Direct Primary Care Doctor
Dr. Brewer Eberly is a third-generation family physician at the Fischer Clinic in Raleigh, NC and a research affiliate with the Theology, Medicine, & Culture Initiative at Duke Divinity School. He completed his family medicine residency and chief residency at AnMed Health in Anderson, South Carolina, and is a fellow of both the Theology, Medicine, & Culture Fellowship at Duke Divinity School and the Paul Ramsey Institute with the Center for Bioethics & Culture.
He has been published widely, including JAMA, Academic Medicine, AMA Journal of Ethics, Hektoen, BMJ Journal of Medical Ethics, The New Atlantis, Perspectives in Biology and Medicine, Student Doctor Network, CHEST, Society of Teachers of Family Medicine, STAT, Doximity, KevinMD, Public Discourse, Linacre Quarterly, and the Journal of Religion and Health, as well as theological spaces like Mere Orthodoxy, Christianity Today, Plough, Comment, Theopolis, (TH-EE-OHP-O-LYS) and First Things. His artwork has been featured on the cover of Academic Medicine and in the AMA Journal of Ethics.
While the majority of his time is spent caring for his patients, his research is rooted in the intersections of medicine, aesthetics, bioethics, and theology, with a particular eye toward medical trainee formation, the nourishment of weary clinicians, and the relationship between beauty and ethics. He is on the planning committee with Columbia University’s Center for Clinical Ethics “Medicine & the Art of Ethics” colloquium on human vulnerability, which brings together vocational artists, clinicians, ethicists, theologians, and philosophers to explore how art invokes moral action, and what that might mean for clinical ethics and the future of medical training and practice. He and his wife Dendy have three sons, and worship at Redeemer Anglican Church in Raleigh.
RESOURCES MENTIONED:
Samuel Shem, House of God: https://searchingformedicinessoul.podbean.com/e/samuel-shem/
Ben Frush, “Suffering Absence: Hauerwas and the Challenges to Faithful Presence in Contemporary Medical Training,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551535/pdf/10.1177_0024363920937626.pdf
Marilynne Robinson, Gilead, 2006.
St. Louis University Theology and Health Care Ethics joint PhD program: https://www.slu.edu/arts-and-sciences/academics/degrees/graduate/theology-health-care-ethics-phd.php
University of Aberdeen: https://www.abdn.ac.uk
Jonathan Lear, Radical Hope: Ethics in the Face of Cultural Devastation, 2008.
Farr Curlin, “So You Want to Be a Doctor? Medicine as Instrumental Job vs. Sacred Vocation,” https://soundcloud.com/thomisticinstitute/so-you-want-to-be-a-doctor-medicine-as-instrumental-job-vs-sacred-vocation-dr-farr-curlin
Wendell Berry, “Health is Membership” (1994), What Are People For? (2010), The Art of Loading Brush (2017).
Peter Berger, Brigitte Berger, Hansfried Kellner, The Homeless Mind: Modernization and Consciousness, 1973.
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TRANSCRIPT*
Welcome to the podcast, Dr. Eberly.
Thank you. It's great to be here. It's a delight.
for the audience, it's been a, a lovely time connecting with Dr. Eberly to get to this interview date because both of us have young kids, and so it is, it is so exciting to talk to another DPC doctor who understands the world of DPC while managing young kids and having the ability to craft your livelihood around your family and around your patients the way that you wanted to, and you particularly.
Have a very interesting story in that you heard about the Fishcer Clinic before you even graduated residency. So just wanted to drop that little nugget there before we get going. But thank you so much for, for being here today and taking time outta your day.
Oh yeah, no, thank you again. And my, I should say my, my wife is the real hero here.
Taking our sons.
Yeah, I echo that one. My husband's downstairs with our two, so that's awesome. Yes, . So I wanted to highlight again that idea that you have learned about DPC before you graduated residency. And I will say that, it's not the most common thing to hear it is becoming more and more common, which is awesome.
Mm-hmm. . But I wanted to even go back a little bit farther into the drive that you had to become a family medicine physician as well as a DPC family medicine physician. Yes. Could you please share what was going on between third and fourth year of medical school that really helped you in terms of what I have read from material that you've written really helped codify your journey into family medicine in particular.
Yeah. No, thanks. Thanks for that question. For having told the story so many times, I don't, I don't have a great uh, summarized version of it. But um, yeah, so between my third and fourth year of, of med school, I did a fellowship called the Theology of Medicine Culture Fellowship at Duke Divinity School.
I had met a physician named Far Lin doing a separate medical ethics seminar when I was a second year medical student, and he had just been talking about this idea of launching a cohort that would bring together. Clinicians, ethicists, public health students, seminary students, throw them all in the same classroom together for a year of kind of intense formation.
