Today’s guest is Alexander Perelman DO, MS! Listen as Alex shares his views as a trainee, sub-specialist and all around great guy!

Today’s Guest

Alex Perelman DO, MS

Alexander Perelman DO, MS is currently a gastroenterology fellow at the University of Connecticut. During fellowship Alex reports that he has had wonderful mentors and opportunities to grow his interest in general GI and esophageal disease.

Dr. Perelman has also had a chance to pursue his passion for quality improvement in patient care and training. He has been able to do this through several roles including as one of the chief fellows for his program, doing quality improvement projects in his division and serving on the professionalism committee for the American College of Gastroenterology.

Alex has been able to find a great deal of joy in his work and share it with his colleagues through meetings, lectures, and published works. He has also started to be more active on Twitter @perelmanspearls with his pet project #medhxmonday where he tries to share some fun, usually GI related history with the world.

Email: [email protected]
LinkedIn
Twitter

 

Key Takeaways

  • Dr. Perelman discusses the evolution from the primary team to a specialist.
  • Alex feels professionally happy due to strong leadership.
  • He also feels that poor interpersonal communication leads to career unhappiness due to loss of human contacts.
  • Dr. Perelman also feels that technology may be partly to blame due to loss of social cues.

“It’s the lack of interpersonal communication that has invaded medicine. I think it’s such an important component of why we’re unhappy or why people aren’t happy with their job is because they’re losing the human contact part of this.”

 

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Disclaimer

All opinions expressed by the guest in this episode are solely the guest’s opinions and do not reflect the opinions of Andrew Tisser DO, Talk2MeDoc LLC, or any affiliates thereof. The guest’s opinions are based upon information he considers reliable, but Andrew Tisser DO, Talk2MeDoc LLC, nor any affiliates thereof warrant its completeness or accuracy. The guest, Andrew Tisser DO, Talk2MeDoc LLC, or any affiliates thereof are not under any obligation to update or correct any information provided in this episode. The guest’s statements and opinions are subject to change without notice.

Transcript

Andrew Tisser 0:06
Dr. Perelman, welcome to the Talk2MeDoc podcast.

Alex Perelman 0:22
Thanks, Dr. Tisser. appreciate you having me on.

Andrew Tisser 0:25
All right, let’s drop the formalities. Alex, if you could give the listeners a little bit about who you are, what you do and your role in this healthcare world.

Alex Perelman 0:35
I think formality aside since we were med school classmates, and we came up through the ranks together. Currently, I’m finishing up training in gastroenterology in the end of my third year over at the University of Connecticut. And so I’m providing at this moment care on the inpatient as well as outpatient service consultations for folks coming in with things like gi bleeding, abnormal liver function tests, things of that nature. But what I’m going to wrap up in Connecticut, I’m gonna head back come to New York and join a private practice in Manhattan.

Andrew Tisser 1:03
All right, well, you must be getting pretty excited at the end of this very, very long road for you.

Alex Perelman 1:09
Yeah, it’s, it’s sort of surreal, you know, going out on your own sort of and being the only person in the room right now you, you know, you’re doing a tough procedure. You have a tough case, you could always look over to a senior supervising attending and say, Hey, what do you think? And then you realize that the only person to turn to in about four months is just you, but I think the training has been good. So hopefully we’re good to go.

Andrew Tisser 1:30
Yeah, as Alex mentioned, we went to medical school together, down in Long Island New York College of Osteopathic Medicine. So that’s our little relationship there. So, Alex, this show is about communication and health care. And this part of the show we’re going to start talking about workplace dissatisfaction and miscommunication, poor communication leading to some physician unhappiness and other health care. worker and happiness. Do you think that that’s true?

Alex Perelman 2:04
I think that plays a tremendous role. You know, I’ve gone through the two roles of being a primary team sort of person when I was going through residency and now as a consulting physician, and I think if communication is broken down, when you’re asking for help, or if you’re being asked for help, then you forget that you’re on the same team. You’re there to care for the patient breeds, I think, some distrust and maybe some some dislike of one another. That is unfortunate, but part of human nature, right.

