Season 3 Episode 9: Roll Tide & Do the Right Thing: The Dr. Elwin Crawford Story

Dr. Abraham (00:02) 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. Dr. Johnsey (00:20) Join us for candid discussions that highlight both the challenges and rewards of working in a field where humanity and healthcare intersect. Dr. Abraham (00:32) Some would say that Dr. Elwyn Crawford needs no introduction. And while I and our team members would agree, he certainly deserves one. We always invite people in our organization and you, the listener, to submit names of guests they’d like to hear from. It’s no surprise to Dr. Johnson and I that Dr. Crawford is officially our most requested guest. Dr. Crawford serves as the system medical director for emergency medicine across the DCH health system. And as medical director for EMS for the entire great state of Alabama. He’s a highly respected clinician, a gifted teacher, a longtime friend of Relias, and an integral leader within our organization. In Tuscaloosa, he might as well be the mayor. He seems to know everyone, and everyone knows him. And he works at at nearly every Alabama home football game and has even worked alongside the Secret Service, providing medical support. During presidential and other special visits. Beyond the titles, Dr. Crawford is a trusted mentor, a devoted husband, a proud father of eight, and most recently, and maybe more importantly, Dr. Crawford, a proud grandfather. and I guess I should have to say this as we’re recording this at the start of college football. Roll tie, Dr. Crawford. Dr. Crawford (01:50) Roll to hot. Dr. Johnsey (01:53) Elwyn, it’s great to have you on the the podcast. I I I I was trying to come up with what’s the right moniker for you. I think you’re the the man of a hundred jobs, the man of a thousand stories, and the man of a million friends was the best one I came to describe you with. But what we want to know is not the necessarily the thousands of stories that you have, but tell us about Elwyn’s story. I I’ve heard it in bits and pieces along the way, but tell tell us all once for once and for all what’s what’s the winding road that’s gotten you to the point you are today. Dr. Crawford (02:36) Okay. Sh certainly. I I grew up in a small town about thirty five miles south of Tuscaloosa called Greensboro. It’s just a small farming community. We we have about twenty five hundred people that live in town. we are mostly again a a agricultural town and a community. our claim to fame is the catfish capital of Alabama. So we do a lot of a lot of catfish farming there. So I grew up there and you know, my parents divorced when I was about eight years old. So my grandfather and and I were were extremely close and my mother and my my mother remarried, my mother and and my stepfather and of course they were married for forty years, forty five years and and But they actually moved to Mississippi actually. he was in the land clearing business, so he he did a lot of land clearing for the for the ten time waterway. And so I was about twelve years old and I told him that I wasn’t gonna go, that I was gonna stay with my grandparents. Now if if one of my kids told me that I’d probably spank and put in the car and tell we’re we’re going to Mississippi. But luckily my mother And my stepfather did not make me do that. So I stayed with my grandparents and and they raised me. And I had an uncle and aunt. They were about sixteen or seventeen years older than me, and they were at home and getting ready to to start their adult lives as I was living there. My grandfather and I were were pretty close. He was a I g I guess b before the word city manager became common, he was basically the city manager for our small community he was basically everything in the city. he ran the water and sewer and fire department and police department and everything there and also had a at that time had a fairly small business doing utility construction on on the side and and then when he retired from the city he he actually went to work and he opened his business full time. So I worked with him and and I think that’s probably where I learned to to to work hard and we work from from can to can and you know pretty much all the time and he he was fairly a no nonsense type of guy. Expect you to work hard, expect you to do right and and I tell the story all the time that you know, obviously all those that went to medical school, obviously we we we made good grades or we we wouldn’t have become physicians. but I would go to school and I’d bring home a ninety nine on a test and he would he’d ask me where the other point was and he he was not not joking. He’s I’m not sending you out out there to to play. I’m sending you out to quote get your lessons and so so anyway, he passed away when I was about to start my senior year in high school and passed away from lung cancer and I I finished my senior year and and joined the National Guard and went to basic training and advanced training. I was a a military police actually in in our local guard unit and went went you know, attended the University of Alabama. I was one of the only kids in a in our small school, you know, there were only sixteen people in my graduating class. And I was one of the only ones that came to to Alabama, most of them went to Auburn. again, we were an agricultural facility, a cre agricultural town and and we we basically did that. So anyway, backing up a little bit, I I guess when I was ten years old, I ran over my brother on a tractor, probably had no business on a tractor, but was and he had a pretty significant injuries and so I that sort of put the bug at that point in time. I I thought I I I think I wanna be a doctor and I remember people telling me, you’ll change your mind and I really never did. And when DC H started their heart program in I guess seventy eight and and I was about ten years old, and yes, I’m telling my age, my aunt that was at home when I was at home was the first nurse that they hired when she when they started the heart unit. And so When I was twelve, thirteen years old, I was watching hardcasts, and and you know, rubbing shoulders with the C V surgeons at at DCH and so the the he’s retired now. There’s a one of the