Podcast Episode 57 | Full Scope Primary Medical Care in Rural America

Full Transcript

Zed Zha (00:00):

We hold people's hands. When they die, we deliver babies when they come to the world. It's a cradle to the grave kind of practice that we do here.

Voiceover (00:10):

From Spaugh Dameron Tenny it's the Prosperous Doc podcast. Real stories, real inspiration, real growth. A show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.

Shane Tenny (00:29):

Thanks so much for joining us for this episode of the Prosperous Doc podcast. I'm Shane Tenny. Glad to have you with us today. In 1948, the term country doctor was popularized through a photo essay in Life magazine of Dr. Ernest Ceriani. Dr. Ceriani was photographed treating patients in his clinic, in their homes, in the back of cars, in the hospital.

Shane Tenny (00:57):

There are still over 46 million Americans who live in rural parts of the country and country doctors are still essential to our nation's healthcare. The closest thing to an original country doctor is now a rural full scope family medicine physician. They participate in attending clinic, delivering babies, admitting and treating people in hospital, conducting nursing home rounds, providing hospice care, just to name a few.

Shane Tenny (01:27):

Well today on the Prosperous Doc podcast, we are speaking with Dr. Zed Zha about finding her purpose as a country doctor and her advocacy work. Dr. Zha works as a full scope primary care physician in rural Washington state. She graduated from the Geisel School of Medicine at Dartmouth and completed her residency training at the Mayo Clinic La Crosse Family Medicine Residency.

Shane Tenny (01:49):

Dr. Zha is a clinical instructor for the University of Washington School of Medicine. And somehow in between it all has found time to speak with us today. Dr. Zha, thanks so much for being with me this afternoon.

Zed Zha (02:01):

Thank you for having me. That was a great introduction. Thank you.

Shane Tenny (02:04):

Well, I think you've got a great story to tell. So I'm excited to just be able to share with everyone a little bit about your journey. Let's just dive right into the question that occurred to me after we connected. And that is you did all this training in Boston, in urban environments and academic centers, where in the process did you decide I want to be a country doctor?

Zed Zha (02:28):

Yeah, that's a great question. So I knew from a very early stage of my training that I wanted to do primary care, family medicine. So I particularly love to deliver babies and I love geriatrics, all sorts of age groups. I really enjoy dermatology too. So in the United States, there has been a really steady decline in full scope primary care, a scope primary care, like how I'm practicing.

Zed Zha (02:53):

So I think it's due to highly specializing aspects of medicine and also liability reasons, especially in urban areas where there are plenty of specialty care. So in order to not give up all the things I love in medicine, I came to rural areas.

Shane Tenny (03:11):

So you mentioned a few things, geriatrics, OB work, Durham, what are the types of work? What is included in full scope and what types of patients do you see in rural Washington State?

Zed Zha (03:25):

So in primary care, of course we are primary care doctors. We do lots of chronic care, preventative care. So we see people in clinic, but in my population, in Eastern Washington, I work in a rural farming community, about 8,500 people. About three quarters of my population are Hispanic or LatinX according to the 2010 census. But I think it's a lot more than that today.

Zed Zha (03:51):

Most of the people are first generation or second generation immigrants from Mexico. Many are here to work on a work visa. What we call H-2A visa. I would say the majority of my patients are actually Spanish speaking, some speak Indigenous languages that we don't always have a interpreter for. Most people are young. So we deliver lots and lots of babies. We have a really popular and busy OB practice. Our patients also suffer disproportionately high rates of chronic medical conditions due to health inequity.

Zed Zha (04:24):

So we do see lots of chronic care patients. But us, rural family physicians, we also are the ones who admit people to the hospital. So when people are sick enough to be in the inpatient units, we're the ones who admit and round on them and take care of them and discharge them. We do nursing home rounds and we conduct hospice care. So we hold people's hands when they die. We deliver babies when they come to the world. It's a cradle to the grave kind of practice that we do here.

Zed Zha (04:55):

Because of our patient population in farming community, in the working class, we do see a lot of acute care too. A lot of injuries, many urgent care related things too. So really a full variety of things that you could see in medicine in general.

