{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/b27pn8zk8t/manifest","type":"Manifest","label":{"en":["Dr. Jody Harmsen"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2021-11-09 (created)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Subject"]},"value":{"en":["Covid-19 (topical term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","rural","anti-vaxxer","Iowa"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/202/345/small/Harmsen_Jody%2811-9-21%29_MD.mp4_1690912015.jpg?1690912017","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102723/file/202345","type":"Canvas","label":{"en":["Media File 1 of 1 - Harmsen__Jody_(11-9-21)__MD.mp4"]},"duration":3088.325,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/202/345/small/Harmsen_Jody%2811-9-21%29_MD.mp4_1690912015.jpg?1690912017","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102723/file/202345/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102723/file/202345/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/202/345/original/Harmsen__Jody_%2811-9-21%29__MD.mp4?1690912014","type":"Video","format":"video/mp4","duration":3088.325,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102723/file/202345","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102723/file/202345/transcript/47175","type":"AnnotationPage","label":{"en":["Transcript of Dr. Jody Harmsen interview [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/102723/file/202345/transcript/47175/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Crystal Bauer: Good morning. Today is November 9th, 2021. My name is Crystal Bauer. And we are conducting an oral history interview with Dr. Harmsen on her experience as a family doctor during COVID-19. Dr. Harmsen, could you please confirm for the record that you aware that this is being recorded, and that you are giving your permission to do the interview.\n\nJody Harmsen, MD: Yes, I'm aware.\n\nCrystal Bauer: Great. Would you please give us your name in full?\n\nJody Harmsen, MD: Jody Harmsen.\n\nCrystal Bauer: And what is your present title?\n\nJody Harmsen, MD: Physician. I'm an independent physician.\n\nCrystal Bauer: And where are you located?\n\nJody Harmsen, MD: I am in Iowa City. Iowa is where I live, but I don't work here.\n\nCrystal Bauer: Can I ask where you work then?\n\nJody Harmsen, MD: Yes, I travel. So Iowa City is an urban center in Iowa, small but it's an urban center in Iowa and I work rural.\n\nCrystal Bauer: Okay. The surrounding areas then state-\n\nJody Harmsen, MD: Pretty much. I mean, I work in Northeast Iowa, and I do have a couple of areas in Central Iowa and Western Iowa. So, not always just surrounding, actually. I travel quite a bit.\n\nCrystal Bauer: Good. Thinking back, where did you go to medical school?\n\nJody Harmsen, MD: I went to medical school at the University of Chicago, on the south side of the city.\n\nCrystal Bauer: And where did you attend residency?\n\nJody Harmsen, MD: I came back to Iowa. I went to residency at Mercy Family Medicine Residency in Mason City, Iowa.\n\nCrystal Bauer: And then decided to stay there once you were done with residency?\n\nJody Harmsen, MD: I grew up in Iowa. My family were all dairy farmers, and so I grew up rural. And I knew I wanted to come back and do that kind of work.\n\nCrystal Bauer: That's great. All right. Well, could you describe your employment right now as a family doctor, what you do on a daily basis?\n\nJody Harmsen, MD: Sure. So I actually went independent in 2018. There are a lot of things that changed right around 2016, for me. And so right now, I actually am self-employed. And I cover in small critical access hospitals. I do both hospitals medicine and ER medicine. Periodically, I'll cover in some clinics as well, some outpatient.\n\nCrystal Bauer: So I'm assuming, since you're independent and you work with different hospitals, do you see a different type of patients, or are they all fairly... What is your population look like that you treat, is it pretty diverse?\n\nJody Harmsen, MD: So I see majority role, and Iowa is majority white state. 93% of people who live in Iowa are whites. So I would say the majority of people I see are rural white members of our community. Because I work mostly in the ER and the hospital, I see all walks of life. But not as diverse as you would see in an urban center.\n\nCrystal Bauer: Sure. So thinking back to the onset of COVID-19 in 2020, could you describe how it first impacted your area and your practice as a doctor?\n\nJody Harmsen, MD: So interestingly, Iowa got hit later. Iowa is rural state, only a couple of large urban centers. And so we got hit a lot later. And people were pretty complacent. And then when we got hit, we got hit hard, because of the complacency and, unfortunately, some of the political beliefs. Iowa's state government, initially, did some pretty good things, and we encouraged masking and schools doing hybrid kinds of things, so trying to prevent some of the spread.