Dr. Abraham (00:02.86)
Reliably Well brings you thoughtful conversations from those who are shaping the future of healthcare, focusing not just on the technical side of the industry, but on the human element, the stories, the struggles and triumphs of individuals who are driving change.

Join us for candid discussions that highlight both the challenges and rewards of working in a field where humanity and healthcare intersect.

Dr. Johnsey (00:32.344)
Great to have our guest this show with us. When we were planning for this season, we thought of lot of people who had very interesting human stories for us. At the top of both my list and Dr. Abraham’s list was Dr. James Gleason. He’s had kind of a multifaceted career in healthcare. Began his career as a pharmacist before returning to get his…

medical degree at the University of Mississippi. He’s got over 20 years of experience, both teaching in institutions such as UMMC and William Carey and Mississippi College. He’s got a very multidisciplinary approach to patient care and a very patient-oriented, very patient-centric approach. He’s very interested in both the science but the human side of patient care.

He and I go back far. Our careers have crisscrossed over, well over that 20 year period. I won’t give away our ages specifically to go back how far they go, but it’s my pleasure to have been able to work with him again through our careers here at Relias and my great pleasure to have him as our guest today on the Reliably Well podcast.

Yeah, and James, I often people in academic medicine will talk about the triple threat of a clinician, right? If they’re a researcher and a clinician and a teacher, I think you’re somebody that’s a quadruple threat and that you never lose sight of who the patient is as a person first and foremost. I would like to say thanks for joining us along with Joe. And we both consider you friends and really thankful to call you a colleague. We start every podcast with the same question.

You can take this wherever you want to go, but tell us your story.

Dr. Glisson (02:27.02)
Well, thanks for having me. I have never done a podcast, so this is my first. But as far as my story, I mentioned to y’all earlier, I think if you summed it up in three words, I am a blessing because really the fact that I ever made it to pharmacy school and then subsequently med school and then.

Got through some my trials and tribulations and I’m now with Relice. I’m very fortunate to have achieved what I have. I’m very thankful for that. As far as my story, I mean, I really heavily considered even dropping out of high school when I was young and, you know, was making a little money and didn’t make the best decisions. But fortunately, I didn’t do that. So I think that we as clinicians are humans first. I’m sure I’m paraphrasing somebody else with that, but that’s one thing that over my years of practicing and

teaching and talking with patients as I’ve really come to try to embrace is that, you know, everybody I’m talking to as a human, whether that’s a nurse or the patient or a colleague. And I try to think about where they’re coming from and the old adage of, you never really know somebody because you don’t walk in their shoes. Well, I think through empathy, we can learn to at least temporarily try on their shoes a little bit, if not fully walk their path.

And I really try to focus on that aspect whenever I talk to patients. As far as my story, also, I went to pharmacy school thinking I didn’t want to go to med school. And then what happened? Fortunately, I had some folks that really encouraged me to take the MCAT. And it kind of landed that way.

I’m an alcoholic. I’ve got almost 14 years sober and I’m very proud of that. And I was a good clinician prior to getting sober, but I think I’m a vastly better clinician now having achieved sobriety and continue to be sober. I think that helps keep me grounded a good bit because I remember being in some pretty dire straits and sometimes people we see in the ER or in the hospital are in very difficult.

Dr. Glisson (04:31.476)
psychosocial situations maybe. And I feel like I can embrace some of that and remember what it was like. As far as what got me to medicine, I can remember being young and I always really liked puzzles. So essentially every patient I interview is a bit of a puzzle. I find that whenever I can make, like I have a gut feeling after talking or while I’m talking to a patient about kind of what their overall situation is both.

just with medicine, but also their social situation and their situation as a human. If I can get science to match that, I’m right a lot, probably 90 % of the time. I’m not saying that to be cocky, you know, seeing a lot of patients over the years and nurturing that gut feeling and then knowing the science that matches with it, it’s really kind of playing a Sherlock Holmes game most of the time. I think that’s probably it, unless y’all have another question relating specifically to that.

No, that’s, I appreciate your, your openness there, James. And you said your story is, a blessing. And I think you meant that for what it comes back to you, how you’ve been blessed going through. I, I’ll, I’ll say looking at it from an outsider’s perspective, you, you’ve blessed others. You know, you’ve gone into some difficult situations where you, where you’ve worked and you’ve, you’ve brought some good clinical skills, really, really great clinical skills into some.

austere environments and that’s been a blessing. And I’ll tell you from a, I can’t remember if it’s first or second year medical student in pharmacology, you you got class notes and then you had, had glistens notes that helped you through your blessing to our class as well in that situation. so in a lot of ways, you’ve been a blessing to those round about you. I remember a book a long time ago as well that was entitled, The Bumps Are What You Climb On.

