How treatment of poisoning has evolved; finding trustworthy medical information online; challenges for young doctors: Upstate Medical University's HealthLink on Air for Sunday, March 20, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," this is Poison Prevention Week, and the Upstate New York Poison Center is celebrating 65 years of service:

Christine Stork, PharmD: ... what was in "Dr. Smith's Ointment?" That was the label of the product, and at that time it was not required to have the label ingredients included. So that was one of the first big roles of the poison center ...

Host Amber Smith: A medical librarian explains how to locate reliable health information online:

Librarian Olivia Tsistinas: ... going and looking online is only going to help them have a more robust conversation with their health care team ...

Host Amber Smith: And a doctor aims his podcast at early-career physicians:

Andrew Tisser, DO: ... the other issue we're seeing is actually the greatest exodus of 30- to 50-year-old physicians from the profession in the history of time, which is really concerning ...

Host Amber Smith: All that, two ways to protect your children from lead poisoning, and a visit from The Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, a medical librarian shares tips for finding credible health information online. Then we'll hear from the doctor behind the "Talk2MeDoc" podcast. But first, a look back into the 1950s, when the Upstate New York Poison Center got its start.

Christine Stork, PharmD: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." The Upstate New York Poison Center marks 65 years of service this year, and this week is National Poison Prevention Week, so I'm talking today with someone who's worked at the poison center for more than 26 years. Dr. Christine Stork is clinical director of the poison center and a professor specializing in overdose, poisoning toxicity and emergency medicine. Welcome back to "HealthLink on Air," Dr. Stork. Hi, thank you so much for having me today.

Host Amber Smith: I'd like to start with some history, because the late 1950s, when the poison center began, the times were quite a bit different than they are today. Rock'n'roll music was new. Television was becoming a popular form of entertainment. The babies born when World War II ended were growing into teenagers. So what about this era made it the right time to start a poison center?

Christine Stork, PharmD: Well, a couple of things happened. In the 1950s, not much was known about poisoning, but then a study came out showing a large amount of morbidity and mortality (sickness and death) related to unintentional poisoning in children. So as a result of that, people started being concerned about toxicology. Kind of at the same time, just as background, there were a lot of babies being born and also kind of an industrial revolution. So a lot of new products were available in the home, a lot of new pharmaceuticals. And remember, way back in the 1930s was when our first medications became available. There really weren't a lot of pharmaceutical products, or products over the counter, before that time. So there was just a big upsurge in things being available to the public, as well as a lot of kind of small children available at the same time.

Host Amber Smith: Was there much scientific knowledge at that time about what happened when someone ingested something that was poisonous?

Christine Stork, PharmD: No, there really wasn't. If you go back and look at the first toxicology textbooks, they're rather thin, and they've grown exponentially over time. So there wasn't much known. There was not much known, sometimes, about the products themselves. You know, what was in "Dr. Smith's Ointment"? That was the label of the product, and at that time it was not required to have the label ingredients included. So that was one of the first big roles of the poison center during that time.

Host Amber Smith: How were overdoses treated?

Christine Stork, PharmD: I think rather supportively. If you go back and look at some of the literature there wasn't, again, a lot of information about antidotes. There weren't a lot of antidotes. That wasn't a lot of information as to best practices. So people just did what they thought they should do. If you go back and look, you'll see literature of using opposite things to try to manage poisonings. A good example is phenobarbital was available way back then, and that causes sedation and eventually can cause people to stop breathing. So during that time, people tried to give stimulant medication to try to mitigate that. And in fact, they realized that that did not work or change the mortality scene after overdose of phenobarbital. So they kind of evolved over that time, and with the advent of the endotracheal tube, which is a breathing tube, which also was not available, if you think about in the early 1900s, they found that mortality instead of being 35% for something like phenobarbital was less than 5%. So, a lot of evolving medical practice, as well as medications, during this time.

Host Amber Smith: When did child-safe caps get introduced? And I wonder, did that have a big impact?

Christine Stork, PharmD: So, yes. I cannot remember the exact year that they came out, but if you look at the poison center deaths from aspirin, in particular, there was lots of aspirin being used during this time. It was prior to the worrying about Reye's syndrome, so a lot of people used aspirin for pain. It was THE pain medication. It was available in homes, and lots of children died. And that was the reason or the impetus behind safety caps. And once that happened, you know, now we have very few exposures in children to aspirin. So safety caps were a huge public health gesture and improved the wellness of children after their implementation.

We see something similar, a little bit more recently, in the 1990s, with blister packing of iron. Iron was also a big problem in children, causing morbidity and mortality. Even though they were in safety caps, many times there was enough to kill a child within a prescription bottle. So if it was left open, it was a very small dose required. And once they were put into blister packs, we didn't see a tremendous amount of morbidity, even, with iron, much less mortality.

