Medic 43, District One, Engine 51.
Response, cardiac arrest.
Hello everybody, welcome again to another
edition of the MCHD Paramedic Podcast.
This is Dr. Casey Patrick, and today I have
a special guest joining me remotely.
Kris Kaull is here to talk with us today.
He's the CMO of Pulsara, a critical care HEMS
medic, also, evidently, an inspiring ninja
as well.
So if you see him sneaking around quietly
with throwing stars and nunchucks, that's
Kris.
But in all seriousness, I brought Kris on
today to the show to discuss a topic that
evidently I think most people in my life would
probably say I'm an expert in, and that is
stupidity.
When you think about stupidity and what it
means or doesn't mean, it can be hard to define.
And now you're asking yourself, "Why in the
world is Patrick talking about stupidity?
This is a paramedic/EMS podcast."
This came from a web article that I found
several months ago, based on a conversation
between a couple guys, Shane Parrish and Adam
Robinson.
It was on Farnam Street, which is a finance
blog.
I'm not a finance expert either like Robinson,
who's a hedge fund investment guru.
I'm not in the CIA or a ninja, like Parrish.
But what struck me from the article, and we'll
link it in the show notes because I think
it's a quick read and worth everybody taking
a look at, is, number one, how hard "stupid"
is to define.
And number two, how much of the risk factors
that basically put you at risk for being stupid
apply directly to emergency providers of all
shapes and sizes?
So to start out, where we're going with this
thing is defining stupid.
It's not dumb, it's not a lack of information,
it's not the opposite of smart.
The definition that I thought was really poignant
in the article is stupidity is the act of
overlooking or dismissing crucial information,
basically when it's staring you in the face.
When we review run sheets here in the office
at MCHD, oftentimes the key players, the key
bits of information that the medics would
need oftentimes aren't hiding.
They're not under rocks, they're not behind
doors.
They're right there on the monitor.
Think back as you're listening to this.
Think back to your last run review, call review,
difficult case.
I know I've sat in that chair of having to
review care that was maybe suboptimal or problematic,
and every single one for me has involved missing
or not seeing the obvious.
One other definition that they discussed in
the article was stupidity is the cost of intelligence
operating in a complex environment.
I think that if there's a critically ill patient
in the back of an ambulance at 2:00 in the
morning on Saturday is nothing if not a complex
environment and your intelligence has to be
operating in that situation.
So run through, Kris, the seven risk factors
for us that Adam and Shane talked about in
the article for making stupid decisions.
Because as we listen to these, I think they'll
all apply.
Yeah.
Thanks, Doc.
You're right.
As we're walking through this and the cost
of being stupid or stupidity, you start thinking
about, "Oh, wait, are we talking about lack
of intelligence?
Are we talking about somebody who doesn't
comprehend information well?"
And it's simply not that the way that this
gentleman is defining stupid and in, Casey,
you said it, overlooking or dismissing crucial
information.
I remember reading the article and then listening
to a couple of his podcasts.
And he says, "You know.
When you're walking towards a door and you
go to go in, and you hit the door with your
face, because it clearly says Pull, and you
thought that you just pushed to go in.
The sign's right there.
It's very obvious, but where were you at that
time?
Your mind was distracted, or you've always
done that same thing over and over where you've
always pushed the door open, so you assume
this next door would push open.
And yet when it's right in front of your face,
that information, that's where we say, "Wow,
we missed that piece of critical, critical
insight that would've helped us with our patients."
We were pushing instead of pulling when the
sign right in front of us told us exactly
what to do.
So the seven risk-
It's funny.
It's funny you tell that story.
I'm going to interrupt you for a second.
No.
It's funny that that's the one you pick because
there's an old Gary Larson Far Side comic
that my mom framed and put in my room.
The sign on the wall says Midville School
for the Gifted, and the kid is running into
the door as the sign on the door says Pull.
Exactly.
I think that's one that has applied in my
life in various times and probably all of
ours, so I think that's a perfect example.
So yeah, back to the seven risk factors.
Yeah.
It's relatable.
Because all of us have either seen or have
done that.
And it's such a simple example of what he's
trying to talk to.
And he says, "Hey, there's seven risk factors.
Now you don't have to have all seven.
You can have one of any of these seven.
They're not in any particular order.
However, if you start having two of these
or three of these or all seven, maybe we should
be mitigating some of those risks.
Because the chances that you're going to do
something stupid are heightened."