And the author’s point was, you know, that if everything’s smooth, that our story is all smooth, it’s really, really hard to get purchase. And a lot of times we can look at those bumps as being, man, that’s really rough and difficult, but a rock climber sees those things as really, really great because those are handholds, those are footholds, those are things that I can see and I can grab ahold of and I can move forward with. And, you know, I think a lot of things are our

Dr. Johnsey (06:56.874)
our perspective. And as you said, you have a perspective on those rough spots in your story as being things that have propelled you and have made you more empathetic, more able to see that story in those people as they’re just human beings. And we all have that story that’s got some good spots and got some rough spots on it as well. It makes us who we are.

Another question that we ask all of our guests, kind of switching gears a little bit, Relias has our five passions, quality, innovation, and people, excellence. What sings to you? What speaks to you as being most James Gleason-like of those Relias passions?

I would say quality and excellence. I try to pay attention to details and I think a lot of times details are missed and then there’s other people that focus only on details. So, you you miss the forest for the tree kind of thing. I really try to, in my notes and everything, kind of explain something about where the patient’s coming from. I think I’m probably one of the few people that still ask what somebody does and what they do on their job, probably.

consistently at least. And I found that especially working in semi-rural Mississippi, like a lot of times somebody’s job can relate to whatever their medical illness is. But quality and excellence, like I’m particular about my notes and how I like them done. And I want Joe Johnsey to be able to pick up my note the next day and go, well, that’s what Glisten was thinking. And that’s what I need to worry about, you know, would not have to dig through some cut.

paste trash that some system puts in the note for you. I’m pretty opposed to that. Like I still dictate my own physical exams. I don’t use templates. And I think that makes me best at what I particularly want to do with medicine. Like it’s one of my nuances, I would say. So whenever I had students, I would often ask them like, okay, well, Mr. Abraham in there, you know, what was on his bedside table?

Dr. Glisson (09:01.95)
What do you mean? You know, I’m like, well, you’re supposed to like really know about the patient, what’s going on around them. So like if it’s a woman that has like hair removal cream or something like that might say she has some kind of elevated androgenous state. And what does that mean? And how does that relate to her medical problems? You know, so things like that. you know, quality and excellence. I really try to do my best. I try to look at every patient and say, OK, what could I miss? And fortunately, I trained at it.

program where they said you had to rule in what you thought it was and rule out all the bad and weird stuff. So like every chest pain that comes in the ER, you got to rule out a MI or a PE, but you got to rule in something else. They were jumping on a trampoline last night and they bounced their chest off the ceiling. Well, that’s not a common thing to think about, but that could happen. So stuff like that.

Yeah, and I think that you’re seeing the human in the patient and in those around you and in yourself, your self-reflection and the grace that you’ve shown yourself over the years and the grace that you extend to other people. You’ve even extended grace to me when I maybe haven’t deserved it, right, as your colleague. And I really appreciate that about you. But to have quality and excellence, I know that I’m a better internist when I come behind and I read one of your notes. I was like, huh, James was really onto something there, you know?

probably wouldn’t have thought about it that way. So I’ve continued to learn from you and your pursuit of quality and excellence and taking care of patients. And you’re also not giving yourself a lot of credit, James, where you’ve helped us really build out this kind of thinking about innovation as one of Relias’ passions. It’s one of our telehealth hospital medicine programs and how you’ve helped train these advanced practice clinicians that are, you’ve helped to really raise the level of care.

in rural Mississippi and Northwest Alabama and how, and I think all of those have learned from you are better for it and appreciate that quality and excellence. With all of that said, who’s had the greatest influence on your life to get you to where you, I’m gonna call you the quadruple threat, from now on, I might change your contact and not go. But who’s had the greatest influence in your life to continue to motivate you to kind of have these high standards that you hold yourselves to?

Dr. Glisson (11:20.45)
Well, one would be a group and that started when I was young, veterans. So I was fortunate enough to be around several World War II vets when I was young and even all the way through my training. And I’ve always kind of had a passion for vets. Even when I was a resident, we still had a busy VA service and I had a lot of World War I vets and tons of Vietnam vets, Korean vets.

And even Desert Storm is kind of coming back. So whenever I take care of a veteran, it makes me want to be a better human and a better provider because they did something that many of us have never experienced and maybe chose not to do. But they did something for our country as a whole. And ultimately for me as an American, and I firmly believe they deserve excellence. And so.

