Physician-Nurse Communication with Dr. Christine Nelson, M.D.

00:01] Michelle: Well, I had a lovely time reconnecting with one of my most highly regarded colleagues, a pediatric hospitalist and clinical professor of pediatrics, Dr. Christine Nelson. With many decades of experience in her pocket, she was my top pick for discussing the physician-nurse relationship and how good communication between the disciplines can promote patient safety and prevent physician and nurse burnout. Charged with teaching our newest physicians, her message for them to promote trust with nurses is, listen and respect. And as nurses, we can also benefit from her wise words.  In the five-minute snippet, I actually stumped her with my Green Bay Packers trivia. Here is Dr. Christine Nelson. You're listening to the Conversing Nurse podcast. I'm Michelle, your host. And this is where together, we explore the nursing profession, one conversation at a time. Well, hi, Dr. Nelson. Thank you for joining me today.
[01:09] Dr. Nelson: Hi, it's good to be here.
[01:11] Michelle: I have been so excited to talk to you. I say that before every interview because I'm excited. I'm talking with medical professionals, nurses, physicians, and it's my thing, it's what I love. So thank you again. So today you are here because we are talking about nurse-physician communication and how important that is, and hopefully, we'll find some ways that maybe we've failed and ways that we can improve. So I'm just going to jump right in. One of the things that I was looking at in preparation for the interview is the Joint Commission website. And of course, there's lots and lots of information on the website about communication, and what they say is communication failures lead to sentinel patient safety events. And you and I have worked together for quite a long time. And how do you feel about that? Do you feel like that's a true statement?
[02:26] Dr. Nelson: Actually, I do. I think that no matter where we are, communication can improve our patient care and our interpersonal relationships, obviously. But, yes, there are obviously many ways that patient harm occurs. But certainly, in my many years of experience, I think communication, either incorrect or inadequate or totally failed communication starts things out. It's often the root cause of a problem. It's also, in a lot of ways, low-hanging fruit to improve. And I think that requires acknowledgment from both sides and including our other colleagues, the pharmacists, respiratory therapists, and everyone, that all of us on the health care team have a role in that and need to be recognized for their expertise and their recommendations and their suggestions.
[03:33] Michelle: Right. So that's a really important delineation that you make. It's not just nurse-physician communication, it's a whole team. And you and I worked in the NICU and we had great teams, just like you said.
[03:52] Dr. Nelson: We absolutely did. And I forgot to include parents in that. Since I'm a pediatrician and you were working in NICU at least most of the time that I knew you, we need to remember that they're part of the team as well. And our communications with them are vital to their child's care.
[04:15] Michelle: Yes. That kind of leads me into another question that I have for you. So everything that you just said comes right from Joint Commission, that it's not just the patient, it's the families. And one of the topics that I wanted to talk about was patient rounding. So traditionally well, I'll say coming from the institution that I worked at, rounding was not one of the favorite things that nurses loved about their job. I don't know how physicians felt about it, I didn't ask physicians. But obviously rounding is a multidisciplinary thing. And the parent, we want the parent there. I think they're the most important person there. They're advocating for the care of their child. But talk a little bit about the importance of rounding and how communication plays into that.