Shane Tenny (05:11):

And do you ever get to sleep?

Zed Zha (05:14):

I...

Shane Tenny (05:15):

How many partners sleep in your practice? Because this sounds really busy.

Zed Zha (05:18):

Yes. It's very, very busy. I would say if you are somebody who gets called in the middle of the night for a question from a nurse about a patient you're taking care of in the hospital, or you have to jump out of bed to go deliver a baby, and then you come back home and you can't fall asleep in the middle of the night, it's probably not for you.

Shane Tenny (05:39):

Although I would argue if sleep is really important to you, medicine may be the wrong profession anyway.

Zed Zha (05:44):

That's a fair point too.

Shane Tenny (05:47):

So in the community you describe with the predominant population being immigrants, or even undocumented workers, I'm imagining that there sometimes a barrier of trust or suspicion around kind of the system. How you kind of work to build trust with patients or kind of break through those fears on their part?

Zed Zha (06:11):

That's an awesome question. I think that's so essential in what we do and how we practice every day as country doctors, because in inevitably speaking, we're probably from a different community. Me, for example, I grew up in Beijing, China, one of the biggest cities in the world. Currently, I think we have 21 million people living in Beijing. So it's an adjustment.

Zed Zha (06:35):

I think me being an immigrant myself, coming from the Chinese culture, I do have the advantage of sharing a lot in common with the immigrant populations I serve. For example, I grew up in a multi-generational housing situation where a lot of our patients still live right now. We both share this relentless respect for our elders. Some of our food elements are pretty similar too. We eat lots of spicy food, lots of different variety street foods and such.

Zed Zha (07:03):

But I think most importantly, I know what it's like to come to a country by myself. Not knowing how to speak the language fluently. Having to start over as an adult. I do have a lot of privileges in life. I think I share some of the hardships or disadvantages with my patients. So to a degree, I think I get it. That's one of my advantages.

Shane Tenny (07:28):

You mentioned a minute ago, just translation services, I guess, through your practice or the hospital system you're affiliated with you have adequate translation services or how do you bridge the language barrier at times?

Zed Zha (07:40):

Most of our medical assistants are bilingual, almost all of them. So we do have that advantage. They can be our assistants. They can also translate for us. We utilize technology to translate too, but we definitely prefer in person interpretation. For the languages that we don't have a formal interpreter for, we have a couple of staff in our organization that speaks the Indigenous language. So we try to schedule our patients, these patients, at a time when these staff are available, even though they have their other day job to do and they're willing to help us.

Zed Zha (08:17):

And this is a small community, we take care of people's families, friends, so whatever we can do, whatever staff can do to help make the visits easier, whether it be helping us translating or just getting patients from homes to our clinic, we're willing to do it.

Shane Tenny (08:39):

As you went through your training, medical school, residency, you're doing rounds in different departments, you're getting exposed to, as you mentioned, dermatology, the OB/GYN rounds, where in there did you get exposed to the concept of just, "Oh a full scope country doctor gets to do all these." How did your training kind of prepare you for what your days look like now?

Zed Zha (09:04):

I would say in terms of medical management, my medical school and residency really prepared me well. Both of the places I went to, Dartmouth and Mayo Clinic in La Crosse, are very inpatient heavy. Which means we took care of the very sick patients. We were the ones who round in the ICU. We admitted every three patients a night in the hospital. We attended all the deliveries in our residency, for example.

Zed Zha (09:32):

So I think that prepared me well for the full scope practice that I have today, which makes me capable to do the work that I do. Once you recognize what it is like to be very, very sick, you could, and also very healthy, you could kind of see the spectrum in between.

Zed Zha (09:52):

My residency training in Mayo Clinic La Crosse was very rigorous. We were very fast paced. We had to learn how to multitask super fast and got stuff done. So we didn't have time to procrastinate, which really helped today because we have so much charting to do. At the end of the day, I'm able to get my stuff done and go home and still, somehow, have a little bit of life. So I think that's really important.