Host Amber Smith: Well, I want to ask you what you can tell us about what the poison center was like when it started. And I know you weren't there when it started. Have you talked with anyone or looked historically? Was it in the hospital?

Christine Stork, PharmD: I know when it first started, it was part of the Onondaga County Department of Health. So that's how it was initiated. Its funding was rather shoestring, and the entire role of poison centers during that time in the 1950s was more of a pediatrician-to-pediatrician service, because these pediatricians would be called about a child getting into a substance. They didn't know what was in the substance. So they would call the poison center, a pediatrician group, which then they went on to hire some people to help with that who looked up the ingredients on these cards. So there was like a microfiche and index card system that was the first databasing of what was contained in products. And that was the main role and what poison centers did during that time.

Host Amber Smith: Was it 24 hours?

Christine Stork, PharmD: I don't know for sure, but I do not believe so, because then later on, when the poison center was staffed with nurses in -- I want to say the 1970s, 1980s -- it was located outside of Upstate's pediatric emergency department. So it was right in the emergency department in kind of like a little closet area. And during the day, the nurses would, again, provide that information, provide a little bit more management.During the overnight hours, the nurses and doctors in the emergency department would pick up that phone.

Host Amber Smith: If I hear you correctly, it started more for physicians to kind of share information among themselves. And today it's, well, physicians can still call for consults, but you get a lot of calls from the public, right?

Christine Stork, PharmD: Yes. It's been an evolution. I think during the 1970s and 1980s, it was largely the public calling. And in late '80s and into the '90s and through today, we're seeing a larger and larger component of health care professionals calling for advice from the poison center. Things have evolved continuously in terms of complexity of toxins and knowledge on how to treat poisonings and even the health care professionals, many of which don't receive specific training in poisoning and toxicology. So as of today, we're about 60/40. We still get 60% of our calls from the home setting, from parents, but 30 to 40% of our call volume is from health care professionals.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Christine Stork. She's the clinical director of the Upstate New York Poison Center and a professor whose specialty is overdose, poisoning, toxicity and emergency medicine. And I want to let listeners know they can reach the poison center at 1-800-222-1222

So what percent of the calls to the poison center today are focused on children?

Christine Stork, PharmD: It depends on how you define children. So we still get about 60% of our calls from the home setting. Of those, a large majority are for children. Mostly, again, toddler children. We do get calls from the home about adolescents and older children. In the hospital setting, historically, I would say in the past five to 10 years, we're moving toward a much higher percentage of calls about adolescents. Adolescent self-harm has gone up dramatically in the past 10 years, if you look at some of the data out there. So while we were called, mostly, from, health care professionals about adults in the past, that's been inching down into the adolescent age group.

Host Amber Smith: Interesting. What are the most common items that you get called for, from homes, about toddler accidental ingestions?

Christine Stork, PharmD: The most common things that we get called about are cleaning supplies, cosmetic agents, things like silica gel, so shoe desiccants is a very popular call to the poison center as well. So, things that you find around the home, things that if you have a toddler in your house, and you turn your head for a minute, they grab: toothpaste, all those sorts of things, cleaning agents. We do get calls about prescription medications and over-the-counter medications, but they're not the majority of calls that we get.

Host Amber Smith: Well, I understand some of the most common poisoning emergencies today involve analgesics (pain relievers) and antidepressants. Is that because of the prevalence of those medicines in homes?

Christine Stork, PharmD: You know, I think there's two things involved. Now, the prevalence of having analgesics in the home that are over the counter probably accounts for the large exposures to analgesics, both in unintentional exposures as well as intentional self-harm. You know, people who are depressed or anxious who are on antidepressants have access to those agents. So that is likely the cause, although not studied real well as to why those people have exposures to those agents.

Host Amber Smith: Well, it seems like the poison center sometimes functions as an early warning system. I'm thinking about the alerts from the poison center when the colorful laundry detergent pods came onto the market and children would put them in their mouths, the poison center was pointing out that that can be harmful. Sometimes we'll hear about batches of illegal drugs that are found to contain really potent chemicals like fentanyl. Do you see the role of the poison center to inform society, in general, about things that could be dangerous?

Christine Stork, PharmD: Yes. I think in recent years, the role of the poison center in public health has increased dramatically. I'm not sure that everyone is aware that every time someone calls the poison center, the data -- meaning the exposure and the symptoms, not the patient-identifying data, but the exposure and the symptoms -- is auto-uploaded to the National Poison Data System every eight minutes. So to identify trends and problems that are occurring in real time is a big role of poison centers. If an alert occurs due to that -- so we have anomaly monitors to look for strange things in our call volume -- those are set to trip the public health messaging, or an evaluation. So that occurs with our National Poison Data System. We do that in conjunction with the Centers for Disease Control and also our state and local departments of health. So things like laundry pods, yes, are identified through that system.