And I was like, Man, that sounds amazing. And I'll probably never be able to do it . But in the middle of my third year of medical school. I was troubled by what I sensed was happening to me, I guess is probably the simplest way to put it. This sort of vast. Vision of medicine that I had inherited from my grandfather and my dad who were both family physicians that I sort of expected to see in medical school was, was just not what I was seeing all the time.
And I experienced a kind of dehumanization that I didn't know what to do with. I loved the anatomy lab. I I sort of sense the calling of medicine there, but then, Since that calling shift in its form and how my day to day process worked and I basically was struggling and just not doing well. So I was seriously thinking about quitting medicine and I don't know if I, I, can't remember how this happened, if I called him up or just emailed him, but emailed far and he said, Don't give up just yet.
Come do this year with us. And so I did that year it was life changing. It's again, hard to summarize everything that year did and what, what the fellowship represents, but really did change the trajectory of my location. Completed that came back to finish fourth year of medical school. I actually didn't match afterward.
So spent a year in Raleigh doing postpartum hemorrhage, Hepatitis C research through UNC and then reapplied to residency during that year. And during that, there's a lot of, a lot of, lot of steps here, . During that one year of research I had been struggling with should. Go to family, the kind of first love that I thought I would do.
And again, back to this mentor far he said, Before you write off family's medicine, you gotta check out this place called the Fischer Clinic. And, and his exact words were, it's a, a place so beautiful. It'll make you cry. know, I've said this before, that this isn't a friend who's prone to exaggeration.
So coming from him, that kind of thing. Was striking. And so I did, I I came to the Fischer Clinic in 2018, only spent a day with them, but then over the course of my residency, we maintained contact in a kind of slow friendship formed. And it's outta that friendship that I was asked to come here, and it's been.
it's just been beautiful and sort of healing for all involved. And it, it's a little weird in that regard that it grew out of a natural friendship developing over many years. It wasn't me logging onto a website searching for dpc. It was sort of discovering this model through friends and then maintaining contact for many years.
And also through the idea you had experienced dehumanization of possibly yourself as well as your patients, and it was an alignment with what you wish to do in family medicine, which is awesome. Yes. So I wanna ask there, when you say dehumanization, because there are medical students and, and residents who are listening and they might not have, you know, experienced some of the dehumanization.
We have, especially those who have chosen the path of dpc. So in your words, when you say dehumanization, what does that mean in terms of how a physician ends up being dehumanized and how a patient ends up being dehumanized in the fee for service system?
Yes. So again, so much to say here. There's so much to say.
And this goes all the way back to like the House of God and Samuel Shim. And there's all, there's a whole history of this process that you can follow sociologically, let alone like in the literature on professional identity formation. And um, but I think simply put, , it's probably not controversial or that, A lot of patients, a lot of physicians experience the practice of medicine is a kind of bewildering force today in which they don't know how to quite locate themselves within it. Both as a patient who maybe experiences their medicine as being treated almost like a machine. we say in training, treat 'em and street them as if patients are engines or cars.
And there is a, obviously a sense in which the body has a kind of mechanical nature to it, but it's, we're not machines, we're embodied and sold creatures. And the metaphors that I think are more protective of that vision of the patient tend to be more like garden metaphors tending a tree.
But then for practitioners too, and clinicians, the medicine now is beset by bureaucracy in a kind of demoralization. And that's not, those words aren't just sort of buzzword things. I think sometimes I, I get the sense that we just sort of memorize. That word bureaucracy and kind of spit it out.
But even that has a rich history. If you go back to Peter Berger, sociologist, his book of Homeless Mind, he talks about how the the two greatest sort of problems with modernity are bureaucracy, which forms a sort of learned helplessness. We all experience these great institutions that are just sort of bewilderingly complex.
And how long earth do I navigate this, both as a clinician and as a patient, but then we also experience it as being demoralized, meaning literally the moral content of the work is harder to see, let alone articulate. So we experience training is no one really asking what is medicine for and what is my calling.
And I'm taking a lot of this from far Klan and some of the writing he's done. But So, yes, I think trainees go from this state of sort of wonder and articulating their calling in the language of vocation. And then at the end of that training process, we often describe it as just the job. I just, I just gotta kind of get through it and get it done.
And I think the current wellness initiatives though, aiming at something good in a sense, don't quite hit the arc. They're not quite capturing the, the problem, but.
Yeah, the many problems sadly, that are out there and that we are working so hard to make a dent in and change. And we are definitely doing that.
And it's very awesome that ironically we are recording this on Labor Day. So, it's, it's awesome that, we have gone back to why we're doing medicine and who are our patients and what do they need and not what yes does the insurance need so, Now I wanna go back to this idea that you developed a friendship with the Fischers, and over time, that was your decision to go from where you had gone to residency in Anderson, which is near Greenville to the Fischer Clinic.