So let's take a look at these seven and you
tell me how many of these sound like EMS,
whether we're in the helicopter, whether we're
in an ambulance.
It doesn't matter.
Whether we're in the emergency department.
Number one: being in a rush.
Number two: being outside of your normal environment.
Number three: being in the presence of a group.
Number four: being in the presence of an expert
or being that expert.
Number five: tasks that require intense focus.
Number six: information overload.
And then the last one: physical or emotional
stress or fatigue.
Any of those respond or make sense to you
in the world of EMS?
I mean, EMS, emergency department, it sounds
like the job description, right?
It sounds like what we're supposed to do and
where we're supposed to be working.
I mean, we're always in a rush, scene times,
turnaround times, door-to-dock times, door-to-aspirin
times.
It's all one big KPI time metric.
So number one is part of the job.
How about normal environments?
Are we ever in a normal environment in EMS?
I mean, it's never sterile.
It's always dark.
It's loud.
It's in the middle of traffic.
It's crying family members, it's barking dogs.
It's you name it.
And we can go on for ...
It's the unknown.
It's the unknown.
Yeah.
It's never, never planned.
No one calls 911 at 2:00 because they had
it on their to-do list earlier in the day.
Groups.
I mean, being in the presence of a group.
It's a team job.
First responders, firefighters, depending
on how your service is set up, police and
law enforcement, family.
And then we pick the patient up, we load them
in the truck and we deliver them to what?
Another group: ER docs, ER nurses, techs,
trauma teams.
You're always in the presence of a group;
it's not a solo job.
What about intense focus?
Does that apply to EMS, Kris?
That's almost a dumb rhetorical question.
There's constantly intense focus that's required.
I mean, again, it sounds like a job description.
Pit crew CPR, intense focus; airway management,
intense focus.
Think about all the information you have in
a 15-minute transport in the truck: vitals,
12-lead, Accu-Chek, entitle, family information,
med list, allergies, past surgical history,
past medical history.
And then that's going to occur at 3:00 AM
on a Saturday, your fourth shift in a row,
and you had a pediatric arrest the night before
that stuck with you.
So physical, emotional stress and fatigue.
I mean, these are all built-in parts of the
job.
So we defined stupid.
We decided that our chosen profession is one
humongous, steep plunge into a stupid pit.
How do we combat this, Kris?
What are some ways that, in your past experience,
that you've either combated it or maybe fallen
prey to some of these?
Wow.
Yeah, that's a big question.
I think what we do is we take each one of
these and we walk through them, because there's
lessons learned in each of them.
I mean, the challenge for us in EMS is that,
just like you said, these seven risk factors
are our job description.
So are we ever not in a rush?
I don't know if we're in a rush.
I think we need to move with intention.
Let's start with that one.
When we move too quickly or rushed, we make
mistakes, and those mistakes are what we're
defining as stupid right here.
So instead of rushing, what do we do?
One of the things that I do and I did for
years working both on a helicopter as well
as on the ambulance is that I would plan for
that day and I would plan before we were going
on the call.
Some of the simple things we do is truck checks
and making sure all our equipment is ready.
We don't do that on the scene.
We do that as soon as we get on shift.
The same thing though, and I was really regimented
about this, is that I would lay out all my
stuff: my helmet, my jackets, my gloves.
I would lay them out in a specific order.
I would have a list of what I would go through
every single time.
So that instead of being rushed, I associate
the word "rushed" with chaos, so instead of
being rushed with chaos and in your mind trying
to remember everything, I put everything into
a system: "Oh, all right.
So I'm going to go down.
Pilot's checking weather.
I'm going to open up the door to start moving
the helicopter out.
I have all my gear laid out exactly where
I need it."
I'm writing down, I'm coordinating.
And while we're moving with intention, that's
different than the word "rush."
I like it.
I like that a lot.
I would extrapolate that maybe a little bit
away from the operational side to the clinical
side.
For example, delayed sequence intubation,
you have a framework and a thought process
that you approach with a similar language
and a similar mental checklist every time.
And you use that.
You practice that mentally.
You're not ...
It's like your sock drawer.
It's organized by color, it's organized by
type and it's laid out neatly so when you
open it, you can find what you need.
Whereas, if you haven't thought about delayed
sequence intubation, you have no checklist,
you're just randomly grabbing factoids and
different practice patterns out of your brain,
it's going to be chaos instead of rushed with
intention.
And I like that a lot.
So checklists don't help if you rush.