\n\nJody Harmsen, MD: But where I work, in the rural areas, there was a lot of complacency and attitude, \"That is not going to come here, it's a big city problem.\" Unfortunately, of course, because people travel, it did come there, and then those communities got hit really hard. And so actually I ended up working more, while some of my clinic colleagues were laid off, or were working from home or doing all telemedicine. And some clinics actually lost a lot of providers, as did hospitals. Because when the pandemic first started, the hospitals weren't doing as many of the elective procedures. So a lot of the small hospitals, the critical access hospitals, they really rely on those procedures to stay afloat, because the majority of the patients are Medicare, Medicaid, and reimbursement is not quite as good. And so it's hard to stay afloat. And so they rely on their cataract procedures and their colonoscopies, and some of the specialists coming in and doing those procedures. And those all shut down. And so a lot of the hospitals also let go of a lot of staff.\n\nJody Harmsen, MD: And so working the way I do, my hours picked up. I did a lot more working, I covered a lot more in the hospitals and in the emergency departments. And then when COVID would hit those small communities, it would hit them hard. In a lot of the rural areas, it's very geriatric, especially in Iowa, there's been a lot of youth flight to the urban areas. And so for instance, the county where I grew up in, Clayton County, in Iowa, my whole family was there. The majority of them are still there. So my mother graduated from high school there, my father graduated high school there. And they graduated with classes of 100 people in their little small communities. I graduated with a class of 48. And my nephew, who still lives there and graduated, his class was 32. So there's been a lot of young flight, and so older people are there.\n\nJody Harmsen, MD: So you have a lot of nursing homes and a lot of assisted living and senior apartments, and COVID just wiped out many, many people. And the hospitals were full, and we had no transfer centers. I just remember, working in a small town in Clayton County, where the two nursing homes got hit really hard. And the floor was full of COVID, and we didn't have any transfer centers, they were full. So we had a lot of death. Because we couldn't keep intubated patients for more than 24 or 48 hours, because we just had the temporary vents. So there was a lot of hard decisions being made by families.\n\nJody Harmsen, MD: And then it went through the schools. Kids usually would get through it, but they would bring it back to their relatives. So really got hit hard. My own stepmother died, she was in a nursing home. And she died from COVID, from it being brought in by one of the nursing staff, brought it in from home. And before the vaccination, the nursing staff lived at home with their family. And there was, again, a lot of political views that prevented a lot of masking outside of the healthcare field. So people would go out and just behave as if it's a normal, and then bring it back to the people they were caring for.\n\nJody Harmsen, MD: So it was really stressful time. And it was super hard, because you would go to work and see all of this really awful thing going on. The families couldn't come in because we had all kinds of visitor restrictions. I mean, myself when my stepmother was dying, she was in the ICU at one of our referral centers. And we had to FaceTime her in her last hours. I mean, it was very, very difficult. So that's the experience I had at the beginning, when it all happened. When it was going on in the big cities in New York and whatnot, Iowa was behaving as if it's not never going to come here. But then it did, and it got very difficult.\n\nJody Harmsen, MD: Now, if you want to talk about post vaccination, and post when we were having shortages of PPE, same thing happened in those small towns. I would have to wear the same N95 shift after shift, after shift. And we'd save even the regular surgical masks, and you put them in a little paper bag. Some of the hospitals would do their little hydrogen peroxide spray, and all the little things that you would do to try to reuse and reuse. The small communities, actually, did rally around some of these small hospitals. Some of our older ladies would stitch up some masks for people to use.\n\nJody Harmsen, MD: So we'd have masks being dropped off at the hospital. And then there would be some of the community eating establishments would bring food for the nursing staff. And then we had a couple of the small manufacturing in some of the small towns actually made face shields for the clinicians. There was one small little textile company that made gowns for us, reusable. So they did rally, initially, when it became apparent that we were really getting hit hard. But after supply chains worked again, where we got the stuff that we needed, we didn't have to conserve as much, and more treatments became available. And the vaccine started to become a reality. That was all forgotten.