So, the first question I'll ask when I talk about the, the geography there of your history is when you were having the conversations that you had and developed this friendship with the Fischers. What was it that really impacted you, that made it clear that you were gonna go to their clinic in particular?
Yeah, that's a great question. Yeah, again, there's, it's just so much to say. It's hard, it's hard to even know how to begin. I think the witness of their work in the sense that they are deeply humble. Rooted people and, you know, humility and it has a roots in hummus. It literally kind of, of the soil so that that language of being rooted in your place.
And we talk about Wende berry all the time and we, we all have a shared affection for Wendell Berry, a great agrarian, saist and poet. I mean, that poem I read, they read on my third day here in clinic doing our work, like the snow, the falling snow, quietly, slowly leaving nothing out. In many ways that captures them, but they're just so self effacing.
I mean, obviously there's a, there's a kind of promotional quality to any, any of the work that we do. But they maintained their patient panel simply by relationships they've fostered over the. 10 to 15 years. I mean, patients followed Dr. Lipinski's from his time practicing other places and patients followed Dr.
Fischer which is a whole kind of separate story and, and a story they, they, they should tell. So I think I'll just say that like the, the humility and the character integrity of their work was just so attractive. I didn't get the impression that these were guys who were trying. Kill it financially.
They were just trying to answer the call and do the work well as well as they knew how to do, and that required this new model. Um, So that, and then, I invited the Fischers down to my residency to speak about the doctor patient relationship and I think through those emails kind of back and forth and.
you know, There's lots to say about how do you imagine new forms of practice within primary care land in this great conversation about the future of medicine, the future of medical training, and all the dehumanization stuff we talked about. So I think in that regard too, they were, they were conversation partners trying to imagine more hopeful rooted ways of doing medicine.
Well before it was even on my radar. Hope that I could possibly work for them. I dunno if that answers the question,
but It does, and I, and I absolutely love that, that the. Ability to open up a new clinic under the direct primary care model from the fee for service clinics that came from that it required the DPC model to be able to do the medicine that they wanted to do.
So I think that's absolutely beautiful. Now when you mention talking to the residents I just wanna drop this in before I go back to the geography part, but When you have talked to residents younger residents, medical students, potentially, when, when you ask the Fischers to come speak, what in particular do you feel is really effective to get to the hearts and minds of the, the medical student or the resident who, thinks that there's only in one way, you, you go from medical school to residency to being employed?
Yeah. What are potential game changers when it comes to. speaking to a medical student or a resident and family medicine or primary care? Yes.
This is, Yeah, I've thought about this a lot. And in a sense, I, think about it as, as a kind of hold my feet to the fire kind of thing, like.
like I don't think DPC is a panacea that's gonna necessarily solve all of medicine's problems and, nor all the problems in primary care. I do think it is the wisest and most beautiful option available. And I said that to say that I have good friends. Know from residency who are better clinicians than me, who are kinder clinicians than me, who are in a fee for service system and are gonna be great doctors.
I mean, I'm thinking of specifically my you know, Hal Harmon Su GVAs be lackey, just anyway, good friends from my, my year in residency who I have such respect for. And they're going to do good medicine in their place. And in a sense it's because they know that they're calling. And so what I, what I like to do with students and residents is to try to take a step back and discern what, is in fact your calling because we need witnesses to the good quiet work that dpc.
Has within those systems in order to imagine other ways within those systems if that makes sense. Anyway, that's how, part of my like research hat, I guess is thinking about ethics and thinking about. Medical trainee formation, and if we told every family doctor to, sort of leave academia and institutions and do dpc, that I don't know that that would solve all the problems.
So again, it kind of, it becomes a discernment issue of vocation and where do you sense that you should do the work. That said, one of the more fascinating kind of conversations I heard out of Dr. Fischer's time. With us was just the simple question of how many patients should a doctor see a day?
And I know this is a common theme, but we could talk about that for probably a whole half hour, but that was fascinating, right? Cuz you hear three distinct responses. And kind of hearing that debate go back and forth was fascinating. And I'll just say this, there was a point where one of the answers was basically kind of referencing what the ACGME dictates on how how many patient encounters, and you can kind of extrapolate out from there how, what that looks like per day.
And I'll just never forget Dr. Fischer very kind of simply saying, just notice that that is external to the patient's needs in front of you. It's not a, it's not a metric that's easily mapped onto. The person right in front of you. And again, that raises questions on like what's, what's necessary and appropriate for training.
Like, I, I'm kind of an odd bird cuz I actually think family medicine residency should be harder and probably longer than it is. Which is all separate conversation too. . But my point is that what you need to see in training, the kind of saturation crucible it is different than what would be required of us outside of that training.