We have to slow down, be intentional and use
similar language, repetitive language, so
that it's not chaotic.
I like that.
How about number two?
Yeah.
Yeah.
And I just wanted to add onto your rushing
there, delayed sequence intubation or induction.
One of the things that I have seen a lot in
the clinical setting is that clinical timeout.
Right before some type of high-risk, low-frequency
situation that we say, "Stop.
Okay."
While we're also taking time and going through
the list and making sure everything's there,
we're also double-checking each other where
we're walking through what happens if.
I always think of, it's not a good time in
a bad airway and it's not, will I have a bad
airway?
It's when I have a bad airway.
It's not, that's not a good time to think
of plan B and plan C.
So that's before you even get into that situation,
if this doesn't work, "Hey guys, we're stopping.
We have our drugs drawn up.
Just double-checking.
We do have suction, we have our bag valve
mask.
If we don't get the intubation in this first
time, we were going to come back, re-ventilate
the person, get some more oxygen on board.
And then what's the plan, team?"
And walk through that.
Everybody calms down, everybody slows down.
But in essence, the task gets done more effectively,
more efficiently, safely and quickly.
So instead of rushing, we're just being intentional.
That second one you asked about as being outside
of our normal environment.
Well, that's what we do.
Now, some people would say, "Outside the normal
environment is our normal environment."
But I think what we're talking about here
is that even if we talk about car crashes,
each crash is not at the same location with
the same type of cars, with the same type
of injury patterns every time.
So even when we talk about motor vehicle collisions,
we're talking about rural, high speed, ice,
snow, rollovers, extrication, trauma.
Maybe it's a medical incident that happened
that caused the motor vehicle crash.
I mean, there's so many dynamics in there
that is our, quote/unquote, "normal environment,"
which means that we don't have a normal environment.
And I'm going to ask you this: How do we get
around that?
What are some factors we can do to help contain
or control or limit that area?
Yeah, I think we can take it back to a lot
we discussed in number one, and I think some
of these themes are going to be recurring.
We know that we're going to be time-challenged.
We know that we're going to be uncomfortable.
And every situation for the most part is going
to be a new one.
So these scream out for structure, for delegation,
for checklist utilization in a methodical
approach.
Again, if you are pulling your care pattern,
your care plan, out of thin air every single
time, you're going to make mistakes.
But if you approach each chest pain with a
similar differential, the chest pain killers
that we like to talk about here at MCHD, or
if you approach your airway with the same
delayed sequence pathway: rule of fifteens,
hard stops for blood pressure, hard stops
for oxygen saturation.
If you approach your basic airway skills:
bag, valve, mask, OPNP airway, a good chin
lift, jaw thrusts, you use your same patterns
over and over again.
And you verbalize those, you delegate and
you have a solid framework or structure to
your care, I think the rush, the time requirements,
the new environment that you're going to find
yourself in on each and every call is going
to be less dangerous.
Yeah.
I couldn't agree more.
You guys are familiar I'm sure.
And if our readers, if there's anybody out
there and listeners who aren't familiar, we
can add it as a must-read book into the show
notes as well.
But it's that it's The Checklist Manifesto.
And in The Checklist Manifesto, he talks about,
as a surgeon, we have simple, complicated,
and complex.
Simple is opening and closing a door; complicated
are all the steps needed to successfully intubate
a patient.
And then complex is, an example would be raising
kids.
You raise two kids.
You only know how to raise kids one way.
And yet the two children grow up being completely
different.
That's complex.
And he's like, "We don't really need a checklist
on the simple things of opening, closing a
door.
We can't put a checklist on the complex.
But what are the things that we can do that
are complicated?"
Because there's a lot of moving pieces but
they're pretty standard and they're consistent.
And if we do the same thing each way, it's
going to minimize all those variables, and
that's really what you're talking about.
I think a lot of times emergency providers,
I speak for emergency docs and I've heard
similar vein complaints from seasoned paramedics
as well is like, "I don't want to practice
cookbook medicine."
People complain about checklists and I love--I've
talked about it on the podcast before, the
pilots go through the same pre-takeoff checklist
no matter if it's bluebird or storming, no
matter if it's a 45-minute flight or a transatlantic
flight.
They don't cut corners with their pre-flight
prep.
I think we get in the same issue.
It's not a bad airway until it's what?
A bad airway.
If you've not completed your pre-procedure
prep and you've not organized your framework
and you've not briefed your team, you can't
go back and do that once there's turbulence.