When, if you think back several years ago, we had a spike or spice (synthetic marijuana) exposure. So in April on a Tuesday morning, we got an anomaly alert that we had a significant increase in calls with regard to that from healthcare facilities. So that is an example of identifying a public health issue. So in response to that, in terms of public health, we will send out alerts. We'll tell people what to watch for. We'll tell people what we think is going on. We'll do that within the public, so if many of you may have heard some of those things, the poison center says to watch out, for example, or we'll also talk to the health care facilities, provide them some management expertise. In that one, I remember a lot of prehospital communications because some of those patients were rather agitated, and it was a problem for the prehospital individuals.

I know now we're looking at, or we're concerned about, edible marijuana, within New York state with its legality, that has increased in pediatric patients. So we'll see whether that has gone up dramatically. It has already gone up without it being sold or regulated to be sold yet. So we're looking to see if that becomes a bigger problem, but we want , parents and caregivers to know that that could be a problem for children, in particular.

Host Amber Smith: Well, I know the word poison is in your name, but do you hear from people who have questions about the prescription they got, you know, maybe they picked it up from the pharmacy and they got home and, you know, they forgot to ask about how to take it or what not to take with it. Do you get those calls too?

Christine Stork, PharmD: Yeah, we do. If you look at poison in the broader context, everything is a poison. It's the dose that defines the poison. So when you think about the types of calls we get, I know we've been talking about prescription drug overdoses, but also, a double dose, a drug interaction and adverse drug reaction, someone who has an organ toxicity due to taking their medication, someone who smells something in their environment, carbon monoxide, bites, stings, something got into their eye. There's a whole host of things that are considered poisons. So where we're not just there for people who toddlers get into things are intentional self harm cases. Anything that can cause toxicity to humans are things that we would get involved with.

Host Amber Smith: Do you have any predictions for how the poison center or the field of toxicology is likely to evolve over the next 65 years?

Christine Stork, PharmD: What I can say is that it will. I'm sure that will be nothing like it is today in 65 years, because the knowledge base and how we do business is changing. I think more recently you'll see things like being able to text the poison center, or being able to have a web based interaction with the poison center. I see that coming in the next maybe two or three years, which would be really interesting to see how that pans out, especially for people who like to use electronics to interact with people. I think that'll be a great thing and an advantage. But with the evolution of things that are out there, exposures that we have, kind of subdivisions of specialties within toxicology. I think all of that will look different and certainly in the next 65 years.

Host Amber Smith: I appreciate you making time for this interview, Dr. Stork.

Christine Stork, PharmD: Thank you very much for having me again.

Host Amber Smith: My guest has been Dr. Christine Stork, a professor and clinical director at the Upstate New York Poison Center. And I want to let listeners know they can reach the poison center at 1 800 222 1222. I'm Amber Smith for Upstate's "HealthLink on Air."

Where to find medical information you can trust -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Where can a person find reliable health information online? With me today to help answer this question is Olivia Tsistinas. She's an associate librarian at the Health Sciences Library at Upstate. Welcome to "HealthLink on AIr," Olivia..

Librarian Olivia Tsistinas: Hi there. Amber, I'm happy to be here.

Host Amber Smith: Now, I know it can be intimidating for someone who has maybe a new diagnosis or a new condition to go online and try to find information about it, especially if this person is not used to doing research. So, where do you advise people to begin?

Librarian Olivia Tsistinas: Well, the first thing that you're doing right, is going and taking a look to see what's out there.

I want all of our listeners to know that going and looking online is only going to help them have a more robust conversation with their health care team. So, just congratulate yourself on wanting to go and look in the first place. Once you get, and you're looking at, that search-engine box, there is a lot of results, and it can be really overwhelming.

One of my favorite places to have people start is MedlinePlus. It comes from the National Institutes of Health and the National Library of Medicine. It's got a lot of wonderful, verified sources, and it's really easy to use.

Host Amber Smith: And it's free?

Librarian Olivia Tsistinas: It is free; it is accessible. And the really neat thing about them is that they link to other professional organizations.

They're not creating their own independent content. So they're really finding some of the best of the best.

Host Amber Smith: So, MedlinePlus, and that's a government website, essentially.

Librarian Olivia Tsistinas: It is a "dot-gov" (written as .gov), and so one of the wonderful cues that you can get from some of those web addresses is who's producing them. Anything with the dot-gov address, you know that you're getting it through the National Library of Medicine, National Institutes of Health, and it's going to be verified and credible. There aren't any commercial interests involved in the production of that.

Host Amber Smith: Now, what else can you tell us about URLs (website addresses)? Because a dot-gov is one, but there's dot-edu, there's dot-org, there's dot-com....