Shane Tenny (10:18):

That's actually a great technical point that I think is worth expounding a little bit. So you chart as you go, you don't let a pile up till the end of the day?

Zed Zha (10:26):

Oh, gosh, you can't. You can't do that. I do chart as I go and sometimes, these days I try to speak Spanish to patients, I'm practicing and learning. But when it's complex and I'm waiting for the translation to happen, I purposely put my patient in front of me by my computer. So as I'm typing, as the translator is talking, able to make some eye contact, but also writing notes at the same time.

Shane Tenny (10:53):

Now you write a blog and in one of your recent blogs, you wrote that, "Country doctors are a dying breed." Now the shortage of physicians over the next couple decades is pretty well publicized. What would you suggest medical schools or training programs do to expose more physicians and recruit more docs into full scope primary care in country medicine?

Zed Zha (11:19):

That's an important question. I think country doctors need to be elevated societally in America. And I don't mean fame and fortune. I mean to let people know about the importance of country doctors out here doing the huge amount of work that we do, advocating and fighting for our patients who are a lot of times marginalized in many, many ways.

Zed Zha (11:44):

I do see lots of medical schools emphasize primary care in their education. So thank you for doing that. But I think the misconception of family medicine, primary care, rural medicine have to stop as soon as possible before we run out of primary care doctors in the countryside. We need to provide more rural rotations in medical school and residencies. And we need to remind people in training that, hello medicine, isn't just practice in ivory towers. It's practiced out here too.

Shane Tenny (12:16):

Yeah. I think that misconception is an important one. Just that there may be a misconception by some folks that if you're not a specialist working in a city or urban center that you're not as well trained or educated, which clearly isn't the case. How do we break down kind of those assumptions, or kind of walk folks in training through both, maybe the cons, but also the pros of working in a specialty like yours?

Zed Zha (12:46):

Yeah. I don't even know where to start from that, about the misconception of being country doctors. Let me just touch on some of the common misconceptions. I think you mentioned some of it. I would say being the outside provider, who's not in the academic center, we are calling the academic center to the inside providers to ask for help for our patients. Sometimes that really sucks. And I know that because I'm here, this is me, my life now, but I used to be the inside provider. I used to be in academic centers when folks called me to ask for help.

Zed Zha (13:24):

And so when this happened, I would ask questions like, "Oh, have you talked to your cardiologist?" Or, "What does the VQ scan show?" And I would roll my eyes when the outside providers say things like, "I don't have access to it." But today the role is flipped. I am the one with no access to many of the things. So I understand that when people ask questions like that or say things that are not the best attitude sometimes, they are assuming us country doctors don't know what we're doing, while in reality, we just don't have the resources, which is why we're calling you to help.

Zed Zha (14:03):

So we can hear the eye roll on the phone. I think at the end of the day, through medical training, if we expose more people to rural medicine, to understand that folks are out here doing the works that we do with the resources that we frequently don't have, that is what can bring all of us back down to the human level. Yes, we have all this titles behind us, we have all these trainings, and all these research projects, but at the end of the day, we're just two humans trying to take care of other humans. If we don't work on the same team, then nobody's going to help us. So when I'm asking you for help, just give me your genuine help.

Shane Tenny (14:44):

Yeah. So important. Can I ask you, when you came to the community that you're in, was there another provider or a practice there already, or what were the people in the area doing for medical care before you arrived?

Zed Zha (14:59):

Yes. So I work with an organization that has, at least, I think probably 15 providers and probably six or seven are doctors who do take calls and deliver babies. So I'm not a solo practice. We're a collegial environment. So we do cover calls. But I think one of the main things about primary care in rural areas is that sometimes you do feel like you're practicing alone together. In a rural area during holidays or long weekends, a lot of the providers are out of town. They have a life, they're traveling and things, and you could be the only person on call for the whole organization. And that can feel scary sometimes when you're the only person. And you're the one who people ask for help.

Zed Zha (15:45):

So sometimes it feel a little lonely, a little scary, but most of the times we do have support of other colleagues.