It
seems to me. Absolutely. And I was on mute while you were saying this purposefully because I agree with so much of what you're saying and when you were talking about how, what's in alignment with external factors versus the patient, I definitely, will call out those people in the audience who were saying patient at the same time you and I were.
And it's just incredible. Like the people who say that totally get the, the root and the heart of dpc and. When you talk about, this idea that you talk to people about their vocation and thinking about their whys, I absolutely love that. And I, again, totally agree with that. I have been doing some residency talks with my old residency and This year coming up in the next few months, I'm gonna be talking to first and second years. And so, yeah, my slide deck is not a bunch of verbiage. It's, literally the first slide that I get involvement with. What do you love about family medicine? What do you love about your clinics?
What do you, what is your most ideal day in your clinic? And some people have not really thought about that. And sadly, that was something that I experienced when I was talking with some third year residents. And so I think that that's a really great takeaway. For those of us who are potentially talking to medical students and residents and asking, where are they at?
Why did they do family medicine? What have they been seeing? Yes. Because it really gets you into their shoes as much as possible when you're doing a, a quick talk. So I love that. thank you. Absolutely. . I, now I wanna go back into that geography question because Yeah, you've shared the absolute, the, the excellent reasons as to why your, your calling was to join the Fischer Clinic.
But I wanna ask, especially for those people who. Are thinking about opening DPC in a place where they did not attend residency or medical school, what were some of the challenges that you experienced moving your family from Anderson, South Carolina to up there in Raleigh North Carolina?
And what are some tips that you would have for other people potentially practicing DPC in a place where they've never practiced before? Yeah.
Man, I don't. I don't know that I would have very wise things to say. I mean, par part of that's, probably a function just of my age. But we did live here for two years and, and I think, part of the geography thing too is like 20% of my time-ish is, with Duke Divinity School and the Theology Medicine Culture Initiative.
So the point being we already had an enmeshed. really thick, like hospitable, gracious social matrix , as one of my friends likes to say here in the triangle, that was sort of able to receive us, you know, like, our old life group leaders and anyway, so we experienced it much more as just almost like coming home, that, that's why I struggled to know if I would have anything really helpful to say to somebody going to a new place other than, At least from a, from an abstract level, knowing the place you're going to go to, right? Like knowing that community and the rhythms that mark that community and figuring out how to kind of submit to them, but.
Outside of the nuts and bolts of just, Yeah. Moving up a house with three kids. I mean, purge a lot, I guess. Sounds like a great time. . Yeah. Oh, it's, Oh, yes. Wonderful. Again, my wife is the real hero here. Truly no. I mean, we, you know, we use it as an opportunity to kind of get rid of things and give things away.
I mean, that's probably the only practical thing I would notice. I don't know that my story's gonna be helpful to the person looking in a new place, because for us it was kind of a homecoming. We, we knew the place, We'd lived here for two years. We'd maintained all these relationships.
I'd come back up here for conferences and, and things every now and then. So it, it was just kind of coming home.
I love that and I think that, high level pulling from what you just shared is that when you have that sensation that you are going home, that it's not, causing you more anxiety and more, potential depression or second guessing or whatnot than Yes.
Yes. The, the feelings of. Wow. Like, I don't know what's gonna happen, but this is the next step that I need to take. And I know that in my heart and soul. So I think that that's a really high level, great tip to share because yeah, if people have that feeling, even if it's not in a place that they've practiced before, even if they don't know, the community in terms of the patients who they are yet to serve I think that's a thing to think about.
I will say, you know, I am remembering something before the job offer came, and before this was even on my radar, my wife and I bought a map and we literally put it in our living room on the wall and we put, two sticky notes above it. And it was the, the harvest Discipline full.
The workers are few. And then the second one was CS Lewis. This fascinating statement he makes to Arthur Grieves, where he basically says, Do everything in your power to live among your friends. And I really, I really think that's true. So, I'll just, I'll just leave it there, that like, there's work to be done.
go. Where the harvest is plentiful. The workers are few, but then also I ideally think that's right, Like do everything you can to live among friends. I think
that's awesome. And that really goes back to my calling as to like why I do this podcast because it is so incredible. Like you and I have never met really to talk before today, and I feel like we've known each other for a while, just because it's so amazing to talk to DPC physicians, and we already have that commonality between all of us in terms of why we're going into this. So this is incredible. Yeah, no, I
agree. It's, it's a beautiful, that's Lewis again about, I mean, I love Lewis, so here, here, I'm riffing on him again.
But he talked about that in the four Loves that. That's one of the marks of friendship is you find yourself. Under a kind of unimaginable speed, already looking at the same horizon with this like shared vision. And anyway, it's wonderful. I
love it. So now I wanna go to where you mentioned before you got the job offer.
So, when you got the job offer in terms of that time. were you hoping that you would get a drop offer from the Fischer Clinic specifically, had you come up with a backup plan?
