Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
We dive into the powerful story of a physician-mother whose world changed with the onset of COVID-19. Our guest, Arian Nachat, a palliative and emergency medicine physician, shares her journey through the pandemic, balancing the demanding roles of mother and doctor. From navigating childcare crises and homeschooling to reimagining her career beyond the confines of traditional health care, she sheds light on the struggles faced by frontline workers. Listen as she reveals how these challenges inspired her to reshape her path, create a health care company addressing critical system gaps, and advocate for a patient-centered, physician-led approach to medicine.
Arian Nachat is a palliative and emergency medicine physician.
She discusses the KevinMD article, “Mostly miserables: a physician-mother’s struggle during COVID-19.”
Our presenting sponsor is DAX Copilot by Microsoft.
Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows.
70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.
Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows.
VISIT SPONSOR → https://aka.ms/kevinmd
SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast
RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended
GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme
I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus
Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Arianne Nachat. She’s an emergency medicine and palliative care physician. Today’s KevinMD article is “A Physician Mother’s Struggle During COVID-19.” Arianne, welcome to the show.
Arianne Nachat: Thank you for having me, Kevin.
Kevin Pho: So, let’s start by briefly sharing your story and journey.
Arianne Nachat: Sure. So, I started out as an emergency medicine physician and became a patient, unfortunately, early in my career. And then I studied Chinese medicine—traditional Chinese medicine. And then I boarded in hospice and palliative medicine and also became pain trained. So, a somewhat eclectic route within medicine, Kevin. And during the course of COVID, obviously, we were all encountering very different challenges and experiences. And as a single mom, that brought a whole slew of other challenges that normally I had pretty well juggled. And so, I decided that I was going to address that in this article that I wrote for you and for our readers, to sort of talk about what that experience felt like.
Kevin Pho: All right, so let’s jump straight into that article. For those who didn’t get a chance to read it, tell us what it’s about.
Arianne Nachat: So, during COVID, obviously, being a single mom, I needed to figure out how to work full-time and homeschool my kids because I was in a state where all the schools shut down for about 13 months. And I still had to pay the mortgage, which became very, very difficult to do. And as you can imagine, as a frontline emergency medicine physician, there were not a whole lot of people really jumping to volunteer to come to my house prior to the vaccine to watch my children. So, I had to pivot and make a lot of adjustments. And in doing that, I discovered that I really wanted to solve a problem that became apparent during COVID-19, which was the fact that we, as a nation, really struggled to talk about death and dying. And COVID-19 had opened a door in terms of people realizing even young people can die unexpectedly. And maybe this is a conversation we need to have and talk about more. And so, I started a company called Pality that attempted to address the space here where we could talk about it, where we could educate other clinicians and other patients on how to talk about death and dying, how to prepare for death and dying. And really to empower people to understand that talking about it doesn’t make it happen, but what it does is it alleviates a lot of burden when someone is challenged with a serious illness or diagnosis.
Kevin Pho: You had so much going on during that time of COVID, and like you said, it sounds like an overwhelming amount of responsibilities, and you also decided to start a company to further address the conversation of palliative care. How did you have the bandwidth and energy just to add that on?
Arianne Nachat: I think the phrase “necessity is the mother of invention” is really applicable here. I wound up having to leave my full-time job. They were not able to accommodate my home responsibilities, so to speak. And so, I took a position working for the Department of Defense, and I started working primarily as an emergency medicine physician down in San Diego. I was living in Portland, Oregon, originally, and started working for the Navy and for the VA doing emergency medicine, COVID relief. And so, they were happy to give me blocked shifts. And so, I started flying down to San Diego, working 12-hour shifts, and then I’d fly home and homeschool my kids for three weeks. And so, during those three-week blocks, I had a lot of downtime between homeschooling a four-and-a-half and a seven-year-old—obviously not an eight-hour day of education—a lot of periods of time where they were just playing or watching a movie, et cetera, et cetera. So, I had time to really think and contemplate, what am I seeing that I can fix? What is within my purview of expertise and knowledge where I can make a difference during a period of time where people were really struggling? And so, people were getting very creative—health care systems were getting creative, Mount Sinai being one of the ones that actually led the way on doing palliative care via iPad. And so, we realized that this is a form of health care delivery that works in this space. And so, I was able to carve out some time to really take something and figure out a systems-wide solution for it. And it was really empowering. And also, frankly, it was really enjoyable. It was fun to have a problem that was sort of like a Rubik’s Cube that I could put my skill set to and help solve.