Librarian Olivia Tsistinas: If it's dot-edu, then it's coming from a school. So, if you went to the Health Sciences Library website, our Upstate Health Sciences Library website is library-dot-Upstate-dot-edu (library.upstate.edu). So, you know it's coming from university. If it's a dot-org, that's coming from an organization.

And that one can be really tricky. Maybe a decade ago or two decades ago, you'd know that that information was going to be from a smaller organization or from a national organization. And now it's a lot more easy for folks to get a hold of that URL. So that one -- proceed with caution.

If it's a dot-com, all bets are off. It's not really clear if it's commercial interest: It could be a pharmaceutical company, it could be someone that's just interested in separating you from your money.

Host Amber Smith: So what you're saying is I really need to figure out which websites are trustworthy. And one way to kind of start doing that is looking at the web address or the URL.

How else can I determine the purpose behind a particular website?

Librarian Olivia Tsistinas: That's an amazing thing to do. One of the best things to do is to scroll all the way down to the bottom of the page and figure out who created the page. Find the "about us," find when it was published. Is it a recent website? Is it a website that hasn't been touched in over a decade?

Once you get to that "about us" page, figure out who they are and why they're providing that information to you. Again, are they interested in selling you a new drug that they've created? Are they a support group that's interested in supporting its members, or is it really unclear? Sometimes you can get to the bottom of the page, and there's just a lot of words and not a lot of answers about exactly who the folks are that created it.

Host Amber Smith: And the articles on there, in addition, do the articles need to be sourced with the name of the author or the reviewer?

Librarian Olivia Tsistinas: Having an author is really important. If you can find an author right out and then identify what that author's credentials are, then you're really cooking with gas. You've got to be able to figure out what their education is, what their experiences (are) and why they are capable of producing this information for you. Recency is important. So we mentioned, you know, has the article been touched in the last 10 years? Was it published in the last five years, or is it something that is being touted in the news as a new discovery, but actually came out a while ago? The other thing that you can look at when you're looking at a website is what sponsorship is, and if they're asking for money to see more information, if they're trying to get you to give up your information to have access. Do they want your email address? Do they want your name? Do they want your credit card information? And that's all a really great opportunity to take a pause and think about some of the other resources that you have available to you. Like your public library system.

Host Amber Smith: Now, I worry that if I visit a website and I search for something like "first trimester pregnancy," that I'm suddenly going to start getting ads for all sorts of maternity stuff.

So, how do I protect myself? If I visit websites, how do I protect my privacy?

Librarian Olivia Tsistinas: Targeted marketing is relentless, and I've definitely had that experience, too, where I've gone to look at something for a baby shower. And then all of a sudden I'm getting ads thinking that I'm going to be a mom again; I'm not. One way that you can do it is you can open up the browser, and most browsers have an opportunity to search incognito, and that way you're not having any cookies (online tracking) follow you. The internet is not going to track the information about what you're searching, and that can also be helpful if you're in a shared computer situation. So if there's some health information that you're seeking out, that you might not want other computer users in your home to be aware of, that's another great way to do it. Again, I'm going to point you back to the public library. If you went to your public library and you search there, that's a great way to not have those cookies follow you home.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air." I'm your host, Amber Smith, talking with associate librarian Olivia Tsistinas from Upstate's Health Sciences Library.

What can you tell us about health and medical apps? How do I make sure that an app that I download to my phone is something I can trust?

Librarian Olivia Tsistinas: Health apps have a whole other set of criteria. So, you've got your smartphone, and you've got a particular interest. That's usually what starts the search. So, whether you're looking at something to stop smoking, or you're tracking your steps, or you're tracking your mood, you go and you search the app store. The things I want people to think about when they get there is, is it easy to use? Does it look like it's targeted for a consumer, or does it look like it's something for a health care professional? I want you to check out the privacy and security options of that app. What are they collecting on you? And are they interested in taking your information, and then again, selling it to a third party?

Well, the way to do that is to see if that app has a webpage. So, if you can't find it right in that app store, to go and put that app name into your browser and see if you can find more information on it. Price is always a concern. So if it's free, why is it free? Where is it coming from? Is it a larger organization?

Is it a smaller organization? Are there in-app purchases, so you're going to only get so far and then it's not going to let you have full access to the services?

The other thing is evaluation criteria. So not only the star rating. If it's got five stars, that's great. But I want you to continue scrolling and see what the reviews are saying.

Are there recent issues with an update? It's unclear why all the five-stars are there because all the ones on the very top are all one-stars. And again, to go back to timelines, is it a new app, what has changed recently? And where did you hear about it?

Host Amber Smith: That's all good advice. Well, let me ask you about Facebook and Twitter and TikTok and all these other social media places.

People who I know share articles on social media. And I believe most of these people mean well, but how do I know that the article they're sharing is accurate?

Librarian Olivia Tsistinas: So all of those social media places are rampant with misinformation, and people share it for a variety of reasons. They want to be in the know. They want to take care of their loved ones.