\n\nCrystal Bauer: I had one follow up question with that, since you were in a unique perspective of being able to go to different hospitals, do you recall what really worked for some hospitals and what didn't, as far as like changing their policies? I mean, were some hospitals more successful in handling COVID than others, that you recall?\n\nJody Harmsen, MD: That's a very good question. So I would say, this is my personal experience, would be it depended on the buy in by the staff. So the critical access hospitals, unfortunately, in Iowa, there aren't very many independent critical access hospitals anymore, they couldn't make it on their own. So the majority of them are bought up by some of the big systems, which is not a bad thing, necessarily. It's just the state of affairs. And so the majority of the critical access hospitals, why work and worked, are under the MercyOne umbrella. And I don't know how familiar you're with MercyOne. Trinity Health is sort of the entire umbrella, and then you've got the MercyOne. So in Iowa, the three big systems are MercyOne, UnityPoint, and the University of Iowa, of course.\n\nJody Harmsen, MD: So the MercyOne hospitals, where I worked, had a very... Because they were affiliated with a large group, including some urban hospitals, they had great protocols that were always coming down and being updated and implemented. There was always something for administrators and whatnot to fall back on, and say, \"I know you might not agree with it, but this is MercyOne policy.\" So there would be grumbling, \"I don't want to have to wear a mask all the time, blah, blah, blah.\" By the staff, but they just knew they had to buy in. So the couple of independent hospitals, where I work, it wasn't that way. It was a different experience, completely. So I feel it really depended on buy-in by the staff to what experience I would have as a physician, as well as what experience the patients would have.\n\nCrystal Bauer: That makes sense. Could you describe, and you mentioned this briefly, the vaccine rollout, and how that has impacted your experience as a family doc, and the reception to both the staff in your hospitals as well as the patient reception to it?\n\nJody Harmsen, MD: It's very interesting. Personally, so one of the hospitals where I work at is my family hospital. My first job outside of babysitting was at that hospital, I worked as a high schooler. I worked in the cafeteria. So in that particular hospital, where I know a lot of the patients that are coming in, like they were my teachers, they're my family members of my friends from high school, or they are my friends from high school, unfortunately, or things like that. So in that community, it's a very rural community, and politically speaking, very conservative, but rally around each other and will protect their community at all costs. But unfortunately, in this world that we are living in right now, where there's so much vitriol regarding thoughts about who should be in charge, it was very difficult.\n\nJody Harmsen, MD: So the hospital, being under the MercyOne umbrella, were one of the early organizations that required vaccination for everybody that works there. Being under the Catholic umbrella, they do allow some religious exemptions. But in general, you were vaccinated, or find a new place to work. Unfortunately, because of like I said, the political vitriol that's going on at this moment, there were a lot of people who were upset about having to be vaccinated, people who actually work there.\n\nJody Harmsen, MD: In the communities, it was mostly nursing staff and support staff. The physicians, generally, were like [inaudible] could I get by now. So that made it very difficult. Sometimes there's some animosity just amongst the staff because of things like that. It was a rough. In the rural areas, in my experience, literally the majority of staff are women, female CEOs, female clinicians, like majority of support staff. So that makes it difficult, just working with people who are raised to be kind to everybody and let everybody feel good, but then behind, when nobody's around, that's when you start being more [crosstalk] about each other. So that made it difficult. That aside, I think the hospitals are working through it. We had some definite issues with people just leaving, like, \"I'm not doing it. Bye\"\n\nCrystal Bauer: \"I'm gone.\" So you have staffing shortages, would you say?\n\nJody Harmsen, MD: So there'll be some staffing difficulties. And already, there's minimal staff at small critical hospitals. So people who are working double shifts, it was difficult for those who were hanging on. And then those who were there and saw the effects of COVID, in a little tiny hospital, when we can't transfer anybody out, and you're doing everything that you can, but you don't have the capability to access to certain things, I mean, that takes a toll. And nursing staff in particular, who are constantly with the patients. And so we had a lot of hardcore old school nurses that were like, \"I'm going to stick with this. We're going to do this.