Shane Tenny (15:52):

Gotcha. Now I want to take a quick break here, but when we come back from the break, I want to ask you a little bit about what it was like when COVID broke out right around the corner from where you practiced medicine. We'll be right back after this.

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Shane Tenny (17:05):

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Shane Tenny (17:26):

Before the break, I was talking with Dr. Zed Zha about what brought her to full scope primary medicine in a rural area of the country, of rural Washington state, and how she thinks it's perceived and perhaps how to just debunk some of the misconceptions that we have about rural medicine.

Shane Tenny (17:44):

I want to switch gears here to another part of her story and discuss her role in supporting patients, and really the greater community of Washington state, during the COVID-19 pandemic. As we all remember in early 2020 Washington state was the epicenter of the COVID pandemic in the United States. And so I think if I understand your story right, Dr. Zha, you're four months out of training, COVID is entering the lexicon of the American population. Most of us are in the Midwest or the East Coast are like, "Oh, that's a distant thing that's never going to affect us."

Shane Tenny (18:20):

What was it like? How did it impact you and your brand new panel of patients and practice that you're in?

Zed Zha (18:27):

Thank you for asking that. This is such an important and essential part of my story. I was, like you said, four months into my first job in the real world. And I was eager and ready to build my own patient panel as it was just started to grow. Of course, at the same time I watched my home country fight the first half of the battle from across the ocean. So months before everybody paid attention here in the United States, I was already worried about my family and friends there.

Zed Zha (18:57):

So I was already reading the literature that's coming out of China, sometimes in Chinese, sometimes in English about COVID every single day. So I was kind of advanced in my worries at that point. So in March 2020, I think it was shortly before the declaration of pandemic, I sent out this email to the providers at my work whom I didn't actually know that well at that point about what I knew of the virus so far with the limited literature that I was able to read.

Zed Zha (19:27):

So I think it was because of that email and the fact that I came from academia and also, I didn't have a huge patient panel to give up yet. I was the perfect person to be picked as the physician lead for the COVID-19 task force that my organization was about to form at that point.

Zed Zha (19:46):

So literally the next day after I send the email out, I was asked to do that job in which was a full time advising job instead of seeing patients for my organization, which has three different clinic locations, across three different counties, taking care of 19 to 20,000 patients in Eastern Washington state.

Shane Tenny (20:08):

And given your connection with China, to your point, you had an acute awareness of this, even in whatever, November, December, January of that time period before, while all the rest of us Americans thought, "Oh, this isn't going to cross the ocean." You're paying attention to it.

Shane Tenny (20:27):

Were you able to get insight or information or talk to family or friends back in Beijing that were able to kind of give you advanced warning of what to expect or how to prepare or that sort of thing?

Zed Zha (20:41):

Yes, I was. I grew up in Beijing, as I mentioned before, and I went to medical school in China for a couple years. I didn't complete my medical school training in China, but I did go for a couple years before I came to the United States and pursue my education here. So many of my friends are actually in medicine that were in touch with online very actively. And so I was getting emails and information from them or personal messages from them.

Zed Zha (21:09):

For example, really early on, it must have been August or September 2020. Everybody was worried about the testing capability in the United States. So I knew people were doing rapid tests at this point at home. People had these kits to test themselves at home and they're not super accurate, but you can get them cheap, two to three tests back to back, that way you can minimize your false positive or false negative rates. So people were doing these at home and I was pushing really hard for my organization, for people around me to think about that.

Zed Zha (21:49):

Maybe we could import, we could get these tests too. They're not super expensive. We can import them in bulk and we can start distributing them. Maybe they're not the standard of care at that point yet, but maybe one day it will be. And the sooner we start testing people, the faster we can control this virus. But at that point, it was about a year ahead of the game. And nobody was buying the idea.

Shane Tenny (22:11):

Your practice, I guess you said the affiliated practices, have a network of 20,000 people, many of which, as you said before the break, are immigrants, certainly bilingual. How were you able to kind of keep patients up to date or just communicate with them across a couple different language barriers?