Yeah. Um. No, I, I, it truly was not on my radar to even ask them. And I can't remember. I think I knew that they were talking about a third. . But um, no, I mean, we were, we were literally preparing to submit resumes through, what is it?
Physician Link. And again, we, we had, we had that map and I mean, I was, I'm, I still am thinking about this, but I was thinking about there at St. Louis has a wonderful dual PhD in theology and healthcare ethics and Aberdeen has a program that would align well with some, some of my research goals and stuff.
But that was on my mind. Like, how am I gonna, possibly, it seems like I'm gonna have to go. Academic to sort of protect academic time. And so I'd been talking to folks around that idea. I, I think either at the same time or, or well before the Fischers. I mean, they offered it over, over our breakfast table, like we, it was a really beautiful, like you.
There may have been tears, . It was, again, it's awesome. I know it's, it's hard for me to talk about without getting emotional cuz it's I mean, these are friends and people I really care about who've babysat our kids and have cared for my wife and I and so many ways for six years.
It's just, it, it didn't have the feeling of a job interview it, they're friends,
so I'm . Just gonna put this out there between yesterday and today. I have had you and another physician say, talk about tears or break down into tears. So, I love this cuz you guys are whipping out that the bottom of the, of the heart there. So that's awesome. Now
I, I blame it on my, my sons. I cried down commercials. Now, I can't visit . Yeah, just very grateful, very.
Absolutely. So when you got this amazing proposition to come to the, and join the Fischer Clinic, how was the arrangement set up?
Could you talk to that? the reason I'm asking this is because there's lots of ways to bring on another physician, and so did you guys have a salary set up? Did you buy into the practice? Did you make your income based on the number of patients you signed on? How did it work for your setup?
So
it it's that last option. So it's membership based. So my pay is based on the prior months production, I guess is the technical language for it. And the Fischers hired on Dr. Bob Adams over kind of basically eight months, something like that. I don't, I can't remember exactly how long, but prior to me coming to sort of on ramp because they had had such a, such a long waiting list for so long, So that was the sort of overlap.
I mean, that's, that's how my salary works. And then, right now I'm paid as a like a kind of consultant, I guess for the Divinity School on some of the work I'm doing there. And there's conversations around what that'll look like long term. That'll be different form of pay. But so yeah, those are the, those are the two kind of nitty gritty salary things.
and then Dr. Adams very graciously on, on ramped, 170 patients. So I started with that number, which again is just an utter gift and I, I get overwhelmed thinking about it.
And I think it's so awesome to highlight that because, there are other people in the DPC space who have opened and quickly went to multiple hundreds.
Yes. But the idea that you had someone to help with that onboarding and that is like the most hardcore example of helping with that onboarding to actually see the patients and Oh, yeah. With the intention of you taking over their care. Yes. But not having to feel pressured to say. How am I supposed to get 170 patients in and I'm starting on day one.
Right. With no patients having been seen. So I think that that's a really, really interesting example for people to think about, especially if there's, a DPC doctor who is retiring and who would like to help out. Exactly. Or a a person who. Family medicine, like the idea of dpc, but hasn't committed to it yet.
A listener might be out there just like that and could see themselves as Dr. Adams did, participating in DPC that way, or as you did coming on with a physician who has onboarded your patients for you. So I think that's an incredible example, and thank you for highlighting. Oh
yeah.
I mean, I, hopefully there's a theme here in the sense that so little of this is, has been dependent upon me. I mean, I've really experienced it as like a kind of Jonah thing or something. it's being given incredible gifts and. Marilyn Marilyn Robinson has this lovely, lovely passage in her book, Gilead, where she, talks about how there are these moments where it's like walking in a garden on Sunday morning after a light rain.
And she says, You have to be careful where you step . I maybe getting that off a little bit, but anyway, that's how I experience it. I experience it as someone is, someone has led me into this wonderful garden that I did not plant. And yet they're giving me a plow and it's kind of like, be careful where you step, like receive it well, and anyway, ,
I love it.
And in terms of stepping on the freshly wet ground, so to speak. Yeah, yeah. When you were working with Dr. Adams, knowing that you were going to be transitioning and taking care of the panel that he had onboarded, How did you guys collaborate in terms of like, did you have specific, okay, this is how he does his notes.
I will make sure that I adapt my notes to how he does them. Or did you guys have a conversation about how your ideal notes would look so that you could understand the, story of care for each patient? I think of soap notes. Great. Yeah, I think of soap notes as like my ideal soap note is, I'm telling my future self the story, so I know what, the conversation was and where, the next step was to be.
So I just wanna ask on those particulars, because it could, play a role in people who are in situations like you guys were, but also even for people taking call for other people, like if they're on vacation.
Yeah, no, that's, that's an interesting question. I, I really haven't thought about that actually.