\" But we were losing some of our younger nurses that have more reserve. It made it very difficult.\n\nJody Harmsen, MD: That's on the staff side, but on the patient side, it was even more difficult. Because the patients would come in, and I'd always ask their vaccination status, at the time when vaccinations were finally available to the regular public. And the majority would say, \"No, and I'm not getting that. Because I'm going to be microchiped, I'm going to be whatever.\" Whatever you're buying into at the time. Or, \"I don't believe in it, COVID it's not real. It's a communist plot.\" I've heard. \"It's a left-wing liberal plot.\" I mean, I've heard everything. \"It's the China virus.\" And these are very common conspiracy theories in the rural areas.\n\nJody Harmsen, MD: I've had patients get angry for me asking. I mean, I've had patients try to lecture me about how I don't know what I'm talking about. That's fine. I mean, I just take it all with a grain of salt. And I said, \"Well, let's just take care of you, do the best we can.\" What's nice is even in the rural areas, it did take a little longer for us to get the vaccine, because we don't have those deep freezers that required the storage. In the rural areas, Pfizer was not even available at all, because we would have to have those really super deep freezers, initially. So you'd find those mostly in the communities with universities or large urban centers.\n\nJody Harmsen, MD: So we had to wait for the rollout of Moderna. And then because we don't have a lot of the big chain pharmacies that made deals with the government to get access, it took even longer. So there wasn't wide availability as quickly as it was in the urban centers. And so we really started with the elderly population, making sure everybody in the nursing homes were vaccinated. Even my uncle wouldn't get vaccinated. It's really hard, I really struggled. Because my family, I have a large faction of anti-COVID vaxxers, not anti-vaxxers. But just-\n\nCrystal Bauer: Just the COVID.\n\nJody Harmsen, MD: In my own family, and even some of the elderly people in my family. So it's been difficult that way. But the experience as far as patients coming in, and then trying to educate them about taking care of themselves and trying to prevent future issues is a lot more difficult. I've had people rip off their masks, and I say, \"You need to put your mask back on, because you have these respiratory symptoms.\" \"I don't believe in all that.\" And I said, \"Then you have the right to leave, but I really do need to have you wear this mask to protect everybody else around you.\"\n\nJody Harmsen, MD: In small rural hospitals, we don't have a lot of ability to keep people away from other people. Especially when the pandemic first started, we had no negative pressure rooms. Half of our ERs just have curtains between beds. And some of these are all curtains between beds. So that mask was a super important thing that we needed to utilize. Luckily, as the pandemic went along and money started pouring in for pandemic relief, they could start doing makeshift negative pressure, and putting in equipment for makeshift negative pressure rooms.\n\nCrystal Bauer: I'm assuming the rollout for the adult vaccine was met with some opposition, and there was just approval for the five to 11 children's vaccine, and that was very recent. Do you expect there to be a delay in that vaccine becoming available in your area, and what do you think the reception will be to that?\n\nJody Harmsen, MD: I live this dichotomous life. So my immediate family moved to Iowa City in 2010 for my husband to get his graduate degree. So we continue to live here, basically. I don't think we'll ever leave because my husband is planted. And my kids, this is the only school they've ever known, because they were very, very young when they came here.\n\nJody Harmsen, MD: So in Iowa City, it is where the biggest university is in Iowa, so the University of Iowa, Big Ten. It has the highest level of care here. The main Trauma Center, it is the main referral hospital for severe illness. And so in our county and our city, the most vaccinated city in the state of Iowa, almost vaccinated county in the state of Iowa, everything is readily available. In fact when the five to 11 year old vaccine became available, our school system, I mean, we are super blessed, our school system is now, this week, holding vaccination clinics in 10 of our 13 elementary schools. They're actually vaccinating kids in the schools. My children are both teenagers now, they weren't at the time of the vaccine. My son just turned 13. But they were both 12 and older. So as soon as that vaccine became available, they got the vaccine the next day.