[05:29] Dr. Nelson: Well, you certainly touched on something that's dear to my heart. And I would never say that my style or approach is the best on the planet, but certainly, where I am now, I am supervising and teaching learners. And our whole goal is to have family-centered rounds. We do a little bit of pre rounding to talk about sometimes the sensitive things and to get make sure that the whole team, the physician team, that is on the same page when we go in the room. But then we do try to make sure that parents are there, nursing staff, if the respiratory therapists are around, that's great. They, in our institution, are not because they have many other responsibilities and try to make it so that the parent is there. Here's the discussion between the members of the healthcare team can ask questions of any of them and then the plan is laid out so that everybody understands what today's goals are. That sounds all academic and pie in the sky, but it most of the time works. There are some situations where it doesn't. Often physicians are on a time constraint and have to do rounds without a family member present. I insist that the nurse be with us. It's sometimes the Charge nurse, but most often it's the bedside nurse that comes along so that he or she knows what the plan for the day is and then writes on the whiteboard goals for the day. As I say, it has its flaws. Certainly when there is sensitive information that has to be obtained from a family or discussed, often we have to go back to a more private setting. But I think that moving in the direction of as close to always doing family-centered rounds, at least in pediatrics, is essential. It should be the same with adults, but that is tough. And even with pediatrics, sometimes it's hard to know who exactly can receive information. Suppose I am on family-centered rounds and it's not one of the parents in the room, but a grandparent. And I may not know if that family wants that grandparent to know all of the information or not. So I may have to cut short the family-centered rounds or the question answering and say, let me discuss that with your grandchild's parents or your niece's parent or whatever, and make sure that you can receive the information.
[08:25] Michelle: Right.
[08:25] Dr. Nelson: There are some tricky things to it.
[08:29] Michelle: Yeah, exactly.
[08:30] Dr. Nelson: Mostly it works.
[08:31] Michelle: I have been a fan of rounds. We didn't always do rounds in my institution really until late in my career. And I don't know if it's just because I like to talk or what, but I just always enjoyed it. And I would talk to nurses and they'd say, oh my gosh, I get so nervous speaking in front of people. And I would tell them, just pretend it's like a report that you're giving another nurse report in the morning or in the evening, and don't take it too seriously. But also the purpose is so the parents can get involved and everybody knows what everybody's goals are and we can all work towards that because our patients get the HCAHPS survey, right? We're always hearing about HCAHPS and one of the things that keep coming up on HCAHPS in NICU care and pediatric care is each person told me something different, each nurse told me something different, each physician told me something different. I didn't know who I could trust. And that's just a common response that we've been trying to solve for decades. So that part is really frustrating. But those patient rounds are so crucial for communication.
[10:07] Dr. Nelson: Well, they absolutely are. I think that the other part that needs to be acknowledged by all of us is that each one of us can learn something from each other member of the team very often something new every day. And even at my age, I feel very strongly about that. Obviously, I'm now in a different kind of institution where learners are always there and the team changes all the time. But even when the team is pretty stable, we can all learn from each other. And I think that one of the frustrations to me is sort of what you hinted at, and that is that some nurses are not comfortable bringing up issues with docs, and obviously, some docs make themselves unapproachable as well, and that's a very real thing. But sometimes nurses are timid enough or insecure enough that they're not willing to stick their necks out and take a stab at, hey, I'm worried about such and so, or what do you think about this? I understand that nurses aren't, quote, allowed, that is, it's not your scope of practice to make diagnoses, but you and I both know that you do, and there are ways to get around the communication issues with that. But I always value the niggly feeling that either you as a nurse or I as a physician get that.  I just heard a good abbreviation for it tar. That ain't right.
[11:54] Michelle: I love that.
[11:57] Dr. Nelson: We need to be able to raise our hands to each other and say, something's wrong here. My gut tells me I don't know what it is, but something tells me that there's something wrong. I'm uncomfortable with whatever, whether it's the diagnosis, the treatment plan, all of those things. We need to be open enough and sort of have a tough enough shell and nurses have to have a tougher shell than I do, believe me. Some of my colleagues are nasty.
[12:29] Michelle: What? Right? It's true. I've worked with pediatricians all my career, and I have to say they're some of the best people and just some of the easiest people to get along with, and we have a lot of fun. But what you just said, that does it have to do with trust? And so here's where I'm coming from. So I read this article, which came from Hospital Pediatrics, 2016, and it's called Assertion Practices and Beliefs among Nurses and Physicians on an Inpatient Pediatric Medical Unit, right? So one of the nurses says, and I'm quoting, I get frustrated as a bedside nurse when I'm asking and asking and I can't get what I want done. I have to go to my Charge nurse to get her to approach the doctors. And then they say, oh, okay, that sounds good. And I'm like, I've been saying this all along to the doctors. Why do I have to involve my Charge nurse to get what I want? So is this like a trust issue that the doctor doesn't trust the nurse's assessment recommendations? Is that what we're talking about? Because how do you know if you trust a nurse? And how do nurses know they can trust doctors?
