Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Behind the Scenes of a Leading Cardiac Surgery Program
Dr. Jeremy Leidenfrost, a renowned cardiothoracic surgeon at St. Luke's, opens up about the extraordinary effort required to maintain a top-ranked cardiothoracic surgery program. Listeners will learn how high surgical volumes are key to sharpening the skills of both surgeons and their teams. Dr. Leidenfrost also discusses the vital roles of specialized anesthesiologists and post-operative care, revealing the meticulous standards based on Medicare data and risk-adjusted mortality rates that contribute to their prestigious ranking. Join us as he shares insights into the demanding world of medical training, where the quest for competence often extends beyond the 80-hour workweek.
The journey of mastering cardiothoracic surgery is not just about hours spent in practice but also about the bonds formed along the way. We reflect on how these connections, akin to those in the military, offer a support system through shared struggles and triumphs. Drawing parallels to Malcolm Gladwell's 10,000-hour rule, we discuss the dedication required to excel in this challenging field. Dr. Leidenfrost provides personal anecdotes from his training days, emphasizing the importance of camaraderie and mentorship in shaping a successful career.
Our conversation with Dr. Leidenfrost wouldn't be complete without recognizing the exceptional quality of nursing care and cardiology collaborations at St. Luke's Hospital, Chesterfield, Missouri. He recounts a memorable story of a loyal patient from rural Missouri, illustrating the program's widespread reputation. Personal and humorous accounts highlight the importance of physical fitness amidst a busy career, inspired by mentors who lead by example. This episode is a testament to the power of a skilled team, where trust and reliability elevate patient care and outcomes.
Hello, this is Jason Edwards and this is Doc Discussions. I'm here with Dr Jeremy Leidenfrost, a cardiothoracic surgeon. Jeremy, how are you doing today? Pretty good, so how many years have we consecutively won the top 50 cardiothoracic surgery programs?
Speaker 2:I think we're in the sixth year In the sixth year, in the sixth year.
Speaker 1:How about that and you're kind of the lead. You do the most cardiac cases, is that right?
Speaker 2:Yeah, I'm probably the busiest cardiac surgeon right now. My partner, Ryan Reedy, is just as busy of a surgeon as I am, but he does a lot of thoracic surgery work as well. He would be considered a very busy cardiac surgeon, but he's also a very busy thoracic surgeon, so he probably does more you know overall surgery than I do, but I'm just focused just on cardiac.
Speaker 1:Yeah, yeah, and actually Mike and Ogawa and I were talking about this before. It is good to be busy. I mean it makes you better. You see a lot of cases, you see all the weird stuff that comes along, and so I feel I'm always very proud, you know, to be a busy doctor, and I'm sure Ryan are too.
Speaker 2:Yeah, yeah, I think you know, as with anything, anything complex, really the busier you are, the better you get, and then the better the team around you gets. So you know we talk all the time you know in cardiac surgery about how there are a lot of programs in the state that do less than 100 cardiac surgeries a year and they're actually kind of dropping like flies because people are realizing, in the age of information and outcomes, people are realizing that it's very difficult to keep quality up with low volume with cardiac surgery because not only do the surgeons need to stay good, but the anesthesiologists that do the anesthesia for you, the ICU, the perfusionists, the room nurses and something that's so complex where you know outcomes are kind of measured in millimeters and seconds. It helps to have a very you know, highly polished team.
Speaker 1:And your anesthesiologists. They're cardiac surgery, specific anesthesiologists, right, right.
Speaker 2:Yeah, they trained to do anesthesia for cardiac surgery and that also makes a pretty big difference, I think.
Speaker 1:Yeah. And then your post-op care, with the nurses and the anesthesiologists who help with that as well, I assume, makes a huge difference. And the anesthesiologist who helped with that as well, I assume, makes a huge difference. So the award for the top 50 cardiothoracic surgery programs, that's not a popularity contest, how?
Speaker 2:do you win that? So the corporation or whoever puts that on health grades? It's all Medicare data. They basically look at Medicare data and look at mortality rates. So it's very black and white.