\n\nJody Harmsen, MD: In the rural, it's a completely different experience. My parents still live in that rural little county that I was talking to you about. And it took them a long time to get their first vaccine, and they are, of course, elderly. And they haven't even gotten the booster yet, because they can't find availability for the booster, and that became available before the five to 11 year old. Which, of course, scares me, because I'm like we need to find this and so I'm contacting their providers. So yes. I do not even think now that it's available yet for that age group.\n\nJody Harmsen, MD: Do I think parents are going to give their kids that vaccine? Nope. I mean, I think that there are going to always be a collection. But I think the most recent, it was something like the NPR does these, the Iowa Public Radio. They do some of these little policies. And I think it was something like 28% of parents say they're going to vaccinate their children for COVID. It's a very bizarre experience, because they aren't anti-vaxxers. It's really interesting. So I have yet to encounter a parent saying, \"Yes, I'm absolutely giving my child the vaccine,\" in the ER, hospital setting that I've been working in, hospitals where I've been working. They don't see it as a thing.\n\nCrystal Bauer: Well, shifting views to more of a broader view, could you describe how COVID has impacted your current position overall?\n\nJody Harmsen, MD: Like I said, my work load has increased. So like I said, because of the staff shortages. When COVID first came to be, nobody saw it in Iowa when all of these were taking place. And they're like, \"Why are we doing this because I don't even see any COVID? Why are we not seeing elective procedures?\" And so I was asked a lot more to cover shifts. We had people moving on, people being let go, people being temporarily let go.\n\nJody Harmsen, MD: And then for a while, there was like a ghost town. So they needed somebody on to cover, so I would have more hours. But there wasn't a lot coming to the ER, because people were trying to stay away. Because they didn't want to get sick, didn't want to... And now, the ERs are overwhelmed. I am busy all the time. And it is a lot more higher acuity, and I'm sure it's because people weren't seeking care earlier. So their medical problems have gotten a little bit worse. And they're coming in and they're more sick than they have been.\n\nJody Harmsen, MD: And it's a mix now, because we still have pockets of outbreaks with Delta. We're in the small towns, and just now I got another call from my cousin. And she said one of the first grade teachers, because they don't wear any masks in the school in my hometown. Because COVID is not a thing. One of the first grade teachers brought it to, so all of these first graders have COVID now. And so now everybody's worried, because you bring it home. So I just got a call.\n\nJody Harmsen, MD: I mean, come on, it's November 2021 now. It's November 2021. What in the world? You've had [crosstalk] for almost two years. What the heck? So for me, I'm actually overwhelmingly busy right now. And a big part of it, I'm in these little tiny, small critical access hospitals that I don't have access to. I don't even have same day lab for some of the things that I need all the time. It's a send out for some of these just basic things like magnesium levels. I'm sitting on these super sick people because I can't get them out for hours and hours.\n\nJody Harmsen, MD: One example, one of the hospitals out in Western Iowa which is the most difficult hospital I work at, because they don't even have staff buy-in. It's a very bizarre... It's super, super... I'm not trying to be political at all, but it is very much unfortunately impacting care. Very politically conservative. And so even just nursing staff, they only put a mask on when they go into a room with a patient, otherwise they're mingling around together not masked. It's a very interesting, it's completely different.\n\nJody Harmsen, MD: We had to hospitalize COVID patient early 50s gentlemen, this is his third COVID diagnosis. But this time he was really sick. And they had him on the highest level... There the highest level of oxygenation they had available is BiPAP. You can't keep an intubated patient there. And the nursing staff called every hospital in Iowa, Minnesota, Wisconsin, no hospital's taking critical patients. Had to get a biplane out of Wichita, Kansas, to come pick up the patient in Western Iowa, to take them to Rockford, Illinois, because that was the only place they could find a bed. I mean, it was ridiculous. They called 36 different hospitals and health systems. When I say 36, some of these transfer centers you call are transfer centers for 10 different hospitals. So many more than 36 hospitals. It was closer to probably 100 hospitals.\n\nJody Harmsen, MD: And are the experience I'm still having right now, and it's not because we have a huge outbreak of COVID. I mean, COVID is still very active in Iowa because of Iowa politics, unfortunately. But they don't have the staff to staff all the beds they need, because eventually they'd let go all staff, and some staff had left because of the COVID burnout. And COVID patients in the ICU stay a really, really long time. So they don't get a bed as easily. And so-\n\nCrystal Bauer: It doesn't take a lot of patients for it to remain full and stay full for long time.