[14:05] Dr. Nelson: Man, that's a tough question. Yeah, and I'm not sure there's a real easy answer to it. Obviously, experience plays a role in that, that is to say, the amount of experience on either side. I fully understand why nurses don't trust my interns in July, but it's equally frustrating to me, for example, if I even explain why I'm thinking something to the nursing staff and they still resist, we're not willing to try. It goes both ways as well. I think you're right. It is a trust issue. And the only way we can get around trusting is to be more open and talk with each other, be present, be willing to admit that we were not right at the time, that there are other ways to do things. One of my very first attendings when I was an intern used to frustrate us half to death because and I quote him occasionally, he used to say, I'm not always right, but I'm never wrong. And what he meant by that and what I try to mean by that, not always, is that he always had data to back up his opinion. He almost always took the least popular opinion, but he always had the data. He always had a reason. So I think we have to learn to probe a little bit more about why someone is doing what they're doing or making a suggestion. I can't tell you how many times I tell my learners, and I'm getting used to calling them learners because they are all at different levels that they have to listen to the nurse because he or she is at the bedside for 12 hours and we're there for snippets of time in between. And that observation that's there and that opinion that's there is vital to our decision-making. That's the best I can do in terms of passing on that information and I'm hoping it's sticking.
[16:31] Michelle: Yeah, that's a really good point. I talked to my brother. Dr. Chris Patty. I interviewed him on this podcast and he was amazing.
[16:42] Dr. Nelson: But all of your siblings are.
[16:48] Michelle: Thank you, that's very kind. But one of the things he said to me is that good communication is the outcome of a good relationship. And I said, wow. that's profound, like I always do when I talked to Chris. Some of the things that came off of the Joint Commission website, were talking about standardized communication tools. So SBAR, situation, background assessment, recommendation, all of that. And then they said the best form of communication is direct face-to-face communication. And I have to agree with that. That's my preferred form of communication, where I will actually go to the physician's sleep room instead of calling them on the phone and knocking on the door. I may have pissed off a few physicians because of that. And then the worst is kind of what you experience in a very large hospital. So geographic and technology factors. So just being super spread out and then technology. Like I know at our institution we used pagers, we use ZZ page, but they had dropped calls and dropped pages and stuff like that, where the sender thinks that their message is being sent, but the receiver never gets it right. So there's all those factors that play into communication.
[18:31] Dr. Nelson: I think the other part of the communication problem that we have in any team will have it if they have multiple members, is that at shift change for whoever you're talking about, the person you're going to communicate with changes and sometimes they don't notate who is now in charge. I mean that's absolutely true in my institution now, I have to go in and change who the attending is and who the resident is. And we do have a lot of missed calls and pages and texts and all those kinds of things. I know that your institution is on Cerner.  Epic, and there's a function there that works very well, called Epic Chat, that as long as you have the right person in the chat, the messages get there, they get acknowledged very quickly. But it requires that people know who is on the team.
[19:35] Michelle: Yes, absolutely.
[19:36] Dr. Nelson: That fails sometimes. Does Cerner have that function? I don't know.