Andrew Tisser 2:31
Absolutely. I think that it’s interesting, too, since you’re so close to your internal medicine training, I know it doesn’t seem that way. But at the end of the day, you have some different perspectives coming from primary team and a specialist. So how have your views changed over time?

Alex Perelman 2:49
Well, I think the evolution of us is really interesting because right like, you don’t have to separate dichotomous boxes where this is I’m a primary care doctor. I’m a primary team, person and a consultant. So because of that special spectrum as you’re transitioning from primary team to the specialty, you’re not realizing what part is something that a primary team should be taking care of what part is really a sub specialty question.

But I think the big picture is always being able to communicate things. You know, this is my concern. This is why I’m asking for help. This is what I think is going on with a patient and maybe I’ve reached the limit of my own knowledge as a primary team. Or maybe I need a procedure that I don’t do. And that’s why I’m asking for help. And if that is not communicated to the specialist, right, then then the specialist may either duplicate work, they may do unnecessary things, they may not even understand why they’re being involved. And that is, unfortunately, something that I see on day to day basis.

Andrew Tisser 3:42
Sure, I mean, especially coming from my perspective as well from the emergency department. It’s always like, Well, why why isn’t the specialist calling me back? Or, or why are they giving me so much pushback and you really don’t know what’s going on in their lives or it are is your request unreasonable You know, I know it doesn’t seem to be at the time, but sometimes you gotta think about that.

Alex Perelman 4:05
Oh, absolutely. I mean, I think back on a lot of phone calls, the common one on call is somebody coming in with gastrointestinal bleeding. And the emergency room will call and say, Hey, I have Pearson x coming in, and they’re stable, but their blood count is low, can you come in and do a procedure? And we will intern say, Hey, give them this medication, check this blood work, get these IDs, and we’ll see them in the morning. And you say, That’s not what I asked for.

But if we took the time and say, Hey, you know, our literature says, if we’re rushing, we can actually do more harm. You know, doing that 24 hours of resuscitation and making sure our patient is stable before we give medications to sedate them to drop their blood pressure actually leads to better outcomes. Right. If we don’t say that if that’s not communicated in a clear way, then you’re going Hey, why is God not listening? And she is going, Hey, why doesn’t Ed understand what we’re saying? You know,

Andrew Tisser 4:54
oh, yeah, I remember that used to be a thing in residency all the time, we would call gi and they say you need to assess it. Take the patient. That would just make people so like, we know we need to resuscitate the patient. We are resuscitation. So we need your camera, you know? Yeah, but that’s not that was not the point being delivered, but I think we beat this to death. So let’s move on. So I’m gonna ask you a loaded question. Are you professionally happy?

Alex Perelman 5:21
I really am. I have to say I really am. But I think I’m also very fortunate. I happen to be at a location where I have good support. We have really excellent faculty, we have really responsive leadership. And I think that that’s one of the reasons I’m professionally happening. I’ve spoken with friends who are not and that’s a little bit scary, right.

I’m in my fifth year post graduation, I guess. 60 or post graduation from medical school. I’m very early career but I have friends who finished internal medicine residency and they’ve been practicing for three years and they’re already unhappy. They’re already sort of looking for the for the parachute if you will.

Andrew Tisser 6:00
Why do you think that is?

Alex Perelman 6:02
So the friends that I’ve come across that seem to be less happy are the ones who, unfortunately, are in the internal medicine space right now. And I think part of that is twofold. One is because they’ve actually been practicing where everyone else whose specialty training is still in specialty training. So so we haven’t had a chance to become unhappy maybe. But I think the other part of it is sort of the paperwork, the additional clicks that keep coming with EHR. I think it’s the lack of interpersonal communication that has invaded medicine. And I know this podcast is sort of rooted in communication. I think it’s such an important component of why we’re unhappy or why people aren’t happy with their job is because it’s losing the human contact part of this.

Andrew Tisser 6:46
Yeah, it’s definitely true. I mean, do you think you’re shielded from it somewhat as a trainee Do you think I, you know, I know we always say I always thought everything would get better after residency, but in some ways Professionally, things got a lot more challenging when we weren’t shielded from all the nonsense.