Speaker 1:Yeah, and so your outcomes which is mainly mortality Right, and do they do? 60-day mortality or 90-day mortality?
Speaker 2:It's 30-day 30-day, 30-day mortality yeah.
Speaker 1:And so your outcomes are superior. 30-day mortality yeah, and so your outcomes are superior, and I assume they adjust it for the patient's comorbidities going into it.
Speaker 2:Yeah, they look at how sick are the patients that you get and kind of, what are your outcomes with those patients?
Speaker 1:So it's risk-adjusted, yeah, risk-adjusted, okay, yeah. So I don't know if you know this or not, but I had to do a mandatory year of training in general surgery before I did my radiation oncology.
Speaker 2:Right, yeah, I can remember.
Speaker 1:I did not love that.
Speaker 2:If I'm being honest, but it was good for me in the long run.
Speaker 1:Yeah, but I did my rotation and cardiothoracic surgery and it was brutal. I remember I would get there at like 3.30 and start preparing however the resident wanted the list. I would do it to all their anesthetists.
Speaker 2:Yeah, I'm sure you were good at it, and then yeah, whatever they wanted, I did If they said jump.
Speaker 1:I said ah hi, and then you know you'd be pulling drains and pulling leads and putting Dura-Gezix on or doing all the stuff, checking, you know, the chest tubes, all that. And then I would go home, maybe at like five or six and be dead tired and I would stop at Dairy Queen and I would get a chili dog, I would get cheese curds and a large blizzard and I still lost like 10 pounds over that like two months.
Speaker 2:It's nice to be young. Huh, it was brutal.
Speaker 1:I mean it was brutal, and I I just when I think you know what would the average listener like want to know, like I think people don't realize like how damn tough it is.
Speaker 2:Yeah, so even in the age of um you know AC, AC, GME, work hours, yeah.
Speaker 2:And that's a restriction by the government that residents can only have so many hours Can only work, I don't know, 80 hours a week or something like that. But that was, that wasn't new, but it wasn't it really hadn't caught on all too well, cause I can tell you we didn't work 80 hours a week. You know, I think we had to like kind of log our hours in a little computer and we would all do it like three months at a time.
Speaker 1:Yeah, You're saying you would work more than 80 hours a week. Oh yeah.
Speaker 2:So, yeah, I would get there usually around five Okay, and some days I wouldn't get home until about eight o'clock.
Speaker 2:And I can remember I had young children at the time and I can remember on a weekend that I would be on call. I would work all week and I would wake up, leave the house before they were awake, come home after they had gone to bed. I was gone all weekend long, repeat the next week, so there would be two weeks. Sometimes that would go by. I wouldn't even see my kids, even though I was not out of town.
Speaker 1:And I think that's one thing that people just cannot appreciate. I mean, working more than 80 hours a week, working 100 hours a week, 168 hours in a week, something like that Right you just, unless you do it, you just have no idea it can be mind-numbing, and it's not. You know, you're not, you know, you're not. It's high risk.
Speaker 1:You know, you're doing surgeries, you're doing all sorts of things that it's not, you know, ice capades, and that's kind of. The crazy thing is that people, no matter what situation they're in, they can. There's biological homeostasis and they get used to the grind. And I'm sure by the time you were, you know, finishing up your residency, it was no big deal to work an 80-hour week. It wasn't, you were conditioned. I can remember and I actually have very fond memories of my training, and I'm sure by the time you were, you know, finishing up your residency, it was no big deal to work an 80 hour week.
Speaker 2:It wasn't. Yeah, you were conditioned. I can remember and I actually have very fond memories of my training. You know it was very hard, it was intense, but you know you kind of form bonds with people that you would never form otherwise and you know it's one of these things where you know a lot of this is you know you have to reach a certain level of competency before you can go out in the world and do cardiac surgery. So you know I found that it was necessary. Yeah, and I think a lot of what people are finding now is that 80 hours a week can sometimes prolong your training because people just aren't getting enough stick time when you know they're forced to go home.