[19:43] Michelle: Yes, sort of. It's not really like a chat. It's more like you can communicate and it goes to an email. So it's not very effective because we know that we're running around taking care of patients. We're not sitting by our email all the time. So I don't think that's very effective. But we do have this ZZ page and I remember using this most often when I would go to a C-section and I was notifying the physician that he or she had a newborn born to them and giving them all the stats and all that. I would go through,  well, the way I type is really the way I text, which is everything, has to be perfect grammar, perfect punctuation. It takes a hell of a long time because I have to get it all right. It's like I'm writing, I don't use abbreviations and all that. So some of the physicians would find me later and say, wow, I really liked your message because I put like, have a great day. Questions or concerns, call me. So I think a lot of them got a kick out of it, but, you know, I got my message across or whatever. So it's all about getting the message across, right?
[21:12] Dr. Nelson: Yes, it is.
[21:13] Michelle: Yeah.
[21:14] Dr. Nelson: And I think electronic medical records are marvelous, but they have their downsides. They require much more time away from the patient for all of us, not just for nursing, but for me too, than used to be. And they are fraught with places where you can make an error, whether it's by cloning and not correcting something that somebody else put in or just not paying attention. And I think that's another place where we really need to focus our communication skills at with learners and with ourselves. It just has to be right. It has to be accurate. And you can't just assume that the last guy got it right when they wrote it down right.
[22:07] Michelle: Like copying and pasting has got us all into a lot of trouble right now. But these systems were sold to us with the selling point being this is going to make your life easier. This is going to make things go faster. Right? Right. We want a refund. We want our money back. Oh, gosh. All right, so we're going to talk because we talked a little bit about that.
[22:45] Dr. Nelson: Let me just jump in with one other thing. I saw a really phenomenal meme on Facebook that has two books of which you are familiar, or at least it's a policy and procedure manual on one side and just a comment on the other. And we unfortunately are stuck with having to use policies in medicine in any kind of healthcare. But this one basically says there's the policy and procedure manual and then there's the workarounds that we develop because the people who wrote them don't take care of patients. And I think that that's pretty darn accurate, actually. Yeah, we get bound up in what's written, and the Joint Commission has a lot to do with it and CMS does, and we've got too much organization in medicine compared to the old days. And you know that I'm old, you're not as old. But there were some advantages to not having quite so many regulations.
[24:01] Michelle: I agree.
[24:03] Dr. Nelson: If we could go to the lack of regulations and the openness of communication and evidence-based patient care, we'd be in Utopia.
[24:17] Michelle: Right.
[24:18] Dr. Nelson: In the old days, there was no evidence-based, but if we put that on top of the old way of communicating and recording, I think we'd be better off anyway. I interrupted your switch.
[24:31] Michelle: No, I totally agree with that, and I think that's something that our listeners would agree with as well. And, you know, having no frame of reference of, you know, you and I have the frame of reference of, you know, back in the day. But a lot of nurses and physicians that are coming right out of nursing school and medical school, don't have that frame of reference that we do. But I would echo your sentiments on that. Those things were a lot easier and simpler back then. I started my nursing career in we didn't have an electronic medical record until God, I was thinking about this the other day, like 2000, right? Yeah. We still did paper charting and I got called in the office quite a few times about my illegible handwriting. And that really didn't sink in until my first and only deposition when I had to sit before an attorney and have to try to decipher what the hell I wrote. It was embarrassing. And all those managers that talk to me about it, I said, oh, man, if only I had listened. And I was all about the content. It's not about but if people can't read what I'm writing, then the content makes no difference. Right.
[26:15] Dr. Nelson: Well, you know the joke and it's not always a joke about doctors' writing being completely illegible. I was in the opposite situation as you. I had perfect parochial school cursive handwriting until probably 1990, and then it all went to hell. And now that I am on the computer and entering everything that way, I can't even read my own. It's really bad.
[26:48] Michelle: It is. Oh, my gosh. How do we go so wrong?
[26:52] Dr. Nelson: Yeah.
[26:53] Michelle: Well, one of the things that since we're laughing right now, I think we should just carry on with that because one of the things I wanted to talk about, and I'll bring this up is in my research, I found this article from the Archives of General Psychiatry.
[27:12] Dr. Nelson: I love that.