\n\nJody Harmsen, MD: And so that if patients that aren't COVID related, I don't have a place to send them. I'm in this little tiny critical access hospital and I had a patient come in DKA, pH was 7.1, and bica was only eight. And I'm in this hospital where I can't even get all the labs I need to follow closely. So I've got a patient on an insulin drip and fluids. And I had to manage the fluids, and I couldn't even get my electrolytes back to manage fluids. And you worry about testing lower than you were all other. And I stayed on that patient in this hospital that I didn't even have full lab.\n\nJody Harmsen, MD: I mean, there's one ER nurse. I'm the only doctor for the entire hospital, one ER nurse, one floor nurse, and me. Three patients don't seem like a lot on the floor, but when you only have one nurse and three patients that are taking care of those, and then you have other patients coming into the ER but only have one nurse, and if some are going to be one-on-one with this DKA patient, diabetic ketoacidosis is what I'm talking about. I can't tell you, I called Minnesota, Wisconsin, Iowa. No ICU beds anywhere. And I'm like, \"Can you just give me a medicine bed.\" They don't even have the medical facility.\n\nJody Harmsen, MD: And really, honestly, this is only one of many that I've been through. In this case, I called the university back, because they said, \"We don't have a bed. Maybe we'll have a bed in two days for you.\" So I called the university back and I'm like, \"You are my only hope here. I really, really need to talk to you. Can please just put me through with a doctor like an ICU doctor, even hospital, somebody I can talk to. Because this patient, if she's going to make it, she needs to be someplace where we can at least get labs back right away.\" And I had a medicine ICU fellow call back, and he's like, \"Okay, I'll take her. I'll do this for you.\"\n\nJody Harmsen, MD: So this is what I'm experiencing right now. I mean, super stressful. You don't have what is available, and you've really got to make do. And this is happening everywhere. And every single shift, I'm sitting on super critical patients. Like we have bad trauma patients, I can't find beds for. I had a patient that had his heart attack, for God's sake, and I'm calling all over the place. I'm like, \"They need to go.\" And they're like, \"Well, is it a STEMI, is it a ST-Elevation in MI?\" And I'm like, \"No, but this patient's super sick and I can't get like-\n\nCrystal Bauer: You're never working in shifts, that's an easy shift, is what you're saying. It's difficult already.\n\nJody Harmsen, MD: Sorry. Yeah, [crosstalk] passionate about this stuff.\n\nCrystal Bauer: No.\n\nJody Harmsen, MD: And then we're keeping patients that generally we wouldn't keep. So in these small hospitals, when we don't have all the capabilities. And you probably seen the research. If you don't have immediate access to a stroke center, people don't do as well. If you don't have immediate access to a cardiovascular center, people don't do as well. So you see people not having as good outcomes in rural areas because they can't get the care they need. And that's exactly what we're experiencing. While it's not because we have a huge rush of COVID, it is related to the COVID pandemic, that this is happening.\n\nCrystal Bauer: Would you say, though, given your background as a family doctor, do you feel like that makes you more uniquely prepared to be able to handle the pandemic than those who are more specialized?\n\nJody Harmsen, MD: That's a great way to bring this all back. I think that is absolutely true. Part of the reason I say that is, because the uniqueness of my training, and actually, just what we can do as family doctors, I think that is absolutely true. Because I have always had to work through multiple difficulties, multi system issues, multi age issues. A lot of specialist are saying, \"Oh, go back to your primary care doctor for that.\" And so I think it does make us more uniquely qualified to do this. And I think that's why family doctor stay in these areas. That's why you don't find ER trained ER doctors in rural areas, you don't find internal medicine trained doctors in rural areas as much. If you're going to doctor really that is their bread and butter.\n\nJody Harmsen, MD: Uniquely myself, I mean, I actually trained in the inner city, and I have worked urban inner city. And rural, in addition, where there are always lack of resources. and so you learn how to be able to work with little. I think that uniquely puts family medicine at the forefront of this work; critical access hospital work, rural health center work, small ER work. I would never work in an urban ER. I don't have that kind of training. I don't have the training for multi gunshot wounds. And I fully admit that. I wasn't-\n\nCrystal Bauer: You know where your limit is, with regard to that.