Speaker 1:And so they end up having to do a fellowship or more training, or when they get out into the real world they're not as competent. So they kind of automatically pare down and just work in kind of a narrow scope Correct. And just work in kind of a narrow scope, correct. And so, yeah, you know, nothing happens in a vacuum, right? And so it's like if you have a surgeon who has less training, they're going to predictably be less good.
Speaker 2:Yeah, absolutely.
Speaker 1:And it's kind of the expected outcome. And it's kind of the expected outcome. The other thing too I think about is, I mean, even as a general prelim resident, you know so I was doing just one year of general surgery and I knew that was going to be it and I was going to go into radiation. You know, the surgery team in a hospital is a, I would say, a prideful group. I mean it's not surprising to me that everybody just said, oh yeah, I'm doing my 80, and kind of cowboyed up and still did their 90 or a hundred and didn't complain about it because that's just the mentality of it I mean it's a, it's a different, different vibe, Right and and you and you can see how I mean.
Speaker 1:I mean you know, so that's kind of the soldier on vibe and and that gets you through a lot of things in life.
Speaker 2:Yeah, the people that are willing to work hard and put in the time are the people that are usually going to be successful and really good at things. It's kind of like Malcolm Gladwell's book. He talks about how to become an expert at something takes 10,000 hours or 10,000, you know repetitions at it.
Speaker 1:And for reference, you know, a standard person works just a touch over 2,000 hours per year on a 40-hour work week, right. And so 10,000 hours would be five years, or at a surgery residence pace, you know, two and a half years, right. But yeah, you've got to get your reps in no matter what it is.
Speaker 1:Absolutely, and so as so, now that you're in your practice, you're still getting your reps in and which keeps you sharp, right, Correct. And then one of the cool things and I think people in the military find kind of a similar experience is when you're going through trying processes with other people. You can't help, but not all, and you almost depend on them. You know like very significantly, oh yeah, that you know life and death hangs in the balance and you're depending on if somebody says they're going to do something, that they do it. You know you can't help but form very strong bonds that, even if you don't see them for a while, right.
Speaker 2:Yeah, yeah, I happened to come through with a group of fellows that were all just incredible people, very, very strong, smart, hardworking people and it made my fellowship easier because I could rely on them. And when it came to study for boards, we all kind of had our strengths and weaknesses, knowledge-wise, and we would all, you, take your boards a year after you go out into practice and they, you know, we had all kind of scattered across the country and we would call each other, uh, every week and we would, we would take each other through board board scenarios. So we kind of stuck together through that and we, you know, we all went and took the oral boards together and all passed.
Speaker 1:And, yeah, you know, we, we still keep up to this day yeah, yeah, I, I did my upper level residents who you know the person when, like, things are going wrong with a patient that you call and they always bail you out like I.
Speaker 2:I grew to like love those people do you remember your first or second year in your upper levels? Like because they take care of you like gods? Yeah, they take care of you because you don't know what the heck is going on.
Speaker 1:It's like your first week of residency the nurse calls you to the floor and you're like, oh my gosh, this patient, it's going to be my fault, they're going to die if I don't do something. And you have no idea what to do.
Speaker 2:And you call and the guy, whoever it is, I mean I've got the picture in my mind. Yeah, calm down, we're going to do this, it's going to be okay. Yeah, yeah, absolutely, I had those. I had those people in training. One one, uh, was he's a cardiac surgeon um in Utah now by name of Spencer Melby, and you know just a really great guy, and you know kind of took me under his wing, uh, when I first started and you know. Obviously never forget that. So is he Mormon.
Speaker 1:He's Mormon, yeah, yeah, so the guy I'm thinking of, mormon to Nathan I can't remember his last name now, believe it or not. But yeah, good, good, mormon guy, yeah, and, and it was, it was, it was a great experience. And you're right, you form these bonds that will just never go away. And you're right, you form these bonds that will just never go away. So, but kind of going back, I mean it is not an easy life.