[27:13] Michelle: Yeah. And this was written by a physician, a psychiatrist, in June of 1967. Leonard Stein from Madison. What were you doing in 1967?
[27:31] Dr. Nelson: Me? I was a second-year medical student.
[27:35] Michelle: Okay.
[27:36] Dr. Nelson: I probably met that guy over at Mendota State Hospital. I don't know whether he was a Resident at the time or faculty when I read it, but I thought it was phenomenal. You should share that link.
[27:51] Michelle: I'm going to put it in the show notes.
[27:53] Dr. Nelson: Reader, your listeners, because it's a combination of tongue in cheek and so true.
[28:00] Michelle: Yes. The first time I read it, I was just saying to myself, what? Really? Oh, my gosh, I'm so glad I didn't have to practice back then because I would not have been able to keep my mouth shut. I would have been labeled as one of those outspoken nurse bitches that he says in this article. And again, I was talking to my brother Chris about this, and he said, this is actually required reading for all of the doctors and nurses, and residents that come through his office. He sends this to them and requires that they read it. But I'm just going to get your opinion right here, and I'm just going to talk about the object of the game. And so this is communication between physicians and nurses. The object of the game is as follows. The nurses, to be bold, have initiative, be responsible for making significant recommendations, while at the same time she must appear passive. This must be done in such a manner so as to make her recommendations appear to be initiated by the physician. First of all, there's, like, so many things wrong with this, right? Because they only identify the nurse as she. And of course, we know that's not true, but it was then.
[29:28] Dr. Nelson: And that same requirement back then was for women in medical school. Just so you're aware that we also lived under that same kind of game. You could not appear to be the bold, brazen female.
[29:51] Michelle: Wow.
[29:52] Dr. Nelson: I mean, seriously, it was very similar. So I related to that. It's such a totally different time now that I love it. I mean, the glass ceiling in medicine or anywhere else has got some cracks, but it's not completely broken, and I don't think that it will be until members of my generation and maybe the one below it are done with this, because I think the hope for fixing some of this is in the younger generations. Some people are just too stuck in their ways, and they're not open to different roles.
[30:32] Michelle: Yeah, absolutely. And it's an accurate one. I remember the days. First, I want to say thank you to all the pediatric hospitalists, because you have changed the care of children everywhere. You've elevated it. I worked a long time before you guys came along as hospitalists. We had to call the physician in their office, right, because that's where their bread and butter was. That's where they were seeing patients all day. And if we had a kid that was declining and we had to call and convince them that they needed to come to the hospital to see this child. I think I've spoken about this before, but one of my colleagues was arguing with a physician on the phone about, you know, we have this kid in status asthmaticus. I think he was like a three or four year old and he was actually just sent over from the physician's office. I'm so glad that's changed today, too, where they kind of have to go. Yeah, they have to kind of be seen in ER and see, how unstable are you? We're not just going to send you right up to the unit where you need to be intubated. But, you know, we always laugh about this, my friend and I, because she was arguing and arguing, and this person just wasn't convinced that he needed to come. And she said, look, this kid looks just like my hamster right before he died.
[32:06] Dr. Nelson: I like that.
[32:08] Michelle: And that did the trick. He hung up the phone and he was at the hospital within, I think, seven or eight minutes. And the kid did fine. He had to get intubated and transferred to the tertiary unit. But it's like, oh, man, it shouldn't have to be that hard. And I think it goes back to trust. And you and your residents, you guys see so many different nurses on a daily basis, and how are you going to know if you're going to be able to trust their assessment skills or whatever they're telling you? That has to be really difficult.