Kevin Pho: So, you mentioned earlier, of course, before the pandemic and perhaps even now, we’re having difficulty broaching that topic of palliative care. How do you think the pandemic has changed those conversations?
Arianne Nachat: Well, I think a lot of young people didn’t think it was a conversation they ever needed to have, right? Suddenly, we had 20-year-olds who were dying of COVID, and so I think that Pandora’s box inadvertently was opened, and people had to come to terms with the fact that people they cared about and loved were dying unexpectedly. And so, suddenly, that conversation became front and center. And I think that as that happened, people started realizing that there’s something called a good death and a bad death. And if we start to talk about it and people get to actually have a say in what their dying journey looks like, that it’s more comforting both to the patient and to their family members. It’s extremely stressful for a family. My worst day at work is when I’m sitting in an ICU with a family of 10 people around the table and no one knows what grandma wanted. And suddenly people have to guess, and that’s a huge responsibility to put on a family member. And so, realizing that these are conversations you can have at any juncture, and really ideally anytime. I tell people I have an advance directive. I’ve had one since I was 23 because I was jumping out of airplanes with a parachute. I figured people should probably know what I want to do. And so, I’ve shared that with my patients and their families to say, this is not about dying. This is actually about living and how you want to live and what’s important to you. And those are really important conversations to have at any juncture of life where your life impacts other people. So, you’re getting married, you’re having children, there’s a change in your family status, there’s a change in your health status. These are all appropriate times to have a conversation and review sort of, well, what’s important to me? What was important to me at 20 is very different from what’s important to me at 50. And so, I think that the pandemic really showed people that talking about what is essentially their line in the sand of what’s important to them versus what’s not. And sharing that with the people they love suddenly was an OK conversation to have.
Kevin Pho: So, you’re right at that intersection of palliative care and emergency medicine. So, that scenario that you described where people can have a sudden confrontation with death and they may not know what their loved one’s wishes were—did that happen more often than not in the emergency department, especially during the pandemic?
Arianne Nachat: Absolutely. And I think that especially on the East Coast, where I trained but not where I currently work, they were hit extremely hard, and they were having to have these conversations in one or two minutes with families. And early in the pandemic, we didn’t know what the best management was, for example, and people were getting intubated. And so, patients didn’t have an opportunity to have those conversations with their family members. So, I think the emergency department and emergency medicine physicians in particular are very savvy and know how to have conversations in sort of short, quick, abridged cliff-notes versions. This is not the ICU version of, let’s all sit down and have an hour-and-a-half-long conversation and explore this, but it’s really essential for emergency medicine physicians. And frankly, any clinician who is working with patients with serious illness needs to know how to broach the conversation in a kind, gentle, empathic way that opens the door to say, hey, we really want to make sure that we’re doing the right thing here. You know, has your loved one ever shared with you what’s important to them? Have they ever had an experience where they’ve had to talk about this because their spouse passed away or another family member was struggling? It’s an incredible opportunity at a very stark moment in time for us to intervene.
Kevin Pho: You mentioned that in your article that physicians during the pandemic were viewed as necessary and expendable. So, how did that realization affect your career trajectory, and did it influence your transition into starting your company and a more CEO role?
Arianne Nachat: Absolutely. You know, having young kids during the pandemic and realizing that we were health care heroes for a while, and then suddenly it didn’t matter that we didn’t have PPE or that we were putting ourselves at risk. And, you know, unfortunately, I did wind up ultimately contracting COVID, not once, but actually three times all within a 10-month period and have struggled with some issues related to long COVID as a result of that. And the fact that there are people who don’t seem to understand the really critical role we played and were putting ourselves at risk was very heartbreaking. And I think that it’s unfortunate that nowadays there is this very sort of passé approach that COVID isn’t an issue. COVID is still very much an issue. COVID is a disease we’ve never seen before, and we’re going to be writing textbooks about COVID for the next 10 to 20 years. We don’t know the implications of long COVID, but we are learning a lot more about it. So, for me, the realization was, what can I do to impact health care in a systemic way and at the same time take care of myself and my kids, putting them front and center?
Switching to a role where I have tighter control over my schedule was essential. I still work clinically, but I work fewer shifts than when I was full-time in clinical medicine. Now, I can schedule my meetings so that I am home and available for a kid’s event. I can take time off in a way that is more under my direct control. This doesn’t mean being a CEO is easy; it’s not. I get phone calls at all times of the day and night, but I can take those calls at home, do homework with my kids, and step away if I need to take a call. For me, the eureka moment was realizing our time here is limited. The importance shifted to being present in my kids’ lives and controlling my schedule to allow for that. It’s been a nice shift. I still work in the ER and do palliative medicine, but I don’t want to step completely away from clinical practice.