Speaker 1:And there's a quote that is kind of popular by Nietzsche that says it's from Twilight of the Idols. It says if a man has a, how he can bear almost any. Why? Or sorry, if a man has a, how he can bear almost any, why? Or sorry, if a man has a, why he can bear almost any, how? And just saying that you can suffer through things if you have a purpose, if you have a goal. And Emerson had kind of another kind of take on that and he said the purpose of life isn't to be happy, it's to be useful. And I kind of think that those quotes kind of remind me of you know, doing a really tough job that you're choosing as your livelihood. Why was it that you chose this? I mean, you knew it was tough. Your dad's a cardiothoracic surgeon. You saw how it was.
Speaker 2:Yeah, I mean I grew up kind of watching him. You know, in practice I would come and round with him as a kid and is that right? And it always. You know it was always neat to round with them Because I mean back in the day we would like go into the patient's room and and the patient, you know, always say, oh my God, your dad saved my life and you know, you should. You know that's so cool that you're rounding with him, you should follow in his footsteps and you know so. I heard that countless times you know, and.
Speaker 2:I thought, well, you know why, not, right? And and it isn't until you're really in medical school that you kind of realize like what a what a tall task that is. Yeah, you know, you realize how much work you have to put in to get there. And then when you are in general surgery training and you kind of see the cardiac guys and you see the cardiac ORs and you know it kind of takes a lot of things, you know that are, you know a lot of surgical specialties and sort of I mean, takes all the complexities of that and just magnifies it, you know, because not only do you have to do the surgery but you have to take care of them afterwards, and these patients after surgery can be incredibly sick. So not only do you have to be a pretty skilled surgeon, be a cardiac surgeon, but you have to be good at managing the patients post-operatively and all of their complex physiology, so kind of.
Speaker 2:I think. As I sort of, you know, went through the process, I sort of realized almost on a daily basis until up up until a certain point, that this is going to be harder than I thought. You know, as you watch the, as you watch your mentors work, and you know, you kind of realize, wow, that's going to take me a long time to get there yeah, I, that's the um.
Speaker 1:The surgeries are very hard surgeries. And then I was always impressed by the cardiothoracic surgeons understanding of physiology, which I found fascinating, um, and so I mean they were, they were really technically sound but also really smart and and but it's like. It's like so you're in medical school or even in general surgery residency and you're staring at like 10 mountains and you find the mountain that's the biggest mountain and you're like I think I'll climb.
Speaker 2:I want to do that one, yeah. And then halfway up you're like sometimes you're like oh no, why did I choose this mountain?
Speaker 1:I could have been done a mile, a mile ago, and it's like it's like you can cry, you can whine, but you got to keep going. That's right. Yeah, man, yeah. And so how would you feel if you weren't a cardiothoracic surgeon? How would I?
Speaker 2:feel I don't know.
Speaker 1:Luckily you didn't have to find out.
Speaker 2:I didn't have to find out, I mean yeah, I was lucky enough to kind of, you know, go to a place that gave me good enough training to go out in the world and, and and make it there are a lot of people that don't.
Speaker 2:Yeah, there are a lot of people that go out and just, you know, for whatever reason whether it's whether it's because they didn't get a good job with good protection from a senior partner, or they didn't get, you know, good enough training, or whatever the reason there are a lot, of, a lot of people that go out into cardiac surgery and don't actually end up doing that for a living. So I I feel incredibly fortunate to to actually be practicing and and be at a good place.
Speaker 1:Yeah, and, and you know, good fortune follows hard work too. So um, no, that that's great. And then um and fortune follows hard work too, so no, that's great. And then we had a very well-known cardiothoracic surgery program here, but I think it became more well-known when you got here. And so there's another kind of element here of practice building which you know nobody learns anything about in residency.
Speaker 2:Yeah, exactly yeah, kind of built on what you know had been, you know, here for a while and had a very solid backbone, obviously an incredible team, and we just kept kind of building on that. And since Ryan's come, we've, you know, made it even better, yeah, you know, making thoracic what it is today.
Speaker 1:And yeah, and Ryan trained at Baylor right Texas heart. Yeah yeah, and so is that where Debakey was and Debakey is kind of like the godfather of surgery right?