[32:47] Dr. Nelson: Well, and it goes both ways. Like we said at the beginning, you as a nurse don't know whether when I first started the job I'm in now, I'm old and people would think, well, I should know stuff, but I had to let them know that I knew what I was talking about. Even though I had street creds, I still had to prove myself. And I think the way you do that, and this is what I've been teaching, is you get to know people, you hang around together if you can, that is. I spend time sitting in the nurse's station and listening to what's going on, listening to how nurses speak with each other as well as how they talk with me. It doesn't look like I'm doing that. It looks like I'm busy doing something else. But I think that is one of the ways. And you could say that nurses should be doing the same thing. Nurses should be listening to our team when we're outside of the room on rounds and be able to ask questions we do, including leading questions, like, why wouldn't you do such? And so I'm going to circle back to my whole thing about nurses not being able, by the scope of practice, to make diagnoses. And I'm not saying I want everybody to just go out and make a diagnosis on a kid, but I mean, there are certain things that if it looks like a duck, and it talks like a duck. It's a duck. And why can't you say, this is such and so? Or do I think this is such and so? I don't quite understand that in nursing education, so to speak.
[34:38] Michelle: Right. And in preparing again for this talk, I wanted to know what was being taught in nursing school in terms of communicating with physicians. And so I called my good friend Dr. Dianthe Hoffman. She's a nurse educator over in Santa Barbara, and she gave me their curriculum where every semester through there, they have a section on communication and advocating and all those great things. But what could you succinctly say that you're teaching residents about the doctor-nurse relationship, and how to communicate? I know that's, like, a huge question.
[35:26] Dr. Nelson: But I think it's easy to answer,  it's listen and respect.
[35:31] Michelle: That's perfect.
[35:33] Dr. Nelson: It's the fact that the nurse has a different skill set and very much to contribute to the care of your patient because she or he is there and onsite. And you have to learn to acknowledge your own faults, your own knowledge but do the same thing. Acknowledge their knowledge and their expertise in their area, because we can't live. The fact of the matter is, patient care would just go to pot if we didn't have nursing staff. It just would. I honestly wish that people could spend more time at the bedside, that we would have lower ratios, for example. I don't know what that is. Higher or lower? That is fewer patients per nurse. And I love that California has a limit, at least not during crises, because my sister was in Nevada and in the intensive care unit there, their ratio was one to six.
[36:35] Michelle: Oh, my gosh.
[36:36] Dr. Nelson: Darn scary.
[36:38] Michelle: Yeah. I'm proud of California for that. And I know it makes it tough on, you know? Yeah. And we've all been suffering, and the poor communication that leads to burnout, and we don't need that. We have a lot of that, and we need to heal that, and it leads to physicians and nurses leaving their professions, and we just can't have that. Well, we certainly had a lot of good takeaways from our talk. I mean, we know that the doctor-nurse relationship is here to stay, and we have to learn how to effectively communicate between the disciplines in order to prevent patient harm and promote safety. And all of our HCAHPS scores just satisfaction from our patients. We want our patients to be well taken care of, and we want them we want their families to feel that. And we also, as practitioners, and professionals, want to feel satisfied with what we're doing. We want to feel a high sense of job satisfaction. We don't want to leave what we're doing. We don't want to burn out. So thank you for adding to the conversation. I really appreciate it.
[38:10] Dr. Nelson: Well, thank you. I think one of the other ways if I can add on is that we need to make a more conscious effort to have direct person-to-person communication rather than electronic, even though electronic is easier. And I talked earlier about Epic Chat and some of those things. There's nothing that replaces face-to-face communication, like you said, with going to the call room, for example.
[38:38] Michelle: Yeah, I'm a big fan of it. I mean, you can just see the nonverbal.
[38:45] Dr. Nelson: Yeah, some people should never play poker.
[38:51] Michelle: Yeah, I've been the victim of some nonverbal communication gone bad where the physician just kind of shut the door and I thought, oh, okay, we're not talking anymore. I'll go away now. But I have to say that one of the things I always appreciated about you in our relationship is, and we've laughed about it because I would call you, this is my Charge nurse days where I would call you for crash c-section. And you'd answer the phone and you'd say, well, I'm in a meeting. You kind of be a little bit annoyed. And I would say, okay, well, I'm sorry I didn't have my Dr. Nelson cam on today. So, you know, kind of a roundabout way of saying, you know, I don't know what you're doing. I still need you to come to the C-section. And you always showed up. You always showed up. And then later you would seek me out sometime during my shift, and you'd come and you'd apologize for your attitude, and it just made me just love you even more. And I just really appreciate that. And you did that to everybody.
