MEMBER SPOTLIGHT: Dr. Gabriel Cade

Meet some of your fellow NCMS members each month in our Member Spotlight!  You can also take your turn in the spotlight. Look at the bottom of this story for more information.

1. What is a quote that has had a significant influence on your life, and why?

“Be Here Now.” The quotation is from a 1971 yogi spiritualist, but I first saw it in 9th grade when my math teacher wrote it in all caps on the board - an unintentionally meaningful attempt to gain the control of a rowdy class. I think it took me another decade (or two) to recognize the significance of this concept. Be present. Be in this moment. Be aware of the experience you are having. Be aware of the patient and their experience - be truly present for each need and concern. My intrinsically chaotic way of thinking and learning had led to many lucky wonderful adventures around the world and ultimately (inevitably) to emergency medicine, but I found this mantra necessary to get the most out of each experience. Even outside of the emergency department I see real value in this simple phrase. Put down my cell phone. Look at my wife. Look at my children. My job exposes me constantly to the frailty and flicker of the human condition and I sure don’t want to miss any of it.

2. Where are you from originally?

I was born about 200 feet from my current desk, in the lovely Blue Ridge Regional Hospital in Spruce Pine, NC, about an hour from Asheville. I had a fortunate childhood playing in the rivers and forest of the South Toe valley and I am doubly fortunate to continue doing so with my own children.

3. How did you decide to become a physician?

The dinner party answer is that I proposed to my wife when I was a two-time college dropout, rock climbing around the US, living in my car, occasionally getting work as a gear tester or travel writer. She and her family were understandably dubious. The reality is that it was inevitable - I was just waiting for dramatic timing. My parents, both medical workers themselves, raised me and my siblings with values of service and compassion. My father is a rural primary care physician, my mother is a retired nurse, and I saw the extraordinary relationship they had with our community. The practice of medicine can create opportunities to be very intimately present for another person - sometimes throughout the gentle meanders of a long life, and sometimes through the immediacy of an emergency or significant fear or suffering. My twin sister is a wonderful primary care Physician Assistant also working in rural Appalachia. My older brother is an immigration lawyer who works tirelessly to help children and families seeking asylum and support. We all believe in the value of this type of work and these relationships. Plus, I’m just not sure my wife wanted to live in my car.

4. What do you like about practicing in an underserved area?

It’s a unique and delightful experience to work side by side with my neighbors as we take care of our neighbors. There are many unique challenges practicing in a rural community. Access to resources - even basic non-medical resources - is very limited. Health literacy is low. Socioeconomic obstacles are significant. My family and I live in the same rural area where I work so we all experience some of these challenges ourselves. This helps reinforce the obvious truth that underserved doesn’t mean undeserved. My patients and our shared situation require that I be better at my job than when I worked at a level 1 trauma center. I have to read more and practice more and be more ready. This helps me be more present, to “be here now.” Luckily, I work with nurses and other local doctors who are really, really good at their jobs, and the more we work together in this intimate environment the better we all get together.

5. Is your practice using any tools to address social determinates of health for patients?

A few years ago I was able to participate in the Health Care Leadership and Management (HCLM) program through KIPL/NCMS. During this program we developed a questionnaire to integrate into triage to help identify SDOH in our patient population. Unfortunately, even as we work to identify more of these needs, we still struggle to provide the follow up resources necessary to make impactful change. There is no doubt that addressing these aspects of care enhances individual and community wellness and reduces reliance on primary and emergency care, but the infrastructure to support the need is greatly lacking.

6. What impact has the Covid-19 pandemic had on your practice?

Anyone involved in healthcare has been facing the dual pressures of dealing with COVID in their lives as well as caring for patients dealing with COVID. It has been really hard. The struggles with misinformation feel amplified in our rural community. The demand on our limited resources has been very heavy and our hospital lost some exceptional nurses to burnout and higher-paying travel jobs. It has further exposed some of the pre-existing failings of our healthcare system without (yet) making them better.

7. Do you have any hobbies or activities for self-care?

I have an amazing wife and two super rad little boys, and I don’t know what I would do to recharge without them. We live deep in the mountains and spend a lot of time tramping and playing outdoors. I also love to play soccer, read historical nonfiction adventure (age of exploration Lewis and Clark and Magellan type stuff), and, when everyone goes to bed, play video games.

8. You spent some time abroad in New Zealand, what were some of the differences in the manner healthcare is delivered in NZ v. US?

My truthful opinion is that the method of healthcare delivery in New Zealand is superior in almost all ways to that of the US system. Emergency department visits and any accident-related events are all free. Medications are affordable. Home health is much easier to arrange for management of diabetes, wounds, in-home antibiotics, physical and occupational therapy, and many other kinds of follow up. Nurses and physicians have compulsory “tea breaks” (with real tea) and generous paid leave, things I had never experienced before in almost 15 years in healthcare. The almost complete absence of medical litigation and metric-driven profit medicine fundamentally alter the approach to care. You don’t have to order every test and every scan on every patient every time. In the United States, the fear of missing something that first encounter, and the associated worry of being sued, complicate medical care and drive the cost of workups significantly. In New Zealand, if someone seemed well enough, we could send them home and just ask them to come back if they weren’t improving for a broader work up without any additional cost to the patient for a second visit. In 18 months of working there, I had less than half a dozen encounters with opiate dependent or opiate diverting patients, which is something I deal with almost daily in my US job. Physician salary is standardized across the country and based almost completely on your number of years out of training, so distribution of healthcare resources is much more uniform across all communities, and you don’t wonder if someone doing the same job is making more than you are - they also pay physicians about a third of what they can make in the US, but the emotionally supportive work environment makes it worth it. You do have to wait longer for elective type surgeries and procedures, but it turns out that you can! I believe in the potential of a centralized healthcare system, and with it a better approach to other social determinants of health.

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by Joy Avery