I, , I think it was important for me, To take. Ownership, which is true, like that's in, and then to do so at the beginning in a comprehensive and Fullthroated way.
So I didn't mirror his notes. and nor do I really mirror. Ben or Zane's notes, I, I developed my own sort of style and, fill it in based on the, the notes that Dr. Adams had left me. So in that sense, they were great cuz I just sort of went through the whole chart and then kind of started over, obviously not reinventing the wheel, but, starting over with my own way of writing and I mean, look, I, you know, I graduated.
What is this, like three months ago? . I've been here for five weeks and I, and I recognize that and it's, I think it's important for me to name that, so I'm still probably too much in resident note land. They're, they're definitely too long and I'm, anyway, so I'm trying to learn how to. Craft them in a more pithy way that doesn't as Barry says, doesn't leave anything out but is readable and tells the story well, as you said.
Yeah.
And it's scared around your patient and not codes that are justified because of the 14 point review systems. Otherwise negative is noted in nature .
So, Yeah, I know it's, Yes, that's, I'll tell you, that's and I suspect we'll talk about this more later, but that, that's been one of the most fascinating.
Things just mentally is to track the different ways that your mind works in the room. I mean, compared to what you've been used to for. Years prior in training, it's, it's really amazing. AB
absolutely. And that actually let's, let's go to that next question because that's exactly what I was gonna ask about.
You've in the past talked about being present versus being absent, and so now Oh yeah. That you are fully, responsible and in charge as you, as you say, to take care of your patients. How do you. Feel that you are present, whether that be in the way that you write your notes or the way that you practice medicine differently because you are so close to residency and you can easily reflect back on like, Whoa, three months ago I was not doing this, and now I can because I'm a DPC doctor.
Yes. Yeah. Oh gosh, I don't even know how to say this specifically either. Let me say first that I, you know, I'm I'm taking that phrase from two people, The first is Stanley Howard Wass, ethicist theologian at Duke. and my dear friend Ben Fresh, who I've, I've written a lot with and I just.
Have utmost respect for, I'm gonna get . I'm just too emotional. I'm too emotional person. But he, he's chief resident in their med peds program at Vanderbilt. Just brilliant Mind has been a, has been a great friend. He wrote this just incredible article that I have given to our medical students in some of the work I do in.
This kind of curriculum on formation where we, we, we would meet in the evenings once a month and talk about how we're being formed in our training process and malformed and how to, how to become reformed and what, what possibilities of medicine are open to us, all that stuff. But My buddy Ben describes the process of training as one in which you are suffering absence. Har was, describes medicine as suffering presence, and he kind of means that in two ways that. To do medicine well requires you to be present to the suffering. And that requires slowness in time and vulnerability and patience and forbearance, and these virtues that you could argue are fading today.
But the, the other sense is that to do that you will suffer too, to do that kind of presence for someone. You're gonna have to make sacrifices. I mean, far Klan, he one time said, Practicing a faithful medicine may look like seeing less patients and taking a pay cut like it, like it may look like suffering presence probably what it entails.
And obviously that's. For, dpc that that can often be the case. But then Ben Fresh says, Residency unfortunately, probably is a form of suffering. Absence. You can't be present to the patient in a ways you long for, because of the structure of the time and the pressure. And that in itself is a kind of suffering.
It's a kind of cognitive moral dissonance that can be deeply bewildering if you feel called to be present to people. one of the more kind of painful things I was told kind of near the end of my training was that I, I did not seem to want relationship.
And that was deeply heartbreaking for me because I experienced training has has. Being able to, to locate relationship within the rhythms of the practice. And other folks could do that. And I, and I have utmost admiration for how they do it. I don't know how they do it. And I've experienced it as requiring more time to be able to do that kind of thing.
Well, there's something magical about that 45 minute window hour. I mean, this is why therapists and counselors sessions are an hour. There's just something about time. That opens up something that could not otherwise have happened. Anyway, I'm, I'm rambling on this, but uh, , , Yeah, I think, I think to be present is, the deepest call of medicine, at least within primary care land.
I mean, a surgeon probably has a different kind of call, but no, no less present in her attention to the surgical field. as medicine is currently structured, it's so easy to get distracted and to have your attention. Caught in a web of 30 other things. And I mean, that's life. You're always gonna have things that are calling your attention.
But and I'll say this, I'm, I'm definitely rambling, but this is the last thing. I'll say that word. Attention is a fascinating word. It means to stretch towards to reach out for, and if you experience medicine as kind of trying to reach out to your patient. But they're distracted or more, more painfully the patient is actually reaching out to you and you can't give them that attention, then it can be a really bewildering space for everybody involved.