Speaker 2:Everybody knows Debakey yes.
Speaker 1:And those guys, yeah yeah, and so he trained, he trained there, and that they the Becky. He had probably passed away before Ryan finished his training.
Speaker 2:I think he was actually still alive while he was there and I think he worked like all the way until the end. Right, yeah, yeah.
Speaker 1:And so yeah, so Ryan trained at a very renowned program and then came here, and so we've got a pretty solid team here and your dad still does surgeries Still working yeah, and your dad's in great shape too. Yeah, you know, every time I look at him, he looks younger than he is. He exercises every day, yeah, he's a big swimmer, right, big swimmer.
Speaker 2:Yeah.
Speaker 1:And so um and and that's kind of um, you know something that younger guys like me and you, we can look at your dad and say, okay, you know, if, if we got to keep tune the instrument right, Keep your body in shape.
Speaker 2:Yeah, do you work out? I try. Yeah, it's. It's like kind of um, it's fallen off a little bit. You know, kind of as you get busier in your career, um, you know you'll have really busy days and you'll go home and you just, I just sometimes don't have energy to do it. Yeah, I do. I do 40 pushups every morning and I try to run the hospital steps twice a day.
Speaker 1:Which?
Speaker 2:is like all the way from the, from the lower level to the ninth.
Speaker 1:And that'll get you up in a muffin. Oh, yeah, yeah, yeah, that'll do it. The um uh yeah, we had um. One of the trauma surgeons would always make us take the steps and he was like a bigger guy and um, and I would be. I was smaller than him, lighter than him, younger than him and he was a bear and he would get up those stairs and I would be dying. And then you'd have to present the patient. You'd be out of breath, you know, but no, you guys have a good thing going here, and so are most of your patients from St Luke's, or how many, what percentage, would you say come from outside of St Luke's.
Speaker 2:So it's interesting my practice the last time we looked at my cases about 70% of my cases come from outside.
Speaker 1:Oh, really yeah, 70% so.
Speaker 2:I get a lot from St Charles. We get a lot from Southern Missouri Cape and Rolla, things like that.
Speaker 1:I've got a funny story. I'll end on this. I've got a patient who I've seen for years and I love him. He's hilarious. We treated him years ago and he was having some cardiac issues and he lives in rural Missouri and he he went to the helicopter, came to pick him up wherever he was I don't know how it transpired and the helicopter said that they were going to take him to another hospital and he said boys, if you're not taking me to St Luke's, you might as well just leave me here. And they flew him up here in the helicopter. He's a total character, but I mean, I guess that was the magic words and then they got him here.
Speaker 2:Yeah, people love this place. I mean, you know it's a good hospital, it's got you know, amazing nursing care and I think you'll, you know, sort of as a fellow, we kind of went all over St Louis to, you know, went to Christian, went to, you know, barnsville County and you know, yeah, some places within town and you come here and there's such a difference in the nursing care, so that's a big part of it.
Speaker 1:It's just a really good hospital to be in, huge part of it we have an army of cardiologists and so if you're having, I actually had chest pain one day- I came home and I was having like 20 PVCs a minute which is an arrhythmia or not an arrhythmia, but I don't know what you call it. But I didn't feel right Right, and so I called Craig Reese and I said Craig, I don't know what's going on, but I'm having like some weird palpitations.
Speaker 2:And my Apple.
Speaker 1:Watch is going off and he said come to the ER.
Speaker 2:He did his thing. He came in and took over and man.
Speaker 1:I felt so at ease just knowing Craig was there.
Speaker 2:Everything was fine. My magnesium level was low. You know too much work, but but anyway.
Speaker 1:But but you know, I I felt more. I was scared, to be honest, and I felt more comfortable being here. For sure, as soon as you know, the cardiologist came to the ER immediately. But, um well, jeremy, I appreciate you, I like working with you and it's always good sharing time with you, and so thanks for all that you and your team do. We really appreciate you.
Speaker 2:All right, I appreciate it. Thanks, jason.
Speaker 1:You bet.