Zed Zha (22:35):

Yes. The language barrier is one thing. Another thing I've observed, or I think you could imagine, as a community of immigrants, many of whom may be undocumented is that there is this lack of trust of authorities. So of course, coming from a community like this, people trust us who are their providers and their families providers more than the official recommendations and authorities when they talk in English, from people that don't look like them.

Zed Zha (23:06):

So when we discovered that there was this mistrust, which exacerbates the misconception of COVID related information, my friend and colleague, Dr. Jude Alsarraj, who's a PhD, and I, in our organization, we felt like we had to do something about that. It's like we went back to college at that point. Every day we sat down and devoured the most recent trustworthy research articles. And we read through them and we interpreted them. We teased out the data and we put them in the language that our community would understand.

Zed Zha (23:43):

And then my media department in our organization collected questions from the community and they help us prepare scripts and they shot videos of us and they put bilingual Spanish subtitles so that we can make our own videos to educate our community on a weekly basis, sometimes even twice a week, basis.

Shane Tenny (24:05):

Wow. I'm just struck by what a gift you are to your community and to your system. To be able to be so compassionate, but so competent on something that was so confusing all at the same time.

Zed Zha (24:22):

Yes. The other thing we did, which thanks to just how robust the family services resources that we have within our organization, we were able to do what not a lot of organizations could do was we took on the task of reinforcing public health measures on the phone with our patients whom we can communicate with more easily.

Zed Zha (24:46):

So, for example, when the health department was short staffed about calling people on the phone to urge them to stay home or explained to them that they're positive or they're exposed, they have to stay home. We took on that task, we organized a team of bilingual health educators who are college educated to sit there and call people on the phone every single day, every patient we have on the list, every single day, until they come out of isolation of quarantine, to explain to them what it means to stay home and how you can stay home better.

Zed Zha (25:18):

And we answered their questions about COVID and when they didn't do well on the phone, we knew before anybody else did. And then they were able to communicate with the doctors and providers about how this patient was doing. And we were able to do close follow up. So in that one month period where we did this, we called people 130,000 times, which is unheard of in a community like ours.

Shane Tenny (25:46):

It's amazing. To your point, communication, I'm struck, is such a central part of what you do day in and day out with the patients that you have and the community around you, but especially in the midst of a global pandemic.

Shane Tenny (26:02):

I know you're turning a lot of these emails and newsletters and things into a book, A Chinese Doctor On Rural America's Pandemic Frontline. It's not out yet, but I think it's cooking in the kitchen. Give us a little behind the scenes of what you're putting together there and what you're hoping the message will be?

Zed Zha (26:23):

Well, thank you for that question. So initially my thought was that I was going to send a weekly update email to my community online, my friends and family across the world, about what I knew about COVID to help them navigate through misconceptions and such. And multiple people said to us, a few months into this email newsletters, "You should turn this into a book." So I reached out to my friend and co-author, Dr. Chloe Ackerman, who is a psychologist and a writer, who is actually the only writer I know in real life about converting this into a book project.

Zed Zha (26:59):

Initially this book was going to be this time capsule of things that we knew, or we thought we knew about COVID-19 over this year of time when I was writing these email emails, but then Chloe started to ask me about questions like, "How do you feel? How did you grow through this process?" In other words, she was asking for more human side of the story. And she was asking me to share vulnerability, which in medical school, they don't teach you how to share vulnerability as much as in writing.

Zed Zha (27:34):

So I was like, "No, no, this is not what this book is about. This book is about misconceptions and facts and data." And so of course, Chloe, she's a psychologist. Her job is to help people tell their stories. So she said, "No, this is super interesting, but your stories and your patient stories are what is going to connect with people and resonate with people." So that changed the whole book. And now this book is not just a chronicle of the global pandemic in a first world real time fashion, but also tells the story of how I faced the biggest challenge of my young career and the stories of my marginalized patients.

Zed Zha (28:20):

It also incorporates my personal story of hosting my parents who were stuck here in the United States with me, from China, for a year and a half. And how a relationship that used to be conducted across the ocean for 12 years in the past, suddenly become this thing that we had to deal with under the same roof every single day for a year and a half. So thanks for people who push me to write about myself. This is a totally different project and more exciting now.