I get a little emotional thinking about it, but like the book I mentioned to you, know, Achilles in Vietnam that you have, that talks about trauma and veterans. really, if you can look through the eyes of AA or 12 Steps, we see our commonalities, not our differences. So everybody has some kind of trauma they’ve dealt with and it may not be a building falling on you or crashing a plane or getting shot.

but it’s something and the human reaction and experience of trauma is equal across the board, irregardless of the depth of that trauma. So I really have tried to embrace more psychological medicine with patients as a result of me having very good experiences with veterans. And I feel like that’s probably overlooked by a lot of.

run-of-the-mill doctors that aren’t like psychiatrists or something like that. So vets have had a huge impact on my life. And then when I was in pharmacy school at the end, we were doing clinical training and I had some residents in one particular attending that just really pushed me. They’re like, go take the MCAT. You want to know more about what’s wrong, not just the medicines to give for what’s wrong, but the puzzle of why it is what it is. And thanks to them, I went to med school, you know, so, and

Dr. Glisson (13:37.962)
Some of them were very empathetic towards me encouraging. And I try to remember that whenever I’m in a position where I can show encouragement to somebody else, specifically an APP, say for example, that’s new or needs some more training or help or whatever. So that’s the two big groups I would say that have had an influence on me. And actually my first sponsor when I went into rehab, I wasn’t even out of rehab yet, but he was a Vietnam vet.

was very real with life and he helped me a lot.

So I do want to kind of hit on one thing. If you listen to this podcast at all, your library hopefully will grow because inevitably we mentioned books and James gave me a copy of this book called Achilles in Vietnam. Jonathan Shea is a psychiatrist who has a particular group of Vietnam vets that have significant post-traumatic stress disorder. And he uses the story of Achilles to draw out how we might

rethink combat trauma and what he calls the undoing of character. But I do want you to comment on one thing, James, in chapter three of this book, and he also hits it in the conclusion, and it is something that I think that you do well, but it also, for all three of us, we take care of patients sometimes on the worst day of their life. They did not anticipate coming to the emergency department or coming to the hospital, and there’s a lot of gravity to information we’re telling them that’s gonna alter their life.

Right? And Shay talks about valuing grief work. And he says that the official and folk culture of the American military and dare I say the American healthcare system must change so that grieving enjoys a high status, that it’s valued and not stigmatized. The capacity to weep and to feel the pain of sorrow does not weaken a soldier or a clinician. If the Iliad shows us anything, it surely shows us this. Comment a little bit about this kind of…

Dr. Abraham (15:36.29)
Digging into your own story and telling the truth about the trauma that we all experience and that commonality that we have, may not, there’s a lot of people may not want to say that they have trauma because it may not be as significant as someone else’s, but we all do to your point and our patients certainly do and their families certainly do when they come to the hospital. Talk a little bit about that grief work and how that might impact a clinician who does have a hard job when he or she shows up to the hospital.

If you’re not true to yourself, you’re not going to be true to a patient or anybody else. So you have to acknowledge your own flaws and trauma, grief, and work on it on your own. If you don’t work on it, it’s going to be much harder for you to help somebody else. So that’s kind of along the same lines of 12 step stuff. know, somebody’s walked ahead of me on a similar path. Can I see some rocks that I can identify with to continue on that path?

That kind of leads me to another author, Khalil Gibran, who, paraphrasing him, he said, you know, grief and sorrow both dine at your table with you, although not at the same time. So when grief, or joy, I said grief, when joy and sorrow, when joy dines with you at your table, sorrow’s asleep in your bed. And paraphrasing him even more, basically, sorrow, if you think of the earth as flat or your soul as being flat, well, sorrow will…

carve niches down into the earth so joy can come in and fill it. So in theory, somebody that has greater sorrow, hence a greater carving into their soul can experience more joy and volume. So I think that has to go along with being thankful and gratitude and up.

really try to remember every morning. I’m thankful to be here. I’m thankful to have a good job and work for a good company like Relias where people believe in me. And I’m thankful that hopefully my story helps somebody else. But I think a lot of people, not just Americans, are in certain cultures afraid of looking weak or, you know, when I went through training, you were just supposed to be a machine and accomplish everything. And I accomplished a lot of things through a bottle. That was my consolation, I guess, every evening going home. But

Dr. Glisson (17:49.8)
If you can admit that you struggle, then I think you can see similar struggles in your patients or in your family or colleagues or whatever, and kind of maybe help them a little bit without telling them what to do. And you don’t have to be a clinician to reveal like, I’m an alcoholic. I’ve done all this stuff. I don’t tell everybody that, but if I feel like it helps me connect to them and it helps them open up, will. But that’s because I feel comfortable with it.

somebody else may not be at the same, you know, part of the path. They may need more time to get there. But if you as a clinician can relate to somebody that you’re human just like them, you don’t have to tell them everything.

but it often will let them open up more to you. And I found that doing that really seems to help at least my interactions with patients, them be open with me and honest with me and then tell me, well, you know, the real reason I hadn’t been taking all my heart pills is because I’m really strung out because my daughter was diagnosed with cancer and I’m working two jobs and I’m trying to quit smoking at the same time. And you know, that just, for lack of a better word, that sucks. Like some days life’s way easier than others and you know, okay, well I get it, I understand.