\n\nJody Harmsen, MD: Yeah. But I think that we have to manage so many multiple things just on a day-to-day as a family doctor, whether it be in the clinic, or whether be in the hospital, or whether be in ER. And some family doctors like myself earlier on, I did broad spectrum Cradle-to-Grave, I did deliveries, I did hospital, I had nursing home, I had clinic, and I educated. I was an attending physician, so I worked with students, and we know how to manage all that stuff. The payment, you're handed something [crosstalk]\n\nJody Harmsen, MD: But as far as the clinical issues at hand, we're uniquely trained to do that. Other people might run away being like that. We tend to run too, I know what it is, we tend to run toward the dumpster fires. We tend to run toward it and say, \"What can we do to help?\" I don't know, I think it might be a little bit of a mental illness that all of the family doctors have, but goes along that way.\n\nCrystal Bauer: So thinking towards the future, where do you see family medicine going?\n\nJody Harmsen, MD: Wow.\n\nCrystal Bauer: Big picture question.\n\nJody Harmsen, MD: I feel a little bit sad about this. Because I feel like... I was an attending residency and that residency closed. And one of the oldest residences in Iowa closed. So the University of Iowa and the Cedar Rapids Medical Education Foundation, they argue with each other about which one's oldest, for the family residency. They opened around the same time, in the early 1970s. And that residency closed, because the hospitals didn't want to support it anymore. There's two hospitals. It was very sad for me.\n\nJody Harmsen, MD: But what I was seeing in the residents as they were graduating is they were all specializing. They were all like great things. I mean, there's a lot of things you can do in it, which is amazing. The residents were going on to Geriatric Fellowship, they were going on to sports medicine fellowships, like great things, hospice and palliative care. Actually, so operative OB, and those residents came back to small town. But they were all leaving, I shouldn't say all, a chunk were leaving. And a lot of them are going on to do hospital medicine. We had a lot of graduating from our residency doing hospitalist stuff. And it's because of the lifestyle.\n\nJody Harmsen, MD: As a broad spectrum of family physician, which is what I always wanted to do, was my passion. And it's hard. It's really hard, especially if you want to have a family, you want to be able to be at your family events. Not to bring in gender, but there's a lot of women graduating family medicine. And if you want to have a family, and you want to do broad spectrum, it's really hard. And more and more demands are being put on the primary care doctor, things that are completely insurance driven and ridiculous. So you never get to leave. You never get to leave your practice. You might go home at the end of the day, but you've got-\n\nCrystal Bauer: Demand is still there.\n\nJody Harmsen, MD: You only got this in your inbox. And so you are taking care of that patient 24/7 even though you aren't seeing them in clinic. And you're doing a lot more. There's the checking the boxes for the quality stuff, and all those crazy things that take a lot of your time and take time away. Unless things change like that, I feel like the broad spectrum family doctor is going away. It's going away. I graduated from medical school, planning to do Cradle-to-Grave medicine, which is what I did for several years. And it took a toll on my family. I had a baby and I was back to work within six weeks of my first baby. And my husband would bring her in to breastfeed in the middle of the day at my lunch hour. I mean, it was really hard. And then when I had my second son, I was like, \"Screw this, I'm taking three months, my son.\"\n\nJody Harmsen, MD: The family medicine training is invaluable. But I see fewer and fewer doing OB, because of the hours and the encroachment. A lot of obstetricians don't want to see family doctors doing OB anymore. Similarly to some of the procedures, I had done [inaudible] my entire career in medicine until one of the hospital where I was working decided that that was going to be an OBGYN only procedure. I'm like, \"But wait a minute-\n\nCrystal Bauer: \"I can do this, I have the skills.\"\n\nJody Harmsen, MD: Unless things change where primary care is being considered a very integral part of medicine and all of these extra outside pressures are laid a bit, I don't know that you're going to have the broad spectrum doctor around very much longer. And I don't blame the young people. I see young people coming out who are like, \"Wait, what is all this craziness? I just want to take care of patients, I just want to be there for the delivery of those babies and take care of those families, and be there for the grandparents. But what is all this other stuff? How come I can't train to do colonoscopies? I thought that was something I could do.