[40:18] Dr. Nelson: Well, thanks. I still do say, be careful, I'm writing the Broom today.[40:24] Michelle: I remember. Yes, that's good. Well, I have to tell you that one of your book recommendations, the Spirit Catches You and you Fall down by Anne Fadiman. I read that, and I think it should be required reading for all healthcare providers, certainly in the Central Valley. Yeah, wonderful. And I really want to do another episode about all the mistakes that I've made, and one of them was with a Hmong family and what I learned from it. But that's for another day. So we are ready to play the five-minute snippet. Are you ready for that?
[41:07] Dr. Nelson: I am. I'm actually a little nervous about it, but it sounds like fun.
[41:13] Michelle: It's so much fun. Okay, let me get my timer. All right, so we're going to start, and I know some of the things that you like just because I know you, all right? So let's have some fun. Your favorite place to visit and why.
[41:31] Dr. Nelson: Las Vegas now because I like the entertainment, but I also have a sister who's over there, so it's my opportunity to see her.
[41:42] Michelle: And what about the money?
[41:44] Dr. Nelson: Well, I said there's entertainment. If you ask locally where I would go to just chill, it would be Tachi Palace.
[41:55] Michelle: Okay. I need to get to one of those because I really do enjoy it, and I have a lucky streak. I always win money, so I need to go.
[42:05] Dr. Nelson: I almost always do, also. Yeah, that keeps you going.
[42:09] Michelle: Yeah.
[42:10] Dr. Nelson: They sometimes get frustrated with you.
[42:12] Michelle: All right.
[42:14] Dr. Nelson: I consider it the price of entertainment. Like, other people would go to a Broadway show or there you go. Stuff like that.
[42:24] Michelle: Yeah.
[42:24] Dr. Nelson: I like the limit, and when your limits are done, you go home. And if that's ten minutes okay. If it's 6 hours, that's also okay.
[42:32] Michelle: That's right. Is there a popular food that you?
[42:37] Dr. Nelson: Just don't like as a category of foods? I am not a fan of middle eastern food okay. Or Indian. And it's the spices.
[42:51] Michelle: Okay. I don't share your,  yeah, I love that. And that leads me to another question. If you could only use three spices to cook with, what would they be?
[43:04] Dr. Nelson: Salt, oregano, and chili powder.
[43:08] Michelle: Oh, you like it hot?
[43:10] Dr. Nelson: No, not hot. Different kind of spice.
[43:13] Michelle: Okay.
[43:14] Dr. Nelson: Probably smoky paprika or chili powder.
[43:18] Michelle: Oh, yeah. Gosh. My daughter is a huge fan of smoked paprika. Let's see. Who would you call if you got stuck in another country at this point?
[43:32] Dr. Nelson: My youngest son.
[43:34] Michelle: Okay. And he would come and get you.
[43:37] Dr. Nelson: He would figure out how to manage. Yes.
[43:40] Michelle: Right. Very good. You have to have somebody like that in your corner.
[43:44] Dr. Nelson: Well, you know, you have to think about these things differently the older you get.
[43:49] Michelle: That's so true. Okay, this is a Green Bay Packers trivia question.
[43:55] Dr. Nelson: All right.
[43:56] Michelle: What was the official name of the Green Bay Packers cheerleaders?
[44:00] Dr. Nelson: Oh, dear. That I don't know.
[44:04] Michelle: What? The Golden Girls.
[44:08] Dr. Nelson: No, I do not know that.
[44:10] Michelle: Okay.