But here’s maybe the reason is you need to remember to do that so you can help taking care of them later so you don’t come in and heart failure and have a big heart attack and then you’re not around anymore. But just somebody like taking their story, explaining it back to them a little bit with some logic to it, I find often helps a lot.

I think that’s, it’s huge to slow down and, you know, break down that story. You’ve been one of those people that have taken that time when we’ve had people who are struggling with stresses in their life, those weak moments, you’ve taken your time to tell your story to individuals. And I’ve appreciated being able to lean on you for that frankness and to let people know that we are not perfect, but we can recover.

Dr. Johnsey (19:48.268)
from our imperfections. In that idea of things that have made us struggle, what do you think is the biggest challenge going forward or presently going forward in our professional environments? What’s keeping us from that quality and that excellence that we want to strive for? What keeps people from perceiving us in our best light as clinicians, as

as caregivers, as human beings.

the lack of a connection. So more and more medicine has been driven into order sets and algorithms and now AI and, you know, computer generated notes and all that. And there’s so much that’s lost. Like I look at a lot of notes every day and when it’s 90 % of the note is whatever the computer put in there is a problem.

One, it’s just a waste of space and it takes up, you know, GPU time or whatever, but it has nothing to do with the patient’s story. The fact that they’ve had five CTs and six X-rays and a long list of labs and all that’s pasted into the note is absolutely just bogus irrelevance. Like we’re clinicians and no computer will ever substitute my gut feeling about somebody. I just, you know, I don’t really feel right about this one. I’m not sure what ever all is going on.

but I don’t feel right and we need to put this one in the ICU or on the cardiac unit. That can never be predicted. So I think the biggest threat to medicine and us humans being human is we lose our connection and there’s too much done on computers and texts and you’re not talking to people. And, you know, that concerns me. And, you know, some people say I’m maybe a challenge or hard because of that, but I want…

Dr. Glisson (21:42.85)
the clinician to be the artist, not the lab jockey or messenger person, stenographer. And you just can’t, you can’t like get that out of a book or anything. So that’s the biggest threat, I think, to humanity as well as medicine. And that goes back to like old stuff like 1984, Aldous Huxley, you know, like all that. You can bring up a whole lot of stuff with that. But it’s sad because I see clinicians that they really don’t know anything about the patient.

They know that they had a high troponin, their EKG was abnormal and they’re on like these non-medicines and their sodium is whatever. But does any of that say anything about the patient really?

Yeah, certainly not the patient as a person. You have clearly done a lot of stuff and we could have multiple podcast episodes to talk about all that you’ve won in your career. And you’ve talked about your appropriate pride and your sobriety and kind of your atypical path to becoming a physician. But as you kind of reflect for a few moments, what’s an accomplishment that you’re the most proud of as we stand here today?

Hopefully I have done some things in my life and clinical life to inspire other people to be better and to be honest with themselves. Like that’s probably the one thing. Honesty and truth, because without those, everything else just falls apart. And sometimes I’ve had to say difficult things that people don’t want to hear, but it’s something that needs to be said.

Dr. Glisson (24:16.408)
Probably if I really would go back in time, I wouldn’t be a clinician. I’d be an artist and a writer. That’s what I probably enjoy the most other than making a good connection with somebody as far as, you know, as a clinician or as a human, know, sharing a common story. I really enjoy that, but I draw and…

watercolors have written a lot over the years. That’s the thing that really makes me human. And I’ve, especially in the writing, confronted a lot of my demons and things that I have regrets about and maybe things that I needed to deal with with my own trauma. And I think that’s ultimately made me a better human, which has made me a better clinician.

I have a James Gleason original watercolor over my left shoulder. I’ve got this big stack of books that James gave me that are great old medicine books. I have right up there, have a small little watercolor that James gave me. So I would say that you’re a great clinician and even better person and a talented artist.

Thanks. Probably if I could add one other book, there’s one that probably the one I’ve recommended to most people is the Spirituality of Imperfection. So it talks about the human story and how we’re imperfect and basically we can learn from each other’s stories. And it is a spiritual book, not necessarily a religious book, which I’m paraphrasing AA off of that. But it’s the single book that’s probably helped me the most in my struggles life.

Dr. Glisson (26:19.518)
Thanks for having me.

Yeah, I’m proud to call you a friend, James. Thank you.

Okay.

Dr. Abraham (26:42.838)
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Dr. Abraham (27:14.094)
We look forward to hearing from you and telling your story. Until next time, stay well, stay inspired, and keep bringing humanity to healthcare.