Being a clinician entrepreneur is vital. I don’t think health care should be shaped solely by MBAs making decisions from boardrooms without firsthand knowledge of patient care. Physicians understand what happens at the bedside and are in a better position to identify problems and devise solutions. This shift in my career has allowed me to focus more on home life and having a bigger impact beyond individual patient care.
Kevin Pho: I want to talk about that transition from clinical to business. There is a stereotype that physicians aren’t well-versed in business practices. How did you navigate becoming a CEO? Did you have any business background, and how difficult or easy was the transition for you?
Arianne Nachat: It was actually quite challenging. We don’t receive business training in medical school. I recently watched a Dr. Glockam Flecken video that humorously highlighted how little training we get on the health care system’s design. It’s a huge disservice to physicians. Earlier in my career, when I was building an integrative medicine service at Kaiser, I was fortunate to have allies who supported me in attending the Stanford Graduate School of Business for some training. I spent four months there learning the business side of health care, which was eye-opening. It gave me the tools I needed to build a business case and communicate effectively with business-minded people.
That experience was invaluable when I transitioned to building Pality. It prepared me to engage with venture capitalists, private equity, insurers, and other stakeholders. But one of the most disappointing realizations was that for many of them, health care was the least important aspect. It was all about return on investment. We chose not to take funding from private equity or venture capital because I had seen what happened in the hospice space, where three-fifths of hospices are now owned by private equity. This has resulted in a decline in patient care, which is heartbreaking. I’ve had patients sent to the emergency room where the nurse didn’t know their name or diagnosis. These experiences underscored for me that while it’s important to understand the business, maintaining quality patient care is non-negotiable.
I also realized that I needed to surround myself with a team that complemented my skills. I brought on a CFO who is well-versed in business and finance, allowing me to focus on what I do best while understanding enough to engage meaningfully in those conversations. The struggle has been recognizing that changing health care from the inside is challenging. Entrenched interests are resistant to change. This raises the ethical question of whether health care should be a for-profit venture. While I understand that people need to make money, when profit takes precedence over patient care, it becomes a moral issue.
Kevin Pho: You are uniquely positioned with experience in both clinical and business aspects of health care. You mentioned private equity, which is also taking over many emergency departments. How can physicians push back to prioritize patient care when private equity is focused solely on return on investment? Where do you see this leading, and what can we do as clinicians to push back?
Arianne Nachat: That’s an important question. Physicians need to engage in the political and legislative process. We need to form a unified voice. I know the idea of unionization is uncomfortable for many physicians, but other professions, like nursing unions, have shown that collective action can make a significant difference. Nurses can impact their salaries and working conditions because they stand together. Physicians, historically, have been more altruistic, thinking we’ll just do the right thing. But if COVID has taught us anything, it’s that we were expendable, and no one was looking out for us.
We need to advocate for ourselves as a group. More physicians are running for political office and speaking out, which is crucial. We need our own lobbying presence in Washington, D.C., and we must be willing to take stronger stands, even walking out if necessary. I’ve seen recent posts from emergency physicians being told their compensation won’t be met. In any other industry, like the pilots’ union, such a scenario would lead to immediate walkouts. But as physicians, we hesitate because people’s lives are at stake. We need to find a balance where we assert our value without compromising patient care.
Kevin Pho: We’re talking to Arianne Nachat, an emergency medicine and palliative care physician. Today’s KevinMD article is “A Physician Mother’s Struggle During COVID-19.” Arianne, what are your take-home messages for the KevinMD audience?
Arianne Nachat: First, get engaged. Find a way to move the needle on health care to make your experience as a physician better. We’ve lost too many physicians, whether to leaving health care or to suicide. We need to take care of ourselves. Second, engage in conversations with patients and colleagues about serious illness, death, and dying. These conversations should not be frightening. They empower patients and provide them with agency during difficult times. Lastly, we need to continue supporting one another. Whether you’re considering transitioning to entrepreneurship, leaving medicine for personal reasons, or aiming to be a better clinician at the bedside, we should encourage and support each other in all aspects of our professional journeys.
Kevin Pho: Thank you so much for sharing your story, time, and insight. And thanks again for coming on the show.
Arianne Nachat: Thanks, Kevin. I really appreciate it.