They want to feel like they're connected to people. One great thing to do is think: If it looks too slick, then I don't know if I can trust it. If it's all very, very polished, and it's not clear where that information is coming from, it's a big pause button. Also, if it seems too strange to be true. Some of these things were created as memes to be entertainment, but then were forwarded as if they were true.

There was one, a couple of years ago about a certain fish that was bred to have no bones in it, so they could just eat it readily. And when I saw it, I was like, that doesn't make any sense. It didn't make any sense. It wasn't true. Sometimes the websites can look professional, but the stories are false. And that's another opportunity to go down to that "about us" page and figure out what it is, if it's truthful. Sometimes those social media posts can have quotations that have been edited. So, they aren't providing the full statement. They're only providing sensational chunks of the article, and it's the same way with data. So, maybe they took a bigger study, and they only cherry-picked out specific terms and phrases to make it more sensational.

Misleading graphs is another way that they do it. If you look on the side, and you check out the scale, does it start at zero? Where does it go to? And are they the same if they're comparing graphs? Another one that happens on social media a lot is old images that are being circulated as new information.

So, those are all a bunch of reasons why, even though our friends who are trying to do the right thing might be sharing old stuff. When you encounter that, once you've become really savvy, and you've started double-checking those things, I also want you to try to be empathetic with the people in your life.

If you try to bring them the proper source of that information, something really gentle, don't publicly shame them. And try to use really kind inclusive language. They were trying to do the right thing. So, we were going to win more of them over with good information if we're softer and gentler about it.

Host Amber Smith: So approach some of the information that you see with some skepticism, healthy skepticism.

Librarian Olivia Tsistinas: I start everything with a lot of skepticism, and it's it's not a bad thing to do. There's health information comes from a variety of places. And unfortunately, when it seems like it's the miracle that you've been waiting for, it's another reason to take a pause and make sure that it's something really wonderful before you get your hopes up.

Host Amber Smith: So if I gather information from government websites or well-known medical schools or large professional organizations, can I feel pretty secure that the information is credible?

Librarian Olivia Tsistinas: I would feel really secure in taking that to your health care provider. So that's a really wonderful thing to print off, to have in hand, to take with you and almost treat it like it's your savvy friend that's coming with you to your next medical appointment.

That's going to be helpful in reminding you what you wanted to address with their health care provider. And it's also going to fit into that evidence-based practice model of where information is coming from. Evidence-based practice comes from our health care's experience, our providers' experience, patient wishes and also the best current evidence.

So, it's going to be part of your health care team's tool kit,too.

Host Amber Smith: Do you have any advice for people who are seeking clinical trials?

Librarian Olivia Tsistinas: So, there is a great website, ClinicalTrials.gov. That's another one where I would want you to reach out to somebody to help you navigate it. Sometimes it can be a little bit hard to figure out.

I would also reach out to your health care team and say, you know, this is a diagnosis that you've recently given me. Are you aware of any trials and can you help direct me?

Host Amber Smith: How do you, as the librarian help a regular person, because I know you work with medical students, but just regular people that don't have any training in medicine, how do you help that person make sense of medical journal articles that are written for scientists and doctors?

Librarian Olivia Tsistinas: So, a lot of the time I'm targeting information created for consumers, but one of the groups that we get a lot are folks that are facing chronic health conditions, or they're in support groups. They're almost like super consumers. So they've already gone through that basic level of information. And they're reaching out to us at Upstate Health Sciences Library because they need a little bit more robust information.

And so those are the folks that we take a look, and we identify OK, this is a study, it's got a structured abstract, and here's the conclusion of it. And that's a little capsule of information that's right at the beginning of the article that they can then take to their health care team.

Host Amber Smith: And then their providers can help them make sense of whether this applies to their situation.

Librarian Olivia Tsistinas: Because what I never want you to do, even if you found an article that looks amazing, it's current, it's got great sources. It's got great references, you've been able to double-check it up and down across the internet. I never want you to use that to make a change in your prescriptions, to stop taking something, to add something, to add an over-the-counter medicine, without talking to your health care team first.

Host Amber Smith: What topics have you found most difficult to find information about for people?

Librarian Olivia Tsistinas: Usually that's when things are latest, greatest newest, now. So, if it's not pharmaceutically related, it doesn't get as much funding, so sometimes it doesn't get as well studied, but also if it is something brand new, there is a big gap between our bench science (research) and what's available at the bedside, sometimes up to 15 years.

And so something that you might see come out, it might be available only for rodents, but they're talking aboutit in the news as if it's available to people. So if it's just studies done on mice and rats, then it's not going to be something that I'm going to be able to find people information for, that they can apply to themselves.

Host Amber Smith: And some of that gets people's hopes up when they hear a news report about something that's not really clear on exactly how far along the pipeline it is.