Absolutely, and I'm sure the listeners are thinking about the many times in fee for service and I, I get it, like it's DPCs not for everyone, but for me, I am still very much a carrier of the, the memories of. I know that I'm your doctor and I didn't have any space, and you were told to go to urgent care, and if I would've known, I would've made time for you.
Or I am so frustrated because I don't have enough time in my schedule to fit you in. So yes, you're gonna have to go to the urgent care, right? And stretching yourself too thin sometimes, not even by your own. Desire to stretch yourself then, but that's what the schedule demands of you. Yeah, exactly.
No, yeah. Goes back to that dehumanization.
Yeah. I mean, no one goes into training saying, Yeah, I wanna like see 35 people. I, I I wanna see between 25 and 30 a a day, and I want to be constrained in my time like, no, no one goes into the process saying that's what I want. As I've experienced it and talked to other students in residents, they lament that that's what has happened to them.
And they actively talk and struggle, over our drinks at the end of the week, kind of lamenting and bemoaning, but then also like quite sincerely trying to to speak together. How do we make this different? How do we do the medicine that we, since we're called to do, but we can't? Locate is burnout really enough?
Doesn't seem like it's enough to really name this problem,
yeah. Yep. And you know, even, I think about it also from the patient's perspective. Nobody told a patient that. When you go to see your doctor, you're only allowed to say one problem, because we only have the time to address maybe one problem by the time you get in the room.
So when we talk about not stretching ourselves too thin, I absolutely love how you mentioned like 20% of your time is spent at the Duke Divinity School, and then the rest of your time. Spent at the Fischer Clinic in terms of professional time. And so I wanna ask about what is your ideal quote unquote, full panel, and what are the thoughts that have led you to, estimate that that would be your full panel?
And what does your ideal balance of life, career wise look like with that particular panel in mind? Yes.
Yeah, I, obviously these are, conversations that I think for me were just crucial to have as candidly and directly as possible with Ben and Liz. Me and my wife first and foremost, like, what, what are the rhythms of our family that we long for, that we've hoped to structure, into our weekends and all that.
But then adjacent to it, the Fischers and, Liz has been particularly helpful. Barry, Barry has this line about grabbing abstract ideas behind the ear and leading them back down to the ground . And, and she's just been a wonderful conversation partner and and director for me to think critically about how this could actually work.
Something we said at the beginning is that Fischer Clinic is a hundred percent fte, right? So even, even the language of. 20, like 20% of my time is at Duke, though practically true in the sense that I have Tuesday mornings and Thursday afternoons blocked for academic research and writing work, the patient will always come first.
So if I'm doing that work and there's a need that the patient has we, we kind of call it like level eight to 10 needs versus a level three need. Then I, the patients need trump's my academic time. So we try to be really clear about that.
So. That's the rhythm of my week. I'm, I'm in clinic like Any other physician would be Tuesday mornings and Thursday afternoons or slotted for research and writing time with the Divinity School and the theology medicine culture fellowship. , some Thursdays. I will commute to Durham and I'll be present on campus to kind of mentor fellows.
They have something called theology and soup where we Meet with the cohort and, and talk through how they're experiencing the fellowship. And the goal is to have future kind of teaching um, within those, those two blocks as well. And, all that stuff. In terms of ideal panel, the, the number that we keep getting, that we keep kind of imagining together is probably something like 600.
But again, it's sort of, it depends on the patient panel obviously, and that, that seems to be ideal for me. But again, this is, I I, I always wanna be very careful, be, not necessarily careful, but just only speak out of what I know. And since I've only been here for five weeks could be that 400 is, is the limit , but we've, we've talked about 600.
Awesome. And I just go back to, when you were between your third and fourth year of medical school, even considering leaving medicine and you took this opportunity to go to Duke Divinity School. I, feel that you had paid attention to your as as Marcy radar had shared at the DPC seminar in Kansas City, you paid attention to your guardrails or your boundaries. In terms of knowing, Dr. Eberly, because you have been in your body longer than five weeks. Like, when you think about your guardrails in general, what are some of the things that you pay attention to to make sure that you are continually present along the pathway that is keeping you?
Calm and focused and able to still be yourself while being able to be present in the community for others like your patients?
Yeah, that's a wonderful question. I mean the, the book I'm reading right now, Radical Hope by Jonathan Lee, it's Ethics in the Face of Cultural Devastation, which is fascinating. Kind of close analysis of plenty Coup and the Crow people. But he, anyway, he has this part in that book where he talks about how we are, we are defined by our limits in our affinity.
We're finite creatures and we're defined by our a, our, our desire to know our longing. So he humans want to know things, but we're finite and there's a limit to what we can know. So how do you deal with that tension, And I, think we probably need a healthy dose of reminder of our affinity today.
I think the optimization culture scares me, frankly. I guess the kind of idea of how can I optimize my body and my time in such a way that I'm getting maximum yield from every part of me. And I guess, part of this is my formation as a Christian, but is leaving the corners of your field unharvested, for two reasons.