Alex Perelman 7:05
I think you’re shielded in one way. I mean, there’s some dissatisfaction that may come from being sort of the middle person, right? You’re not the final decision maker. Sure. And so, you know, you might have a conversation with the attending on the other side, and then you make a decision but then you go to your team and say, Hey, this is what the the primary team is asking for. And I don’t agree with it. But you’re attending says, that’s okay. We’ll do it anyway. You know, because of their own personal beliefs or because their assessment or experience and that can lead to some dissatisfaction.

But overall, you’re shielded because you’re still on a track, right? Like, you know, today I’m doing this this is my responsibility tomorrow, I’m doing this and it’s a little bit out of your control, but at the same time, we’re comfortable with that if you think about it, right pre med was a track. Med School was a track residency is a track fellowships a track, it’s when you get out on the other side, and you see hey, it’s still not in my control. I think that’s where the dissatisfaction starts creeping in.

Andrew Tisser 7:56
Yeah, those are definitely good points. I I know in my own life, I was that way, right. So there was always the next thing. And I was so excited to get finished with my training and then just have no next thing and be able to just work and go home. But as the months went on as a new attending, I definitely was just kind of lost because I thought there’s got to be something else than just going to work seeing a million patients and going home, right. I mean, I, many of the patient encounters were, you know, were valuable, and I definitely were help was helping people, but there was no next thing and some of that, I think, is just our personality as physicians.

Alex Perelman 8:36
Yeah, I think that’s a huge part. I also, I think it’s sort of where we choose to practice at the end of the day, you know, if people really find join in educating people then working with students working with residents, that might still bring you joy. And so the next thing might be seeing your mentee grow up. But again, if you’re in private practice, and you don’t have that opportunity, or you’re in a hospital environment, we don’t have that opportunity. I think it’s really easy to sort of get Lost in the minutiae of the day to day?

Andrew Tisser 9:03
Definitely, I, you know, how about your GI attendings? Some of them that are, let’s say, early in their career? Have you seen any prominent dissatisfaction or unhappiness or frustration? And what do you think leads to that?

Alex Perelman 9:20
I gotta say, No, I don’t know if gi people were just a bunch of happy folks, right? Playing and poop all day. So maybe maybe that just keeps us going. But everyone seems to be happy. And I think part of that is the personality that’s attracted to gi, you know, super, super serious folks who like procedures have a tendency to go to either surgery, or they’ll go to cardiology, whereas gastroenterology, I feel like we’re, we’re the folks that are comfortable speaking to people about poop all day, right. So if you think of it from that perspective, I think we can find joy in just about anything.

Andrew Tisser 9:52
I mean, everybody likes a good poop joke, right?

Alex Perelman 9:54
Oh, Listen, I’ve got a million of them to the point where I don’t think I’m allowed to make them at home anymore.

Andrew Tisser 10:00
Well, Alex that’s great. I, I’m, I’m happy to hear that there’s a trainee out there that isn’t at the, in the pit of despair, as many of them are. But what are some of your personal strategies to help improve your day to day job satisfaction, I hate this term burnout, but to combat some of that,

Alex Perelman 10:23
well, so I will say that the term burnout is not my favorite, but at the same time, it’s huge. So I’m currently serving on the ACG professionals committee, and we are doing a survey on burnout because we’re seeing it in gi you know, I might not be personally experiencing it, but I know it’s out there. But for me, as I said, I think I’m fortunate to have matched in a program that’s responsive, and I think that is a big part of why I’m happy. So in my course of training, I figured out Hey, I’m interested in this quality improvement project.

I wrote up an email proposal, I sent it to my chief and my program director currently doing that project with their full support. I had an idea for a subspecialty clinical elective for myself, I wrote it up, sent it to the person in charge, guess what, we built that elective within a few weeks. So the opportunity of sort of owning your path. I think that’s what gives me joy. And then the fact is, honestly, we work with great folks. We’re very family oriented program. And I think that that’s a big part of it, where you’re feeling that people support you and they want the best for you.