Shane Tenny (28:49):

And when are you expecting it to be completed and available?

Zed Zha (28:54):

This is a work in progress. And we are just submitting to editors and we have a literary agent. Her name is Kathryn Willms from the Rights Factory. So she's representing us in pitching to editors. We're hoping that we will get some offers soon and hopefully in the next year or so we should have the book ready.

Shane Tenny (29:17):

Yeah. It sounds like you've gotten some great counsel in putting it together and it's going to be a captivating narrative of what life was like and how you changed through COVID as well.

Shane Tenny (29:29):

It struck, I mentioned a minute ago, just how it's clear communication is so central to what is needed by your community, but so central to your gifting and skill set. But I also just sense such a passionate advocacy for your patients. Can you talk just a little bit about advocacy and where that shows up and why it's so important?

Zed Zha (29:53):

Yes. I think to me, and to many of my colleagues, social justice matters more than anything. Without health equity, we simply cannot talk about healthcare. All of us providers have the responsibility, medically and morally, to advocate for our patients. And even the most informed and educated, resourceful patients needs their doctors sometimes to speak on their behalf when they're really sick.

Zed Zha (30:22):

Not to mention my patients who are people of color, immigrants, and non-English speakers. I happen to know what it's like to be in that position coming from across the ocean and not knowing anybody. And so when I first came to the United States, I didn't know how to order food. I didn't know how a credit card worked. I didn't understand people needed their personal space, but I didn't know any of the American sayings that was considered awkward and kind of weird. I know I was not, I just didn't have what it took to speak up on my own behalf.

Zed Zha (30:56):

So today, I don't let that happen to my patients. I know sometimes it's hard for them to express themselves. So I feel obligated to do that on their behalf for their health reasons and social reasons.

Shane Tenny (31:11):

Is there a situation that comes to your mind recently where you had to advocate for one of your patients?

Zed Zha (31:18):

Oh, my gosh, yes. So I had this patient who, during the pandemic, we're still in the pandemic, but couple years ago, who spoke one of the Indigenous languages that we talked about. So already had two different language barriers. And when we talked to him we had to translate from English to Spanish and to Maseko, which is what he spoke. Only about half a million people in the world speak the language. So already it was tough and he was by himself.

Zed Zha (31:48):

He contracted TB and it was very severe. He ended up losing part of his lung then COVID at the same time. So that was really a scary situation that I did not think I would have to face in the United States as an attending physician, in a rural area, not in an academic center, we had limited data on how people like that would do in general, let alone without resources.

Zed Zha (32:12):

So that patient and I, and my team, struggled to get him the specialty care that he needed. At some point we could not get some of the specialists to pay attention to how big his chest wound was. We were seeing him every other day in clinic to measure and take care of that. He had this big wound vacuum that attaches to his chest, that he didn't understand how it worked. So we were changing the wound dressing for him every day, measuring his wound care, we're taking care of him every day.

Zed Zha (32:45):

So we saw how sick he was, but I could not get the specialist to lay hands to him. When he went to the specialist clinic, sometimes they don't even open the wound to take a look. And one time he was so sick that he was developing a big fistula, which is a tunneling of that wound into the center of the chest, which was very scary. It was as long as a long Q-tip can go. So I was worried and I'm not a surgeon. I don't know how to deal with this surgical wound and complications.

Zed Zha (33:17):

So I advocated for him to go to the specialty clinic. He went only to be turned away, super sick, did not even get seen because his medical coupon expired. And I had just been talking to the specialist the day before on the phone to ask for help. I said, "You need to see the patient. This is not looking good. I need your help." And they promised me on the phone, they will see the patient.

Zed Zha (33:41):

Next day, we transported our patient in full PPE an hour and a half away to this clinic. And patient didn't get seen because the medical coupon expired. I didn't even know what a medical coupon was until then. Why are we talking about coupons? We're not buying cabbage in Walmart. So this was eye opening for me. I become pretty angry in that case, very emotionally involved.