original cardiologists, a guy named Bill Hill, and he would let me come over to the cath lab, you know, early teenager and and watch hardcasts. And and back then I don’t even know if they do it now, but in tenth grade in Alabama they taught C PR. So the local amulet service came out and taught C PR when I was in tenth grade and I knew the guy that ran the ambulance service there in Greensboro and and I said, Hey, I wanna ride on the ambulance one day and he said, Well come on, anytime you want to. So a week or ten days later I I went one afternoon after school and actually I I I left school at that lunch to go ride on the ambulance. I don’t think grandmother or granddaddy or my grandmother knew that. But anyway, I started riding on the ammo. And I had not been there about fifteen minutes. We had a pretty bad trauma call and I guess a bug bit me then and so I started riding on the ammo says I guess tenth grader and eleventh grader and was able to go through the basic EMT class but but wasn’t old enough to get my state license. They were a that was before national registry the licensed basic EMTs in the state of Alabama. So I was able to take the state tests and pass the test, but couldn’t get my license. So of course can’t do that now. But I my senior year in high school, they would call me from if they got backed up, they they’d call me and I’d leave school make ambulance calls. And so anyway, it took me a little while to finish my my undergraduate Because I was in the guard and I was traveling quite a bit, to Europe, South America, Central America. We I I went a lot of places and so anyway, so I became a paramedic and was working on the ambulance and there was a guy here at that point in time named Philip Bobo, who was the state EMS medical director and was the director of the emergency department here on the urgent care and he hired me to be one of the EMT intermediate instructors at at Alabama ’cause at that point in time the the training programs at the university. And applied to medical school and and did medical school in Birmingham and when I finished up UAB did not have an emergency medicine residency. of course they had had one and it it it closed up and and now they do. Now they’ve got a pretty thriving residency. But I was in that sort of gap. time when they didn’t have one. So I went to LSU and did my emergency medicine residency there and and came came back here. My wife and I she’s from my hometown as well and and I t I tell folks jokingly she doesn’t like this but she came to my third birthday party and and she she her dad was from Greensboro so So we started dating in high school and we’ve been married thirty five years and dated five years before. So we’ve we’ve been together forty years and so so anyway, so we came back here in two thousand. I’ve been here ever since and been extremely blessed to be able to do what I wanted to do as far as EMS and working in the emergency department. I tell people all the time I I have the the best job in the world because I get to do a lot of different things. I get to work in the emergency department. I I get to do a lot of EMS and that’s still my passion and and I enjoy that. So that’s sort of the the winding road of of how I got here and and sort of how that that got started I guess years and years ago. Dr. Abraham (11:11) And I would assume based off of that wind and grow that there’s probably a little meat left on the bone that you hadn’t even shared and that I would love to hear some further details of some of that stuff, Dr. Crawford. I’m you kind of talked a little bit about the accident with your brother and the, you know, CPR exposure at a young age, start riding ambulances, but you you have a lot of leadership positions where you’re leading other people. not just doing the work. I’m curious what kind of drew you toward all the leadership positions that you have and was that a desire or something you were thrown into? But talk about what drew you to not just the work, but leading so many different groups of people. Dr. Crawford (12:01) Well, mo most of those were were by accident to be honest with you. I was the new guy on and new kid on the block in at DCH and there were three of the longtime physicians there and one of was the medical director and they had decided that they were going to transition into urgent care and leave the emergency department. So I was called one day and told that hey, you’re gonna be the director of the emergency department. I had no training, I had no desire or anything. I said, I don’t think I I’d really want to do that. And they said, Well it doesn’t matter if you want to do it or not, you’re gonna do it. so I was thrust into that position I guess in two thousand eight. and as Bill Castles, Bill was the administrator there at that time, as he told me later, he said, you know, he said you ran up Fool’s Hill a lot and so I I I did. I I had I had no training about being an emergency medical director. I I was fortunate to have some folks that took me under their wing and one was Ken Aldridge. Ken was Vice President of Medical Affairs at at DCH and and Ken was very politically astute and he became he’s been on the medical board of the state of Alabama Ken took me under his wing and really taught me, he although he wasn’t emergency medicine, he was urology by training, he really understood the politics of of the hospital and and he taught me an awful lot about how to to be a a medical director. And as far as the EMS side, it was really sort of by accident as well. Philip Bobo when I first came back, he had he had transitioned out of the emergency department and had transitioned out of the out of the state EMS medical director position was basically doing urgent care. And he was still our regional medical Alabama has six EMS regions and and he was still the regional medical director. So they asked me to be his assistant, and basically my job was to basically any time we had a new EMS physician instead of Al our in this region, I was my job was to train them on Alabama protocols and and get them up to speed on on what it took to be an medical director in Alabama. And I did that probably six or eight months and Philip decided that he was going to transition