So I think we have to be humble enough to
know that yes, we know how to intubate, but
that checklist is there to help us.
It's there to help us provide a framework.
It's not there to tell you what to do.
In a sense that there's still room to make
individual patient decisions, depending on
the individual patient presentation.
You still have leeway in there.
But that fallback, that framework, is going
to be necessary.
Every time when we try to deviate from that,
in me personally and my own experience, that's
when those mistakes had been made.
When I don't think about it and assume it's
going to be easy and assume it's going to
be straightforward, and that's when that's
when those airways or those maybe not-so-sick
patients that turn out to be really sick sneak
up on you.
Yeah.
And I hope, and I think, and I'm glad to hear
your team is really adopting the opportunity
to use checklists and walk through that.
We were raised in this area that it all had
to be in your mind.
And if you didn't keep it all in your head,
then you must not be a good medic.
I was talking to Mike Taigman.
He's spoken and has done so many things on
leadership and personal development and doing
these things.
He's like, "If I ran an ambulance service
now, I would buy an iPhone for every one of
my medics.
"I would have them say, 'It's your phone I'll
pay for it while you work here.
I'm going to pay for the phone.
I'm going to pay for your monthly.
And your only requirement is that you keep
these five or six apps on there, because I
don't want it in your head.
I want those things to be a resource that
you look up and do that so that you can actually
use your brain power to make critical-thinking
decisions.'"
That's in parallel to one of my pilots, a
good friend of mine.
He's a commander with the US Navy to this
day.
And he was just astonished at the fact that
we tried to stuff everything into our brains
and memorize it.
He's like, "Man, we are in such a checklist
culture in aviation that it just seems that
you guys are loose cannons."
I mean, he actually looked at it as negligent.
Where he's like, "I have checklists to make
sure the basics are done, which frees up my
mind and I'm not being overloaded.
I can focus on flying the helicopter during
an emergency.
That's what I need to do.
I don't need to remember XYZ emergency.
I can look at the list and follow those steps.
I need to navigate and aviate this helicopter."
And that's exactly what you're saying.
We need to free up our mind from all these
other things that we can memorize so that
we can actually treat the patient.
So checklists, I think, is going to be key
both to rushing and being outside your normal
environment.
It leads us nicely, I think, into number three,
which is group pressure.
When I looked at group pressure and thought
about being in the presence of a group being
a risk factor for being stupid, my initial
thought was, "Turn that 180 and use the group
to your advantage.
As opposed to letting the mob control you,
you control the mob."
If you're the senior-most skilled medic on
the scene, you are the boss.
Use the family to collect vital history, use
the law enforcement to help control the patient,
control the family, control the crowd.
You've got first responders or firefighters
on the scene, use your partners, your other
crew, to gather and record information.
Give everybody clear, calm instructions, and,
again, reduce the chaos, like we talked about
with number one.
It doesn't mean that you're not moving with
intention, but it's not chaotic.
And when you combine using the group to your
advantage with the checklist, again, you're
trying to turn those things around.
And rather than making them risks, you're
making them a help or a benefit.
Does that make sense to you, Kris?
Yeah.
So number three, like you said, was group
pressure and then number four is expert presence.
I'm going to give you two different stories
about these two, because one is you're the
expert or somebody's an expert in the group.
And the other one is the group mentality.
There's a great TEDx talk that came out of
our area here.
We have a snow science school.
I'm based up here in Montana.
One of the TEDx talks a couple of years ago
was from one of the avalanche experts.
He spoke on groupthink and group mentality.
There was an avalanche where one of his students,
who, in all intensive purposes knows more
about avalanche safety and control, and she
was ultimately killed when they triggered
an avalanche doing back-country skiing.
They went back to human risk factors and what
you ended up doing or what they did in this
group ... and once again, let me put that
TEDx talk about the avalanche into the show
notes, because I think it's applicable to
EMS.
But with the group, when they were all experts
and they were heading up there, she may have,
and we're just extrapolating, but may have
felt, "I wouldn't have gone this far if I
wasn't with people that aren't as good as
I am or have this knowledge."
But because she was with people who she thought
were better than her or as good as her, and
if they felt confident, then "Clearly, I might
be missing something about this area."
And they ended up going further out than they
probably would have had they not been in a
group.
Now, of course, in snow safety, you always
go with a minimum of two people.
