And that makes the documentary more riveting because doctors tell intimate details of their profession as they see it. Some of those emotions might not make it to the C-suite on a day-to-day basis, while physicians make the rounds. It's emotions that health leaders should see.
By injecting himself, Flesher does a sort of Michael Moore routine, but he's no wise guy. Just an exhausted emergency department doc. When they began filming, Pando says Flesher's "eyes were hollow."
One day, Flesher talks to the camera, as he sits in his green scrubs in the hospital where he was working.
"We're just jammed, ambulances everywhere, beds full, I'm carrying 16 or 17 patients of my own, pretty sick," Flesher says in the documentary. "Before I go three steps, I'm confronted with the billing agent for the ER who says we can't get paid because my charts — eight of nine — required review assistance components. Two, I'm confronted by the service rep for the hospital (who says) my patient satisfactory scores are only 93% - we've got to be above 96."
"The CEO says we are getting backed up (in the emergency room), and we need to get patients through the ER quicker," he adds. "The Joint Commission rep says she caught me drinking three feet too close to the patient care area and she's going to cite me for—whatever. I didn't even see a patient yet and my mind is already clouded."
As he began working on the film, Flesher found out many others were disheartened, and he felt the system failed them.
"The obstruction of physicians and its direct effects on healthcare are far more profound and potentially devastating than I'd imagined," he says.
In his journey to find himself, Flesher seeks out an older and accomplished physician, Peter Rosen, MD, who has received numerous awards in the field of emergency medicine. He expected Rosen to be stodgy. He found otherwise. He found a wise man.
"I think you can work to prevent (burnout)," Rosen says. "The important thing is to revive your ideals — why did you want to be a doctor? Because it still exists, no matter how many hidden agendas you have to meet at work, no matter how many stupid pieces of paper you have to fill out."
"Despite that, I can still have fun taking stitches out of that 5-year-old kid and joking with him for a minute and a half."
Rosen's inspirational comments run through Flesher, but they last only so long.
Now out of residency for 8 years, Flesher left the hospital and became a traveling, part-time physician, "to get more time and flexible schedule" to carry out interviews and make the film. He is working mostly in Pennsylvania and West Virginia.
Flesher's wife, Kathrin Allen, MD, is an anesthiologist. Does she agree with the film? "She does for the most part," Flesher says. But she's only been in practice for a year and a half, and, Flesher adds, "isn't so jaded yet."