completely out of out of EMS. so again I was I was thrust into that position. and I had a little bit more insight into that position, I guess, just from being a a paramedic and being around him. And I did that for several months and state of Alabama at that point in time decided that they were going to basically hire one state EMS medical director and have two assistants. And there’s a guy named Chris Roscoe and Chris became the state medical director. And John Campbell, who was just a a giant in EMS, developed at that time basic trauma life supports called Interma International Trauma Life Support now. But John was just an absolute giant in in in EMS and EMS circles. And he and I became the Chris’s assistants and Chris left that that state medical director job. after a few months and John wanted to transition out of clinical practice and so he became the medical director for the state and I became his assistant. So I was his assistant from two thousand five to two thousand eleven. And then in two thousand eleven John decided that he was going to retire. And I was fortunate and and blessed enough to be able to to assume the role of of State DMS medical director in two thousand eleven. And I have been the the medical director since that time. You know, it’s one of those things I I tell people all the time, it’s just you know, you just I guess in the right place at the at the right time and the Tuscosa fire department was transitioning from longtime fire chief to a new fire chief and they wanted to go a different route as far as medical direction and so they asked me when I come on and that was in two thousand eleven as well, the city of Tuscosa. decided they would go to one amulet service rather than two amulet services. So I became the sort of the system medical director for EMS in Tuscaloosa in two thousand eleven as well. All that came about at about the same time. So I became the the system medical director for Tuscaloosa Fire Department and North Star. And and over the years that that has actually transitioned into the city of Northport and the Tuscosa County Sheriff’s Department. We we run EMS for the Sheriff’s Department as well. So that that role has expanded to a in a s in a certain extent and and now I’m the the a a true system medical director for EMS. I I I perform medical direction for the city of Northport, City of Tuscosa, North Star and Tuscosa County Sheriff’s Department. So so that that’s sort of how I became the most of it was by accident and just sort of thrust in those positions, especially in the emergency department because nobody else wanted to do it. And and again, I did that from two thousand eight to two thousand eleven in the emergency department when I became the state medical director. I stepped down as the as the medical director in the emergency department. team help came in about that time. And I swore I’d never be a medical director in the emergency department again and then in two thousand nineteen Luke West called and he said, Hey, would you be willing to step in as a medical director? And I said, Absolutely not. And he said, Well, would you would you think about it? And I said, Luke, I’ll pray about it and I’ll think about it. But I’m I’m telling you right now, probably not. And so it rocked on there for three or four days and I talked to my wife about it and I told Luke, I said, Look, if you’ll get me some help I’ll do I’ll do it. And and Luke and Joe were were kind enough to get get some assistance that took some of the load off of me and I was able to do and and and it’s been a a total different environment than when I first was the medical director. I so, you know, of course I lean on Joe a lot for advice and and so it it it’s been a a different in environment. So that’s sort of how I became the medical director again. repeating a lot of it was just sort of thrust into those positions ’cause I just happened to be there. Dr. Johnsey (19:02) Elwyn, we have a s sort of a standard question to talk about your the influences on you. You’ve mentioned a lot of them from your from your grandfather to Philip Bobo to others that that were sort of inflection points on your on your path. I I wanna change that question a little bit and I wanna ask you your maybe your superpower, one of your superpowers. is those relationships that you have as you as you tell a story, you relate it to a lot of people that you’re connected to. I can’t go into a hospital in Alabama and start talking about Relias before, you know, 60 seconds later. You so you work with Dr. Crawford, you work with Elvin Crawford and and that connection is is made right then for us as to who we who we really are. because of our connection to you. I want to ask, how how is it that you what what’s what’s developed that superpower in you to to make all of these connections, to have these relationships that are not just superficial, but they they carry on and people remember you, people have a a a feeling of closeness with you. that again’s not just something that’s transactional here or there, but but is is genuine. What what what gives you that ability? Where’d that come from? Dr. Crawford (20:36) I think that a large part of being a medical director, whether it be in the emergency department, EMS or wherever is relationship building. And I and I take that extremely serious. I you know, I I I try to understand other people. I try to understand what makes other people tick so that I can build those relationships because you know, you know, from dealing with administrations of of different hospitals, they’ve got they they’ve got their goals and things that they’d like to to see happen. And and sometimes my, you know, my goals or things that I want to see happen don’t necessarily align with the hospital, but I think if you can build those relationships, you can understand each other and and come to a consensus. Don Williamson was a state health officer when I first became involved in EMS and and he was a he was a true politician. And I see Summer has an old Miss shirt on and he he he actually is a a huge old miss guy and he was actually one of the assistant state health officers in Mississippi before he came to Alabama. And I learned a lot from him just from