Librarian Olivia Tsistinas: And that can be really hard for the medical library team, because we're the ones delivering the news that maybe it isn't ready for them yet, but it's something that's still coming.

Host Amber Smith: Well, let's remind listeners again, the No. 1 place to start is the website ...

Librarian Olivia Tsistinas: ... is MedlinePlus.gov. I refer people there all the time. It's got so many robust resources available to folks.

Host Amber Smith: Well, I want to thank you so much for making time to share all of this information.

My guest has been Olivia Tsistinas. She's an associate librarian at the Health Sciences Library at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- he trained in emergency medicine at Upstate. Now he hosts the "Talk2MeDoc" podcast.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Dr. Andrew Tisser is a doctor of emergency medicine in Buffalo who completed his residency at Upstate. He has a podcast on the side called "Talk2MeDoc," aimed at the early-career physician, and he's going to tell us about it. Welcome to "HealthLink on Air," Dr. Tisser.

Andrew Tisser, DO: Hey, Amber. Thanks so much for having me.

Host Amber Smith: You majored in psychology at SUNY Geneseo, and then you attended the New York Institute of Technology to obtain your Doctor of Osteopathic Medicine (degree). What attracted you to the field of medicine?

Andrew Tisser, DO: Yeah, that's a great question. I, unlike many, did not come into college knowing I wanted to be a doctor. I know a lot of people were like that where that was their childhood dream, and they had doctor sets as kids and things. That was never my path. So I came into college, just enjoying psychology, and that's why I majored in it. And I got involved with the local fire department, doing some EMS (emergency medical services) work and working as a fireman, actually, in college. And I got more and more involved with that and I realized that it wasn't quite enough for me. When I would drop off the patient in the ER, I wanted to know what was going on after I was done. And I had a paramedic actually, that was very influential in my career. His name was Gordon, an older guy. I don't know how old he was . Back then he seemed ancient, but I don't know, I don't think he was that old. And, I told him, "You know, Gordon, I think I'm going to try and get into med school." And, he said, "Andrew, we don't try things in life. We just do them. So you're either going to go to medical school or you're not." And I said, "OK, well, you know, if you're going to put a fire under me like that." So that's kind of how it ended up, and I applied and got in, and here we are.

Host Amber Smith: So you liked the emergency medicine stuff, just from your volunteer work with the fire department, and then you stuck with emergency medicine, once you kind of found your way through in medical school?

Andrew Tisser, DO: Yeah. I tried to like everything else. I really did. Because with the inherent some of the challenges that come with emergency medicine, I tried to really like something more reasonable, to some degree, but I just didn't. I didn't like anything as much as emergency medicine. I got bored easily. And so, that kept me in the field that I knew.

Host Amber Smith: So what do you remember about your time at Upstate, because you were an emergency medicine resident from 2014 to 2017. What was residency training like?

Andrew Tisser, DO: Tough. You know, I don't know that many practicing physicians who look back on their residency as being cheerful and full of, rainbows and unicorns and such, because you have a short window of time to train a proper physician, right? And to learn the vast specialty of emergency medicine in general, where we got to know a little bit about everything. You only have so much time. And so we work really hard. But Upstate was a nice place. It really was. What was really cool about Upstate, the hospital, is that we had such a large catchment area, so we got to see, really, just the spectrum of disease from really local urban type people all the way up into like the hill country and Amish and Mennonite populations, and really just a very interesting patient population.

The other thing I really remember a lot about my time in residency is just the pediatric emergency medicine training I received was amazing. And, with Dr. Richard Cantor, who I believe has retired since, but he was one of the greatest pediatric emergency medicine people in our field, one of the creators of the field. And so being out there and after I left Upstate, we went to Chicago for a few years. Just seeing the disparity in training that I received to some of my peers was fantastic. And, Syracuse is a fun city, you know?

Host Amber Smith: Well, what, what has kept you in emergency medicine?

Andrew Tisser, DO: You know, it's interesting. I've worked in pretty much every practice setting possible at this point. I followed my wife out to Chicago, where she did a fellowship (specialized training program), and in my time there, I worked at six or seven different hospitals in the two years we were there doing some part-time work in a lot of different places because I really didn't know what kind of setting I wanted to work in. And so I worked in these tiny little hospitals, all the way up to these giant medical centers, and everything inbetween. Again, my training was fantastic to the point where I was able to adapt really quickly to any of those settings. And so I've learned over time, what keeps me happy, and it's doing a lot of these other things, doing the podcast. I do a lot of administrative work nowadays. I'm the associate chair of emergency medicine for my hospital, so I do a lot of that and a lot of side projects and I have an 11-month-old that keeps me happy, too. And busy.

Host Amber Smith: Well, tell me how you got started as a podcaster.

