Dr. Simone Gold
speaker
456 appearances
3 recordings
2 series
first heard Jan 2025
last heard Jun 2025
Dr. Simone Gold’s voice in public audio — every appearance, attributed to the second.
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But I'm going to show you a different side of it. Yeah, yeah. So, because on the surface, and to policymakers, that sounds brutal, that sounds terrible, that sounds like it contributed to Libby Zion's death or caused her death, right? That's how it sounds to all the politicians. Okay, whoa, I did that my first year, very hard. went to law school, went back to residency, and the rules had changed.
The rules had now said, no, no, residents have to get enough sleep. So the work schedule became on every fourth day, the first day was like eight to six, the next day was maybe eight to 10 p.m., then the third night, basically you worked during the day and you had a night float. So you could work eight or 10 hours, then a night float would come in.
This is maybe how nurses worked, which is you have a shift work, graveyard shift maybe, and then cross over, but you didn't have responsibility throughout the whole cycle. So doctors became shift workers. Now, this was a terrible decision if you want the doctor to understand disease from the bedside. If we're not scientists, right? We can't analyze the data, read the data, really understand it.
Then our best hope of helping patients is to really understand the disease from the bedside, right? To be with that patient for 36 hours. What happened when I went back to my residency with the change in work hours was, resident physicians, young physicians were no longer following a disease kind of from beginning to end for the progression. They were checking in 8 a.m., checking out at 6 p.m.
The crisis would happen at 10 p.m. or midnight on the night float. The night float didn't care about the patient, didn't really know about the patient. You come back in again that next day, it became very sluggish. You didn't see the disease progression from beginning to end. A person would come in with congestive heart failure and there was never a situation anymore where you followed the disease
to see its whole natural course.
It wouldn't be necessary, but for physicians, you want... It's not as much of a crisis. When you are seeing a mid-career physician who's 50 years old, you want them to have gone through that full cycle of seeing the disease at some point in their career. The only way you can have that is if you're really in for uninterrupted.
When they switched it to shift work, I saw firsthand the shift in how doctors interact with patients, treated patients. No longer did you feel such ownership over the patient. This was your patient. It was like kind of your patient for eight or 10 hours. Then it was somebody else's patient for eight or 10 hours. Then it was your patient again.
And you didn't follow the disease the whole time. So in my first year... Did that increase finger-pointing? I think, yes, but it was deeper than that. Nobody was really in charge, quite frankly. It was just a checkbox or template that was in charge. Before that, if my patient crashed in the middle of the night, I was there and I knew it.
And so I became a better doctor through those exact experiences. That was gone once the work hours changed. And I don't think policymakers had any idea that there would be a downside. It sounds all positive to protect the work hours.
I just wanted to share that.
My internship was one year. I was rotating internal medicine, all the disease of the internal organs, and then I did three years of emergency medicine. In between, I did law school. I just kept myself very focused on the law in those three years. I moonlighted as a doctor to support myself, so I was working as a doctor. This is during law school? During law school, yeah. 20 hours a week.
Yeah. While you were in law school? Yeah.
I did very well. I only became a quack much later.
Right, so I think looking back at my life, I looked at the two and I didn't have a clear path in my mind as to what a doctor, lawyer would do or could do other than politics. I didn't have a clear path.
Yes. So I did two short stints in Washington. One time I worked for the Surgeon General, and one time I worked for the Senate Labor and Human Resources Committee. When did you do that? One was around 1990, another was around 1993 or 94.
First was at the end of medical school. I worked for the Surgeon General.
When I went back to medicine, I missed the opportunity to make a change in health policy. So I went to work for the Labor and Human Resources Committee, which kind of oversaw Medicare and things like that. and that was in the middle of my training as an emergency physician. I know this is hard to follow because this is a very unique path.
Nobody really does this sort of thing where they zigzag back and forth.
You were intervening on all three of those. I kept looking for this, but when I went back to work for the Senate Labor and Human Resources Committee in Washington, D.C., I was working for Senator Jeffords, who's an independent from Vermont, and I really think the system was too dirty to fix the health care system. That was my conclusion. How long did you work for him? Also, just three months.
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