Andrew Tisser 11:30
Yeah, I mean, you are definitely fortunate the the horror stories we hear from across the country, unfortunately are not as optimistic. So but that’s great, you know, and I’m glad that that some of us are doing are happy and are not and are not pulling their hair out every day and counting the time till the get out of training. So, so that’s awesome. Do you think Alex that the you know back to the communication aspect and not only between us as physicians within the team itself, whether that be the nurses, the techs and everyone else. Do you think there’s an issue with communication there? And then, if so, how do you feel that affects our day to day?

Alex Perelman 12:15
I think there’s a communication issue, honestly, both within teams and between teams and different levels of teams. You know, just because I think that changing the way we communicate has occurred. And I think that that’s unfortunately, maybe the invasion of technology and into our day to day and that’s what sort of breeds the the unhappiness, right, because a text message doesn’t carry the social cues, the intent, the ease of follow up, what do you mean by that?

And so I think those moments are what, what leads text to say, Why is he yelling at me, or why are they understanding what I’m saying? Or this person who just had a little bit of blood in their stool isn’t having gushing bleeding? Why is gi rushing in there, or, hey, I did the rectal exam. As a primary team, why is God doing another one? Because it wasn’t communicated? And there’s a lot of that going on, I think.

Andrew Tisser 13:07
True. Yeah, I think that’s, that’s fair. The the issues, you know, within teams and between teams, I think I think the technology problem has been brought up a few times on this show. And while I’m optimistic that technology will help us in the long run, I think in the short term, it has affected kind of our deep person to person communication and how we interact with each other.

Alex Perelman 13:33
I think, you know, I saw it somewhere on I think on Twitter yesterday, actually. Were someone said the intent of technology was to get out of the way and allow the person to person communication medicine to occur. Instead, what’s happened is technology has gotten in the way. Right so when EHR has an easy radiology report, no one goes down to radiology anymore to radiology rounds. If all you have to do is text, the request for a consult. You don’t have to pick up the phone and say, Hey, Dr. So and so this is my concern. This is the preparation presentation. This is what we’ve done. This is what we’re thinking we need from you. Can you help, but it’s different when you can just send the GI fellow or the cardiology fellow tech saying scope Cath question mark, and that’s the entirety of the console, you know,

Alex Perelman 14:22
I think this one actually really stuck out to me it was about two years ago, I got a room number, date of birth initials and question marks scope. And it was the middle of the day, I’m in the middle of procedures. I’m like, Okay, if an attending is worried enough to actually send me that maybe something’s happening. I looked at the chart, Why think what they meant was this person needs an outpatient colonoscopy, can you please help facilitate that? But that took about an hour and a half of back and forth with one another, the nursing staff and etc, to figure out what exactly what’s being asked and I think that that can certainly have some job dissatisfaction, shall we say?

Andrew Tisser 14:59
No, I I know, I remember been training when we would call EMT at to see if, if people needed, you know, a scope from there and they would get so annoyed when we would consult them and be like, Oh, I’m calling you for this and be like, no, you’re calling me because you have a clinical question about the patient not because of a technical skill that I can do. Which, you know, looking back now I understand why they would be frustrated.

Alex Perelman 15:26
Yeah, yeah, I mean, I think I had made this PowerPoint that I really believe it I think I’ve made it about orthopedics at some point, which is you know, everyone wants you to be a hammer, but you’re really a multi specialty tool, right? Like so sometimes we need to scope the scope and sometimes we need the pliers so maybe not so much the scope. No, absolutely.

Andrew Tisser 15:46
Man scope question mark. That’s That’s ridiculous. Anyway. So you know, Alex, I think given your your happiness and your current job satisfaction, Had, do you have advice for maybe other consultative services that are very frustrated and, and how that they can perhaps improve some of their day to day?