Andrew Tisser, DO: Sure. So, initially, the podcast was to be focused on communication in health care. When I was leaving Chicago, one of the security guards bought me a bottle of champagne and I said, "oh wow, you didn't have to do that. That's nice." And he's like, "well, you talk to me, like I'm a person, Doc." And I was like, "Oh gosh, that's terrible. Don't most people talk to you like you're a person?" And he said, "No, you'd be surprised." And so I sought to really get some information about communication in healthcare and how we talk to each other. And so thus, "Talk2MeDoc," right? And after about a season of that, it grew a little stale. And the only reason that is is because a lot of people were saying the same thing, that we're all the same team; some of the hierarchy in medicine is really not as much as it used to be: and everyone has a voice. And while all true, I didn't think that continuing in that topic was really that interesting for my listeners. After a while, after I had interviewed people from pretty much every part of medicine, and my interest became more aligned with the issues relating to the early career physician. And then I pivoted the show, and that's where we've been ever since.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Andrew Tisser. He's a doctor who has a podcast aimed at early career physicians, and he did some of his training in Syracuse, in the emergency department at Upstate University Hospital.

So now that you changed sort of your focus, or refined it to aim at the early career physician, what are some of the issues that you find important to these people?

Andrew Tisser, DO: I think fundamentally a lot of the issues are the same across the spectrum of medicine, right? But the early career physician -- and I arbitrarily say up to like seven to 10 years out of residency, and I just made it up -- but I think that demographic is faced with a lot more different issues than than the previous generations.

The biggest one, you know, the elephant in the room is student loans, right? We're looking at people coming out of medical school, you see all these things like, oh, the average indebtedness is $200,000. Most of the people I know would die if they had $200,000 in debt because we're talking $400,000 or $500,000, $600,000 in student debt. So that is a big issue in and of itself. That leads to a lot of downstream issues, something we refer to as golden handcuffs, right? People that are staying in medicine either full-time that would like to go to part-time, or working ungodly amount of hours per month, per week, in order to afford a lifestyle that's inherent with their hard work and their training. So, we see a lot of burnout because of that, right? And a lot of physicians would really do better if they cut down clinically. You know, instead of working 180 hours a month in the emergency department, if they are working 130, they probably would have a lot better life. But a lot of that is tied together with finances.

The other issue we're seeing, again, is, actually the greatest exodus of 30- to 50-year-old physicians from the profession in the history of time, which is really concerning, right? Because I want someone to take care of me when I'm older, right? This is multifactorial, and this was happening before the pandemic, but the pandemic has certainly made things a lot worse.

We also see more of a focus on health and wellness initiatives and burnout in residency (training) curriculum, but we're still not seeing a ton of work on like just the practical side of medicine: how to negotiate a contract, how to buy a house, what is a physician mortgage? What should you look for in a potential employer? Why higher salaries don't necessarily lead to better happiness, what to do with your marriage. How are relationships in the early career? There are a lot of things that are different nowadays because of the focus on metrics, because of the focus on increased documentation standards and burden, because of the increased amount of patients we got to see per hour, and on, and on, and on we go.

So I feel that this demographic is different than the previous one, and so that I focused on a lot of those things. Certainly older physicians can listen to my show and get a lot of value as well. But, I talk to what I know about.

Host Amber Smith: Medical school, you're learning medicine and how to heal the sick, but I don't think you get as much, or any, training in how to run a practice or understanding how the health insurance system works or Medicare, Medicaid. I mean, those are huge things that I guess you're just supposed to know through osmosis?

Andrew Tisser, DO: It's very much true. Or even alternative careers. You know, I had a colleague once that said she would cry in her car before every shift. That's how bad it had become. And she said, there's just, there's just nothing else I could do. Well, that's not true, right? There's a lot of viable careers for physicians if they want to leave the bedside. So some of that stuff as well. And recently I've been having a learner series on, so we've had medical students and residents and fellows coming on as well to talk about some of the challenges that even this generation which isn't that far from me, right? I graduated residency in 2017. I'm not that far out. But there are new challenges, that I didn't even face that are coming up now. There's a never-ending amount of stuff to talk about. I've met some really cool people. I bring in guests from the spectrum of life and not just medicine, from every industry. And, so, you know, it's been fun. It's been a fun project.

Host Amber Smith: Let me ask you a little bit more about the student loans, because everyone's heard how much money doctors are going to owe when they get out of medical school. Do you think that deters some people from even going to medical school?