Zed Zha (34:07):

I called that office, specialty office, multiple times. And I asked them, "If you had told me you were going to see my patient why didn't you see my patient?" I could only imagine saying what they thought of me at that point. They were probably like, "Who's this doctor who's worse than a fly during a meal?" So I was calling them and I said, "This is not acceptable. You need to see my patient."

Zed Zha (34:32):

Then I realized, I'm just asking the wrong question. Maybe even to the wrong people, the folks who work in specialty clinic, my respected colleagues, are just doing what they're told. If the patient doesn't have the right means to make a payment or to demonstrate that they can eventually take care of the bills or have the proper insurance, they are not obligated to see them. This is a system problem, not a personal problem. Nobody had anything against my patient. It was the system who's failing him.

Zed Zha (35:05):

So at this point, I constructed this email with some strong wordings to the Health Department. And so I listed the things that I saw that was not fair for this patient. And I asked the question in the email. I said, "If this patient of mine was in a different socioeconomic class, different ethnic background, I wonder if the outcome would've been the same?" And I think that's a fair question to ask.

Zed Zha (35:37):

And so then I received a bunch of additional resources right away from the Health Department, so that was really helpful. And we eventually were able to sort it out and patient did better, and he's doing great. He's doing awesome right now. But that was one of the examples where I just could not imagine having to go through that where he was, and if we didn't have the resources to provide him what we could have done. And if I didn't become the fly on the wall, I don't know what that right analogy is, but what could have happened? I don't know.

Shane Tenny (36:13):

Not an outcome that was as good as what happened.

Zed Zha (36:17):

That's very possible.

Shane Tenny (36:18):

Yep. Yeah. The beauty you bring to your patients is competence, conviction, and compassion. And that conviction is what I hear in your story of just standing up and speaking for a patient who can't speak for themselves. So Dr. Zha, one final question, before I let you go, you have already made such an impact on the community around you, the patients, the gentlemen you just described. And I know that you didn't do it all on your own. We all accomplish and move forward because of the gifts that others have given us. We stand on the shoulders of those who have gone before us.

Shane Tenny (36:58):

You've mentioned some dear friends and colleagues already. I wonder if there's anybody you'd like to just shout out here on the Prosperous Doc podcast as being a big part of your journey?

Zed Zha (37:08):

Yes. 100%. And I can't wait for this podcast episode to get to the people I'm about to mention. So Dr. Cathy Morrow at Dartmouth who believed that I could do what I do today, Dr. Jim Withers, who is the leader of homeless medicine in the world who took me on rounds with him on the streets, and literally go to the extra mile, to meet people where they are. My attendings in residency at Mayo Clinic La Crosse, who saw me through my growing pains, but still thought I could get taller. And Dr. Dennis Costakos, who gives me nothing but solid, solid advice in career and life. And lastly, Dr. Richard Usatine, who doesn't know this, but tell me everything I know about dermatology, and under whom I will be completing a year of fellowship in underserved dermatology coming this September.

Shane Tenny (38:02):

Excellent. Well, a huge shout out to all of those individuals. Dr. Zed Zha, thanks so much for your time, for your passion, and for what you are doing in the world of medicine out there in Washington state. Thanks for being with us today.

Zed Zha (38:17):

Thank you so much for having me.

Shane Tenny (38:19):

And for those of you driving, working out, walking, listening to our podcast, thanks for being here. It's a privilege to be able to do this podcast. And it's because you are listening. If you have ideas for guests, for topics, for colleagues, for those who are doing important work to improve the prosperity of those in the medical or dental fields, would you email me directly? Shane@whitecoatwell is my direct email address.

Shane Tenny (38:49):

Also, believe it or not, those reviews on iTunes or Google Play are really important to the search function. And so if you enjoyed this conversation or others, I'd welcome your feedback, your reviews, your comments on either Google Play or iTunes. Thanks so much for being with us today. We'll see you back here. Next time.

Voiceover (39:07):

This episode of the Prosperous Doc podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years to connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of the Prosperous Doc podcast.