[44:10] Dr. Nelson: I like the other Golden Girls a lot.
[44:12] Michelle: I know, me too. Right?
[44:14] Dr. Nelson: I do have to tell you that I met Bart Starr way back in the day what? And I didn't know much about it. I was doing a rotation in Green Bay, and he brought his kids into the pediatric office, and of course, I was dumb as a doorknob. Oh, yeah. Well, I think I know that name because I was all stuck with learning everything.
[44:40] Michelle: Sounds kind of familiar. Yeah. Who was the coach that led the Green Bay Packers to their first two Super Bowls in 1966 and 1967?
[44:53] Dr. Nelson: Vince Lombardi.
[44:55] Michelle: Yes. Do you have a favorite tailgate food?
[44:59] Dr. Nelson: Brat.
[45:01] Michelle: Oh, gosh. I agree. Okay.
[45:04] Dr. Nelson: California.
[45:05] Michelle: You have to have them in Wisconsin. Wisconsin brought I'm gonna have to travel there.
[45:10] Dr. Nelson: You can buy some of them, but somehow they don't cook the same.
[45:16] Michelle: Are those the ones that have, like, the cheese inside of them?
[45:19] Dr. Nelson: No, just plain ones.
[45:20] Michelle: Okay.
[45:21] Dr. Nelson: Johnsonville is a good brand to try.
[45:25] Michelle: Okay.
[45:26] Dr. Nelson: But you have to soak them in beer.
[45:28] Michelle: Oh, my gosh. Okay, I'm going to have to try that. We have 40 seconds. Have you ever been in a food fight?
[45:39] Dr. Nelson: No.
[45:40] Michelle: Okay, let's do it. Let's get started.
[45:43] Dr. Nelson: I like to eat it. I don't like to throw it.
[45:45] Michelle: Right. So we're in your house, and we see your favorite travel photo. Where was it taken and why is it your favorite?
[45:58] Dr. Nelson: It is a picture of a very lovely house on the tip of a peninsula in British Columbia, and I took it on one of my cruises. It just happened to turn out perfectly every time I look at it.
[46:19] Michelle: Well, that sounds amazing. Anywhere where there's water, fog, and cool air, that's where I want to be, especially now in August in the Central Valley.
[46:32] Dr. Nelson: Yes.
[46:33] Michelle: Yeah. And I'm in my closet right now, so it's like about a billion degrees in here.
[46:38] Dr. Nelson: But the sacrifice feels about like that right now.
[46:42] Michelle: Right? Because of your AC situation. Oh, my gosh. Well, this has been so much fun. I know that our listeners have I know they've gotten so much information from you and insight. And again, I thank you so much for coming on here and talking to me today.
[47:02] Dr. Nelson: Well, I appreciate it, Michelle. And I love your podcast. I will be listening to get the inside scoop on nursing.
[47:12] Michelle: Thank you so much. All right, well, you take care. One of the things I'm going to do is put your book recs in there, and I'm going to figure out how to link the doctor nurse article because that's just really good reading for anybody.
[47:32] Dr. Nelson: I'd be able to make a new document and just upload it. I don't know if this podcast works that way, but that's yeah, I have.
[47:44] Michelle: It is a PDF, and I have Linked PDFs before, so I think I can do it.
[47:48] Dr. Nelson: Yeah, because it's such an old article that it's going to be hard for people to retrieve it if they don't have some access.
[47:58] Michelle: Yes, that's a good point.
[48:00] Dr. Nelson: Major database.
[48:02] Michelle: Yes, that's a great point because I actually had to retrieve it from one of the best medical librarians that there is, and she's awesome, but that's a good point. I'm going to figure out how to do that. Yeah. Well, thank you so much. Have a great rest of your day. I hope it's cool.
[48:22] Dr. Nelson: I hope so soon. Thank you, Michelle. You stay cool as well. Great talking with you.
[48:28] Michelle: Same care. You take care.