But it's interesting, because then I took
that to EMS and I said, "You know what, when
I'm with a group of people I know ... Let's
go back to Commander Williams with the US
Navy as a pilot and a flight nurse, Em, Emily,
and Em and Matt and I flew together for many,
many years.
And then I would work a shift where I would
have a brand-new pilot and/or a brand-new
nurse, or maybe I covered a different base,
and my entire crew is new.
Well, I'd double-check everything they were
doing.
When the pilot was doing the pre-flight checks,
I would double-check her or him.
If my nurse was getting ready to push the
medication, I would be super on top of double-checking
those dosages for that nurse, for him or her,
in reviewing that.
I think it's actually the opposite.
As I was listening to that TEDx talk about
avalanche, I'm like, "I actually have gotten
complacent with the group that I know.
My partners and the firefighters and the team
I know, I'm assuming.
I know their skillset, so I assume that they're
doing okay."
That gets us to fall into these areas where
if we all are making errors or can make errors
and we all could be in a rush or outside our
normal environment or in this group, it's
the team that you're most comfortable with
is where I always have that tingling or that
sixth sense where we should probably be thinking
about this and double-checking each other
and even being more vigilant in that group.
That's actually a direction I hadn't thought
of.
And as you're telling the story, I've had
a couple different emergency medicine lives
and different hospitals, different situations.
My first job out of residency was at a community
hospital with a ton of nursing turnover, a
ton of young nurses.
So when we did airway management, I was very,
very aggressive with being direct and verbal
and exact, and this dose at this time, then
this.
And just really made sure that I was dotting
I's and crossing T's.
My second job was at one of the local hospitals
here in Montgomery County, and the nursing
team that was there had been there for forever,
longer than I'd been an emergency physician.
They could run the airway as easily as the
doc could.
And the first airway management case I had
there, I did the same normal practice pattern
than I had had.
They all just busted out laughing like, "Really?
You want us to give the sedative report before
the paralytic, Doctor?
Why would you want us to do that?
That doesn't make any sense."
And obviously sarcastically, because what
I told them was obvious.
Right.
Right.
But in the end it was just me being safe.
I think that after my 10th or 15th or 20th
airway with that crew, I think that's the
situation you're talking about with, if you're
surrounded by people you trust, sometimes
you can be a little more lax and a little
less exacting.
And that's probably not a great habit to be
into.
So move us into five, six.
Five, and six really kind of go together to
me, so I'm going to hit those relatively quickly
because I think they overlap with some of
the others: focus, tasks or tasks that require
intense focus and information overload.
Again, from a focused task standpoint, we
talked a lot about checklists and delegation
and being in a group.
I think, again, trying to use those to our
advantage for these focus tasks or the complicated
tasks like you talked about, Kris, so that
we can free our mind to make the more patient-specific
medical decisions.
And information overload, really, that's a
skill of sifting and sorting that I don't
know how to teach it.
I've kind of struggled with that.
It's one I think comes with experience.
You've got to gather all that information.
You've got to sort through the junk.
Sometimes, though, when we talk about the
stupid part of overlooking or dismissing crucial
information, one that comes up over and over
and I'll run reviews here at MCHD on my own
personal, bad patient outcomes is the vital
signs.
I use this all the time, half joking, but
we don't call them the "kind of important
signs" or the "somewhat important signs" or
the "every now and then, these are useful"
signs.
They're called the vital signs, and those
should be what directs our care from the start.
Things like diaphoresis, power, altered mental
status, those big exam findings that are really
unassailable.
Like somebody's altered, somebody's pale and
ashen, if their sweat beaded all over their
face and it's 42 degrees outside, they're
sick.
We know that.
If their heart rate's 140, we've got to justify
and rectify that.
If their pressure's 70 and they're pale, don't
take the blood pressure seven times expecting
it to be 120.
If they look like a sheet and their heart
rate's 140 and they're had vomiting and diarrhea
for a week, then their pressure probably is
70.
So sift and sort, delegate, use your checklist.
I think those things we've already talked
about are going to help us with focus task,
help us with information overload.
Then, finally, number seven: fatigue.
And again, this is an entire podcast topic
in and of itself, but at least it's becoming
less of a culture of ... I think at least
here at MCHD as far as toughing it out, that
was the way I was trained 18, 20 years ago
was that no retreat, no surrender, no complaining.
But there's a time for rest.
There's a time when call volumes reach that
critical level.
At MCHD here, we have no-questions-asked rest
time if you need it.