Andrew Tisser, DO: Yes. We're not there yet, but it's getting worse and worse. It's becoming a profession of the children of the wealthy. You go into medical school, right? And you grew up middle class, so you had to take out loans, right? That is just the nature of it. If you come out with a loan burden of half a million dollars, and you're not on track for any of these PR forgiveness programs, which are very few and far between, you can't take a job as a family physician, almost, right? I mean you can, but you're not going to have the life you maybe imagined. And not to say that physicians aren't the top 1% of earners in the country. I'm not trying to discount that in any way. But if you're looking for a straight return on investment, it's not the best one anymore, right? Because you know, reimbursements are going down. Salaries are going down. Tuition is going up. And that's just where we are right now. And unfortunately we could have a discussion about the unregulated tuition in this country, which is a whole different issue, but that's where we're at. And, of course, if you wanted to do health care, why wouldn't you go to PA (physician assistant) school and be done in three years and not have residency and not have the loan burden? It's certainly is becoming a roadblock to becoming a physician, if that's what you want to do.

Host Amber Smith: Is there something you'd like patients to understand about doctors?

Andrew Tisser, DO: We're people, right? I think there's still this vision in people's minds of like the mighty physician that can do no wrong, right? And how many times do I go up to a patient when I don't have a diagnosis for them and just say, "Hey, I don't know. You're going to have to talk to your doctor or a specialist. We've run all these tests. Everything looks OK. I'm not saying something isn't wrong with you. I'm not discounting your symptoms. I just don't know." And people appreciate that, right? It brings a humanity back to some of this, right? We're just people, people that have a lot of expertise and knowledge, but we make mistakes. As long as we're able to own up to that, I think it makes for a better physician-patient relationship.

Host Amber Smith: How would you advise a young physician who got into the profession because he or she wants to help people, but now they have to decide what specialty to devote their career to? What sorts of things do they need to be thinking about when they choose their specialty area?

Andrew Tisser, DO: It's really tough. If you take your average medical student, graduated college at 22, got to make a decision on what you're going to do for the rest of your life at 25 years old. That's tough, right? So, the way I advise students always is to make a list of all the specialties and I like to cross things out. And when you cross out a specialty, it's important to note whether or not that was because you didn't like the specialty, or you had a bad experience. Is it, you didn't like ob/gyn (obstetrics and gynecology) because you didn't like the OR (operating room), or is it because you didn't find the specialty interesting? If you didn't like the OR, that eliminates a bunch of other ones. And so go through it that way. Everyone says don't pick a specialty based on money, and I agree with that, but I think lifestyle concerns matter. And I think it's something to think about. When you're 23 years old and single, you know, working half the weekends and a bunch of nights per month seems fine. When you're married and have a bunch of kids, maybe you won't feel the same way. So sometimes it's hard to think past the present, but these are concerns, so just think about those things.

Host Amber Smith: So your podcast -- "Talk2MeDoc" -- where can people find it?

Andrew Tisser, DO: Everything I do can be found at my website, AndrewTisserDO.com. And I'm on all socials everywhere. I mostly hang out on Twitter and LinkedIn these days. But any place you find podcasts, Apple podcasts, Spotify, all the big ones. I'm there.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Tisser.

Andrew Tisser, DO: Well, thanks for having me. It was a lot of fun.

Host Amber Smith: My guest has been Dr. Andrew Tisser from the "Talk2MeDoc" podcast. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Travis Hobart from Upstate Medical University. What can parents do if they're living at a home with lead paint?

Travis Hobart, MD: If you're living in a home that might have old lead paint, a couple of things that you can do for your family and for your children: One thing is making sure your child is getting good nutrition, because if they have enough iron and enough calcium and enough vitamin C in their system, then they will absorb less lead from their environment. So I think it's important to make sure they're getting good nutrition. If you're afraid that they're not eating well or something like that, certainly talk to their doctor, or maybe consider using a multivitamin with your doctor's advice and approval. So I think that's an important aspect of prevention.

And then the other thing that I would recommend for families to do is: if you think that there's lead paint in your home, it's important when you're cleaning to do it with a mop or a wet wipe rather than a broom, because if you sweep up the lead dust, it just kicks it up into the air, and then it resettles down on the floor. And so the important thing is to mop it up or wipe it with a wet wipe so that you're getting it out of the environment and keeping your kids from being exposed.

Host Amber Smith: You've been listening to Dr. Travis Hobart from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: I love when poets take a familiar image and turn it ever so slightly until we get a new perspective. Gigi Marks is an educator, independent scholar, editor and conservationist. Her poem "Overlooked" explores why we might not want to take the road less traveled.

"Overlooked"

There is a path I wouldn't take

the briars spreading with no handsbreadth

opening across it, hooked into each other,

the dark weave forming from their thorny

stems, the scattered rocks there

making dips and rises on the soil's

tipped up face, the kind that could catch

and cast you earthward or make you

stumble. I was looking for the shortest

journey home, not one that held

the ring of small shining cherry trees

encircled or the great oak is old

and as wide, it might seem, as the sky;

when I found the clear path,

I took it, tired and sick and only

wanting to be back home with you.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air": secrets to a good night's sleep. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.Org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.