Alex Perelman 16:11
Well, I think the the thing is maybe taking ownership of your own training. And if you’re already out in practice, maybe taking a moment and communicating better with primary teams and setting expectations, I think that’s definitely something that’s helpful. You know, one of the things that I do and sometimes I do get frustrated, I’m gonna admit that is maybe having a conversation with the residents, the folks who are calling for the consultation sort of setting out Hey, this is what I want, because I want you to learn from it.

I want me to be happy with my job, but most importantly, I want the patient to get the care they need. And that only happens if everything is sort of lined up. So I think doing that and then I think also for program leadership, it has to be a recognition that if people are not happy, if they’re quote, unquote, burning out, they’re gonna leave. Right so so creating an environment where the atmosphere Essentially you support people’s ideas you support someone wants to start a podcast you support if someone wants to do a didactic session or something like that, because then it gives them a feeling like they’re heard. And it lets them stay and do the job, but also be happy with what they’re doing.

Andrew Tisser 17:15
Right? I mean, we’re seeing the largest exodus of 30 to 50 year old physicians in the history of time from the profession. And honestly, to me, it’s quite scary.

Alex Perelman 17:25
Oh, yeah. I mean, I think if you realize that the people are retiring by the time you and I are in our 50s and 60s, I’m not sure if there’s gonna be people to care for us.

Andrew Tisser 17:35
Right. So, you know, that’s another goal this show is to bring some awareness to the issue and see how we can help each other. Not only our physician colleagues, but our nurses are burning out at crazy rates and everyone in the team just because of the demands of the system.

Alex Perelman 17:52
Oh, for sure. And I think that’s the problem. I mean, medicine is in ways a service industry, but at the same time It’s a service industry, I think there was a recent piece that talked about how some places are taking advantage of the sort of mission that healthcare providers nursing staff text field, right?

Like if there’s a job to do, you might be a nine to five worker, but you’re going to stay till seven to get it done, right, because you’re just going to do it because it and they’re taking advantage of that. And what happens is, if you’re a nine to five, staying to seven, five days a week, you’re going to burn out, you’re going to get tired, you’re gonna feel like it’s invading your space, you’re not seeing your kids, any of those things that sort of give us joy as well. And I certainly can appreciate why folks are not happy in that perspective.

Andrew Tisser 18:36
Absolutely. Well, let’s transition the show a little bit to get to know you. What do you like to do for fun?

Alex Perelman 18:44
So fun has been a moving target, I’d say in the last maybe three years. So my oldest daughter is three years old. My son’s going to be one in about a month. So fun went from going out and traveling, eating out in restaurants with my wife to maybe go until play I’m just watching my kids run around or crawl around and I do get joy from that just spending time with them. And then I recently rediscovered a hobby of trying to make my sourdough bread recipe by feel. I’ve written it down Don’t tell anybody.

Andrew Tisser 19:17
Well, that’s pretty cool. I have no idea anything about that.

Alex Perelman 19:23
It’s it’s really interesting. So the first time I tried to do it, I tried to get a natural yeast which was essentially just keep putting water and flour every day and letting it stand in the environment and the yeast that’s around around us gets in there and start fermenting and you get what we call a mother dome. And then you’re supposed to just take really good care of it.

Unfortunately, after about six months, I killed mine. I’d like to say it was a palliative care approach where I put it in the refrigerator and forgot to feed it. But then one of the other gastroenterologist out on the twittersphere posted a picture of a sourdough he made I asked him for the starter And he sent it to me. And so I’ve revived a new mother and have been taking good care of it.

Andrew Tisser 20:06
Well, I wish you the best of luck. That’s, that seems like an undertaking. Yeah, yeah. Do you have a book recommendation?

Alex Perelman 20:15
So one of my favorites, honestly is Richard Fineman, classic Fineman. I don’t know if you’re familiar with him, but he’s just a quirky brilliant guy back from the Manhattan Project that has a couple of Nobel Prizes under his belt. He was a painter, he became a musician. So he’s just a really fascinating guy, and I’ve gone back and forth to his book. I think the nice part about it is it’s stories from his life. So if you can’t commit, you know, to a 400 page book, any given time, read a story, get a good laugh, move on. Also, little blue truck is really getting a lot of use in my house these days.