And that's there for a reason.
It's there because we know there's a point
that you can pass safety, where it becomes
unsafe to continue working.
And you wouldn't want your family member cared
for by someone who was snoozing or had been
up for 29 straight hours.
So use it if you need it.
Then as far as emotional fatigue, necessarily,
I think to tease that one out, because this
job's tough.
Those pediatric arrests, mass casualty incidents,
drowning, those are tough to be a part of.
And debrief, talk, counseling, all those things
are available and they're beneficial.
There's no reason to tuck all that inside.
It can just metastasize.
So that takes us through the seven: rushing,
outside your normal environment, group pressure,
expert presence, focused tasks, information
overload, and fatigue.
Anything you want to add to any of those,
Kris, before you start to wrap it up here?
Yeah.
Good job on the fatigue call-out.
When we're rested, I always think that I always
joke even at home, the most two important
things we need to do is be well fed and well
rested.
We just make better decisions.
We make better decisions when we're out with
our friends.
We make better decisions as a family.
How can we not make better decisions when
we're well rested and well fed, when we're
taking care of patients?
And with the emotional side of it, my thing
is there isn't a right answer for each person.
We all have different thresholds.
However, it is a common theme.
We've all experienced a level of burnout.
We've all gotten frustrated or bitter.
We've all had other life factors that have
added on top of that.
So those people that are listening, you're
not alone.
I think there's good ways to deal with that.
You listed a couple of them: debriefing, talking,
counseling and physical activity.
Walking, running, exercising.
And then there's poor ways that we are really
good at in EMS of taking care of this stuff.
I don't know what you're talking about there.
Exactly.
What could you possibly mean, Kris?
Yeah, exactly right.
And so our list includes alcohol and fast
food and not sleeping and on and on and on.
So we can take all those, and they're all
outlets.
And choosing the more positive ones for our
body and our health are going to help us in
the long run.
Yeah.
I mean, I've got teens, junior high kids at
home.
And as you were talking, you think about we
just went back to school, we're recording
just after the holiday and it's time to get
back to school.
So what we do for our kids?
Get in bed early.
You get a good dinner, you got to go to school
tomorrow.
You need to get a good night's sleep.
And then what do we do when we're going to
take care of critically ill patients?
We don't sleep, we eat poorly, and we don't
exercise.
And why would we expect a different outcome
other than poor?
We tell our kids to do one thing and then
we go and do another.
When we're in markedly higher-stress, overloaded
situation, than second period, world history.
So it's pretty bizarre when you really think
about it that way.
So to just to take us home again, I want to
thank Kris for joining me today as someone
who has been there and done that really in
every facet of EMS medicine.
It's always nice to have that perspective
when we're talking about more operational
things than clinical, and I think this one
really straddles the line.
But just remember: No matter how smart you
are, we all work in an environment that's
ripe for stupidity, all seven, every call
just about.
Taking it back to GI Joe.
I was a GI Joe watcher when I was a kid and
GI Joe used to say that knowing is half the
battle.
A lot of these risk factors, they're movable
objects in EMS.
We can't get rid of timestamps and metrics.
We can't get rid of the dark highway and the
car crash.
We can't get rid of information overload.
But knowing is half the battle and being aware
and recognizing the risks and anticipating
them, that goes a long way for conquering
them.
A deliberate practice is vital.
I love, I'm going to steal it, that just rushing
equals chaos and we don't want chaos.
We want deliberate action and deliberate practice
as well, and these are vital.
Verbalization, delegation: vital.
Nobody needs a checklist until what?
Until they do.
You can't pick and choose when you're going
to pull your checklist out of your pocket.
It's got to be habit.
And then, finally, I say it all the time,
but vital signs are vital signs.
Don't ignore the objective things that are
staring you in the face.
So again, Kris, thanks for joining us.
We're going to post the Farnam Street article.
Kris' checklist manifesto, couple Ted talks.
Good stuff for you guys to look at after the
podcast.
As always, if you have questions or ideas
for future casts, shoot us an email: podcast@mchd-tx.org.
Leave us a review or a like wherever you listen
to your podcast.
And again, thanks, Kris.
And we'll talk to y' all soon.
This podcast was brought to you by the Montgomery
County Hospital District, Texas.
Production and editing by Andrew Adams.
Questions or comments, which are always welcome,
can be sent to podcast@mchd-tx.org.
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Music copyright Kevin Macleod, Incompetech.com,
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