing that I love the most is that what started to emerge was that it felt really good to give that shirt to people. Especially if someone was doing something that I was inspired by. So here's this thing and symbolically meaningful to me, and then I can give it to someone else and say, "Hey, this is sort of like your award for being awesome." and then people loved wearing it and would like write to me about how it made them actually feel more hopeful. And I thought, "Okay, perfect. This is like super good vibes".  

Gabe Charbonneau, MD: I had a question, for Subha. If you could have anything happen, that was something that would really help you with your effort, the sky is the limit, something magical - what kind of changes would just transform things? 

Subha Airan-Javia, MD, FAMIA: I think it would be, if I was going to sum it up in one word, it would be - choice. The choice for the people who want to use our platform to be able to make that choice for themselves leads to a lot of burnout with a lot of the people, I speak to as well. I have a lot of things I want to use, I'd love to use this, I'd love to use that, but I don't get a choice. It's hard for me to make that happen. I guess the corollary to that would be alignment between IT and what clinicians are asking for. Yeah, that's a hard one. 

Gabe Charbonneau, MD: The analogy that I've been sort of obsessed with is, is the App Store ecosystem on our phones. Not just that, but also the history of how that all happened. There's a really interesting historical podcast I listened to that talked about BlackBerry, how that whole thing happened, where BlackBerry was really dominant. What smartphones were like before the iPhone, and specifically like before the App Store opened everything up. Part of it was actually this philosophy that carriers wanted to be in control of all the apps that you could have. So a lot of us don't remember what it was like when we had a phone, and it might be a smartphone, but the only things you could have on it were carrier approved. So Verizon says you can have this app, but Sprint says that app. That feels like the world that we're living in, where it's like - you brought up choice, and think about how that transformed everything when the iPhone came along. When it first came out with the App Store where you could put apps on there that wouldn't destroy everything. There's a review process, but you let people decide what they need and vote with their downloads for what was helpful. You leverage this collective interest and intelligence for what people want to need to work, versus the model that we're in right now. It's like, 'here's your one size fits all technology product, and someone that you don't know picked it for you.' It was the best of bad options, and it's not customized for anyone. 

Subha Airan-Javia, MD, FAMIA: You don't want it? You want something different, too bad. 

Gabe Charbonneau, MD: So it's kind of like that carrier lock-in. 

Subha Airan-Javia, MD, FAMIA: Interesting analogy. You tweet Simon Sinek quotes all the time. All the quotes that you've posted have always resonated with me. When I was on service, just a couple of weeks ago, I constantly found myself saying to the residents "you have to ask why - why does this person have this diagnosis? Why is this person on this medication? Why does this person still have a Foley? Do they still need this Foley?" When I looked at Simon Sinek, his first book is "Start With Why". So I started listening to it, thank you for exposing me to that. I wanted to know, what is your favorite book by him? And what draws you to his work? 

Gabe Charbonneau, MD: Okay, so I'm glad you went there. The most recent book he wrote is called "The Infinite Game" and I really liked that one. Well, at least I really like that concept. I have to be honest, I listen to more podcasts. There is one where he talked about the ideas and got more out of that than I did the book. So sorry, Simon, but I love the idea. I can share some of those, they're really great about understanding how sort of our, our cultural mindset about business is part of like, why we're stuck. And when I was reading that one, like six months earlier, I drafted this email where I just felt compelled after reading and listening to that, that I needed to write to Simon Sinek and tell him, thank you for all these things. So I wrote this big long email and I included graphs of the famous one about, how the cost of life expectancy in the United States is off the rails in the wrong direction. I wrote about that and I wrote about my concerns about what was wrong in medicine and how I appreciated what he was writing and talking about because I felt like it was so important to what we were wrestling with. Then I shared with him a picture of people wearing the Fight Burnout shirts and told him that this was this thing that I made. Then I put it in my drafts folder and never sent it because I thought “he's just going to think this is dumb, people probably email all the time. So I'm not going to send it.”. Then I just let it sit for about six months and randomly, I was looking through my email drafts, found it, and I read it. I thought, “actually, this is pretty good, what do you lose by sending it right?”. So I sent the email. and then what's really interesting is - nothing happened. I usually never checked my spam folder, but I did, I don't know why. In my spam was this response, from Simon's assistant, who said Simon loved your email and wants to set up a time to talk to you. Yeah. So we had this hour-long conversation and interview. 

Janae Sharp and Subha Airan-Javia, MD, FAMIA: That is so cool. 

Gabe Charbonneau, MD: Yeah, super cool. What his advice is for what we should do, and we're actually kind of experimenting with it. It is basically, to start creating book clubs of getting people together to think differently about leadership. He said he's seen this work in other realms, that it can kind of start off as this little thing and spread into a bigger social movement. There's a group of us that's reading, "The 15 Commitments of Conscious Leadership". Kind of going through, every two weeks, we're picking a chapter and sort of trying to hold ourselves accountable for doing the work. That's whatever the commitment is for that week. 

Janae Sharp: That is a great story.  

Subha Airan-Javia, MD, FAMIA: What are some sources of wellness in your life?  

Janae Sharp: Ah, okay, love this question. 

Gabe Charbonneau, MD: I'm going to start with a geeky answer. Oura Ring is a source of wellness in my life. I've tried so many different trackers and stuff, but the thing that I like about this one is it's helped me to realize when I'm burning the candle too hot and my patterns for doing that and when I need more recovery. The insights about recovery are really good and it's helped me to sleep better, exercise better, and know that when I'm in the clinic, going to run me into the ground. I have to be careful with how many days I do that, and that I budget some downtime afterward. It's kind of this geek data for helping me figure out how to keep my life more in balance. Another thing that not everyone knows, I work three days a week and have for 12 years. In the clinic, I work three days a week and that's an amazing life upgrade because our job is already hard enough. I've been talking to more and more people who are realizing, that's one of the ways you can make it sustainable. That control over our schedule and schedule flexibility is a top desire, and that needs to happen more. 

Subha Airan-Javia, MD, FAMIA: Just for the record three days a week still feels like full-time, it's not like you don't do anything. 

Gabe Charbonneau, MD: It's like one of the only levers that you can pull on because we've sort of mark in the sand that like four or five days is full time. With the amount of work that you do outside of seeing patients and the intensity of that work, it is full-time. 

Subha Airan-Javia, MD, FAMIA: What a paradigm shift, right? If we could make that a standard, that all of the other things that we're normally doing in the evening and night hours, and the weekend hours become day-time things just like most other jobs. It really actually has helped me have more space for human connection, which is what I want. 

Janae Sharp: I'm glad that you were able to come and share your stories. 

Gabe Charbonneau, MD: Thanks for having me, guys. This was wonderful. 

Janae Sharp: If people want to get in touch with you, or can do anything for you, what do they need to do? 

Gabe Charbonneau, MD: Go to medicineforward.org and tell all the physicians in your life who want to be part of disrupting the status quo because they know that we need a better system. Also how we need to reclaim the importance of humanity, especially the importance of trusting relationships with our patients. 

Subha Airan-Javia, MD, FAMIA: Yeah, absolutely - I'm on there. Let's bring the joy back into medicine.