Andrew Tisser 20:49
What’s that one about?

Alex Perelman 20:51
It’s about a very happy little blue truck that helps a big yellow truck out of a mud pile.

Andrew Tisser 20:56
Now that sounds right up my alley. They’re little blue track. All right, I gotta read.

Alex Perelman 21:05
The one, the one that’s on my waiting list, and I think it has some wonderful reviews is actually the Immortal Life of Henrietta Lacks. So that one’s actually about the woman who’s behind the Hela cell line. And I’m sure as a pre med at some point you’ve pipe headed in a lab and probably work with or near the cells coming from her tumor. So that’s on my to read list, but I can’t say that I’ve had enough time to get to it. This little blue truck, that’s the way

Andrew Tisser 21:36
All right, I’m on it. What, what other projects are you working on right now besides trying to finish your training finally.

Alex Perelman 21:44
So I’ve got a lot of things in the pipeline. So I’d like to joke that I have a Type A minus or possibly B plus personality where I have a list of a million things to do. And I start them and they slowly trickle down. So currently, I’m working with a few other guys to Get some good media information out there on the safety of ppis. And the real dangers of ppis.

Because there’s a lot of misinformation. And I think it’s important for both primary page primary providers as well as patients to have some of this information as well as the medium that I’m currently also trying to put together a quality improvement project in my fellowship, which is going very well and transitioning back to life in New York and I’ve been out of there for six years between residency and fellowship so sort of getting back used to being home

Andrew Tisser 22:31
Well, at least you’ll be back with good bagels and pizza again. I can’t wait.

Alex Perelman 22:35
Well, you know what, though? I did my my residency training in New Haven. I have to say that pizza can rival New York I know I’m not supposed to say that.

Andrew Tisser 22:46
I you know, I’ll have to there’s definitely no good pizza up in Buffalo. I’ll tell you that much. The wings. Yeah, the wings. We got that. So if you could give, let’s say your early career. Physician colleagues a piece of advice when it comes to job satisfaction and overall happiness. What would that be?

Alex Perelman 23:09
I think find like minded people find like minded practices don’t look at the bottom line. And I think that was a big lesson for me. As I was looking for my first job, you know, I wasn’t looking at the salary that that potentially can be earned. I was looking for people that value the same things I did. I was looking for people that had a similar ideology about practice as I did.

And, you know, I think I found that I’m not sure because I haven’t started there yet. But at least from the people that I know that practice, that seems to be the case, and I think they’re happy and I think I’m going to be happy there because of those same factors. It’s the same approach I did when I look for residency. It’s the same approach. I did look for fellowship, so I think it served me through my years.

Andrew Tisser 23:52
Yeah, absolutely. Having worked at many different places at this point, job satisfaction, good. Good. supportive environment is so much more important than the bottom line because a couple extra bucks for working really, in a horrible condition is is not conducive to success. Yeah. So if people wanted to find your reach out to you and maybe learn some more about sourdough, or whatever else you’re working on, how can they find you?

Alex Perelman 24:20
So the easiest way is I’m on Twitter, I’m on it all the time, maybe a little too much. So I tweet at Parliament’s pearls. And believe it or not, I actually went and committed and created a Gmail account to that same effects of Romans [email protected] If you have any particular questions, you know, medical advice, why’s that? That’s not me. See your your provider or come see me in the office, but I won’t do that by email. But sourdough. I’m happy to share

Andrew Tisser 24:47
very well. For the listeners. that’ll all be in the show notes for you. Well, this has been a lot of fun. Thanks for talking to me and coming on the show. I really appreciate it.

Alex Perelman 24:57
Thanks, Andrew was great catching up with you.

Andrew Tisser 24:59
Yeah, you Well and I will have to check out the New Haven bagels because I still pizza excuse me the New Haven pizza. I do not believe you.

Alex Perelman 25:07
I’m telling you Pepys is the way to go. Although people will say Sally’s or bar, but I’m a Pepys type of guy.

Andrew Tisser 25:14
Alright, man, thanks again.

Alex Perelman 25:16
You got it.

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