\"\n\nJody Harmsen, MD: I think in Alaska in some super rural areas, you can still find it. But it's a lot harder to get that training, so people are choosing lifestyle. So I have become more and more pessimistic about family medicine as the true Cradle-to-Grave. Can we keep a hold of that? That would be great. The thing I miss the most about doing the kind of medicine I do right now is, I don't have that whole family connection. And I miss that, I really do. And being in the community where they see you at the grocery store, \"Hey, doc, can you look at my thing down here on my ankle or whatever.\" My pastor say, \"Hey, I have this thing on my thigh, can you take a look at it.\" I miss that. But what I don't miss is missing all of my kids stuff, like missing important events and family life. So I can make my own hours now.\n\nJody Harmsen, MD: And I still get to see broad spectrum problems, because the ER is in rural areas. It's like clinic, a lot of it is like clinic. You've got like heart attack in one room and the next room, I've got this rash on my leg, can you please look at it. But I don't have that continuity. I miss deliveries a lot, like my last delivery was January 2018. So I miss that too, because that's a really important part in somebody's life. But our little small hospitals, they aren't doing deliveries anymore. They can't afford to keep the liability up and whatnot.\n\nJody Harmsen, MD: And this is just my little area of the world. Other people might be having completely different experiences, but I see it contracting more than I see it expanding. And that, to me, is sad. Because that's why I went to family medicine for, is Cradle-to-Grave medicine. I don't know that everybody is doing that anymore when they're going into family medicine, they have more of a vision of something little less than that.\n\nCrystal Bauer: More specialized. Well, I appreciate your perspective on that. Going back to COVID-19, is there anything that we haven't covered in this interview related to COVID-19 and family medicine, anything we haven't covered?\n\nJody Harmsen, MD: One thing. I mean, and I know we've been hearing about this, and I think it's absolutely true, that patient relationship that you have is what, I believe, impacts the most on decision making about COVID-19. And family doctors are in a unique position to do that. I know I'm preaching to the choir, and I know that this is been shown over and over again. Just as an example, like I said, during COVID-19, I have not been in clinic. So I have not had my own primary panel. But I have worked in my hometown hospital frequently. And like I said, I see my teachers there, I see friends of my parents, and unfortunately, I even see classmates.\n\nJody Harmsen, MD: And I had a classmate who has very severe asthma, and a lot of other medical problems, unfortunately, who came into the ER. I had to admit him for a severe asthma exacerbation. We were able to keep him at our little hospital. And he was anti-vaccine, which, to me, still super crazy. And he's very high risk, with other medical problems as well. And so one thing that's nice about having those relationships, I graduated from high school with him, so I've known him forever, and also another nice thing about working in a rural area and having the broad spectrum, is being able to spend some more time with your patients.\n\nJody Harmsen, MD: So I actually sat with him several times in the room, because I had around him every day. And we chatted about it. I'm not going to claim all of it, but he got the vaccine. So we talked about it and talked about it, and talked about it, and talked about it, and hashed it over, and hashed it over. He has a daughter who's in high school, and we talked about what happens, because unfortunately, his wife died of endometrial cancer a couple of years earlier. And he was all she had, they had one daughter together.\n\nJody Harmsen, MD: So he ended up getting the vaccine, and that's because of that personal relationship. And that is what family doctors can do. I feel that just needs to be emphasized, because you have that brief interaction with your specialist and they might be the best specialist on the face of the earth and they did some great things. But with that specialist, half the time you can't remember the name of that specialist right, or even remember exactly the last time you met them or be with them. But your family doctor is not that person. That is a person that you are constantly in contact with, and you can have these heart to heart discussions, and you can hopefully impact their life in a broader way to make some healthy decisions for their bodies.\n\nCrystal Bauer: Well, Jody, I'd like to thank you so much for doing this interview, and being a part of history during this unusual time of COVID-19. And thank you for sharing your experience so far with this.\n\nJody Harmsen, MD: Thank you for having me. 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