Like, because we need at least two reasons. We, we need rest. Deeply. It's built into the rhythm of everything in creation as far as I can tell. Things, sleep and pause. And we should too. But then second, because it leaves the space to serve others. And you can't predict that, how how that will come upon you.
And, that sounds way more holier than now than I I I don't do this in the ways that I hope to do. But I guess to answer your question more practically, it's just lots of candid, very clear, very direct conversations with my wife and with my partners and with the folks at Duke. I mean, again, because of the virtue of of the kind of friendships and relationship we have, we're seeking mutual collaboration and mutual forms of flourishing together, and we kind of just laid out on the table as much as possible.
And so emphasizing that level of transparency, I mean, I'll literally will ask Ben and Liz. Hey, like the div folks are sort of thinking maybe I could do this. What do y'all think of that? And then same thing like, so, so there's a, there's a very much an openness of, they're not just my partners in a sense.
My boss, they are friends and that can be sticky territory. But I've experienced it essentially only as protection and care and friends who want you to flourish and are going. Speak plainly if they think something's gonna be too much. And what I've found is so far it almost always lines up with the sense I get through prayer and through conversation with my with my wife.
Yeah. Yeah. And, . . So on that note, I wanna ask, if you were to take your experience and pull from a high level as to. Things that you have, questions or considerations about your life that you've gone back to. If you were to say to the audience, Hey, in one year out of residency, whether you're in fever service or dpc, this is, these are the three top things I would think about to, to check in with yourself to see, are you still in alignment with what your goals were?
And are those goals? You know, The goals you wish to achieve versus if someone were at their, three years at a residency journey, five years at a residency journey.
, it's, I'm retreating to a philosopher again, but um, this is back to Leah, back to cot, but what can I know? What should I then do and what should I hope for? I think those are the, I'll just say those three things. What, what is it I know about myself and about my community and about my patients and the rhythms of my life?
And what can I conclude from that knowledge? What then should I do? What, what is my calling? What am I going to do with, with my life? And then what should I hope for? What, what is appropriate to hope for? . Hope is a powerful thing and but it's linked to action. It's linked to uh, knowledge.
Well, I think Dr.
Eberly, you have as they say, understood the assignment. So that was amazing. and I, , I think that that is really a great. , platform to build off of because you could insert, am I in alignment with what I want to do for my family goals, for my professional goals, whatever it is.
So that's incredible. So now in closing would you like to share any last words with our audience in terms of if someone were to consider DPC in addition to what you've shared, what would you tell them?
I'll say this, I, I have a note on my phone right now that I'm just sort of updating almost daily of things I want to write about maybe in six months. I sense that I need, I need more time. I'm still young and I'm still new into it and I wanna be careful there, it's been a delight updating that note.
And I was thinking about that note today. I was thinking about things I would tell students and, and I'll just very briefly just say these few things. One is a patient came in this is in the first week. And in his literal words, when I walked in the room, I said, Hey, I'm, I'm Dr. I'm the new guy. And he said, I'm looking forward to dying with you.
And it was just such a powerful moment for me of like, what that call makes to you, let alone how the model protects that call to actually happen. That it actually is possible through this model that I could know this, this man well enough to, help him die well to be with him as he dies.
That, that kind of thing. And I guess the last thing I'll say too, just maybe any students or residents who are listening is. The ways in which this has been healing for me and the ways I've listened to patients describe how this model is healing for them are just beautiful and worth telling and writing about.
This is a model in which time becomes not a burden, but a gift that you actually have the time, there's time to study and deep dive into things. You may have not experienced having the time to do in residency. For me, there's been a kind of delightful return to the fullness of the physical exam. I mean, in some ways residency trains you out of touching people. and so many patients come to us saying that doctor didn't touch me and that's why I'm here. Yeah, I mean I think we used to be thankful when there were no shoot, no shows in clinic. This is probably a universal resident experience, is my understanding.
And now it's, we're genuinely sad because these are, these are patients we know and there's a deep sense of belonging cuz it's not tied to production. It's tied, to belonging. Okay, I'm saying too much. I'll, I'll stop there. ,
that was awesome. Awesome. So thank you so much, Checker Eberly, for joining us today.
Yeah, thank you. This was really, really wonderful and yeah, thank you.
Next week look forward to hearing from Dr. S Bu thrill of BU Vita Health in Turlock, California. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about dpc. Leave a five star review on Apple Podcast and on Spotify now as well as it helps others to find all.
DPC stories. Lastly, be sure to follow us on social media. If you're wanting to continue learning more about DPC in the meantime, check out DPC news.com. Until next week, this is Maryelle conception.
*Transcript generated by AI, so please forgive errors.