building relationships and and doing that ’cause ’cause Don could walk into a building and and everybody knew him. And I’ve tried to to do that, but I but I think the the thing that I would like for folks to say is that I’ve treated folks right. And when I meet somebody, I I I’m you know, look, I I’m I try to be genuine. At the end of the day, I’m I’m just a country boy from a small town and I try to connect with these people. I try to build relationships with these folks. And of course a lot of these folks that I know all over the state I’ve dealt with through EMS and and you know there are medical directors and and physicians that came through our training program in Alabama as far as a paramedic training forty years ago that that I still know and that that still know me and and that that that that I built those relationships with. but but I think that I I take serious building the relationships and getting to know folks and and I try to help folks. You know, I I if somebody calls me and and ask for for my help, I’m gonna try my best to help them and and and do it the right way and and make sure that that I’m always doing the right thing. And I think if you try to do the right thing and you build those relationships, I I think that’s probably you know, if if it’s a quote superpower that I have, I think that is something that I try to treat folks right. I try to do the right thing. And I try to build relationships and and you know, I’ve always said if you do the right thing, you don’t have to defend your actions, as long as you’re doing the right thing. And and I I live by that that motto and and so I think that’s the that’s the the key I g I guess to to knowing these you know to to knowing these folks and building these long lasting relationships is is I I I I I take that serious. Dr. Abraham (23:58) And it certainly speaks to your character, Dr. Crawford. It’s not, yeah, it is a superpower. And you’ve probably rattled off 60 names since we’ve been going. And they probably can all attest to your character at different points and interacting with them. You’ve seen several different iterations of change in payer environment or different hospital administration or worked in different states and places and interacted with others and the challenges of being a clinician in those environments evolve over time. And while there is nothing new under the sun, there are different pressures at different points in time. I’d love to hear you talk about what’s the biggest challenge in being a clinician today. And then I’d imagine you’d have some wisdom on potentially how to combat that. Dr. Crawford (24:54) I think it goes back to what we just talked about. I think the goals of an organization such as the hospital and the goals of the individual clinicians aren’t necessarily always aligned. I think that’s the biggest challenge that I see as a clinician that I have to work in and the expectations and and trying to meet the expectations of of everyone. My expectations as a clinician aren’t necessarily aligned with the expectations of the hospital. the hospital’s expectations aren’t aligned with with mine. And and I think understanding where each other is coming from and and and and patients too. And and early in my career I I was always afraid to ask a patient, you know, what what are your expectations today? And and and I’ve I’ve evolved to that especially on those folks that that come in that have chronic problems and and they’ve been to three specialists and now they’re in the emergency department and they want me to fix them. And and I I have just an honest conversation and I do it very nicely, but I I ask them, I you know, what what are your expectations out out of this visit? Because, you know, I can you know you’ve been to see three f three specialists and and or sub specialists and and you know and and they’re still working you up. I I probably cannot fix you today, but I can I can try to help you. So I think that is the challenge that I see as a clinician is is trying to understand the different goals of the of the different people. And that goes with insurance a insurance you know, companies, that goes with with different physicians that I deal with, with the nursing staff, with the hospital, and understanding those different goals and and I and I think most people still keep the patient at the center of what we do, it’s just we have different routes of how we get there. So if I had to hang my hat on something, I would say that the just managing the different expectations and the different goals, and trying to understand where we all are on that merry go round, I guess. Dr. Johnsey (27:03) So Elwyn, with those different goals, those different outcomes maybe that that different people have from their perspective, it causes a lot of challenge, a lot of you know, difficulty. I I’m seeing the you know the the burnout continues to be something that’s mentioned on on message boards with other clinicians. The average age of physicians leaving medicine is getting closer and closer to the age that they graduate medical school. So there’s there’s some some negative things that are that are out there. So tough question now. What what gives you hope? What gives you energy in the roles that you play? What what what can you tell that that that young person who’s looking at going into medical school, looking at getting into the healthcare profession, what do you tell them that that gives you hope, that you look forward to a brighter future for them than than the negativity that that we see a lot of times in clinicians’ experiences and in in some of the headlines that are that are going about. What what helps you to to encourage others? Dr. Crawford (28:23) You know, that’s a tough question, but you know, I think that I I think the hope and and and I guess the thing that gives me hope is is there’s still good people in this world. There there’s still good people that that still try to do the right thing. And and and that gives me hope when I I feel like, man, the the world is just, you know, circling the drain and and but and and then something something comes up and I and I deal with somebody and you think, man, that’s just a It’s just a great, you know, th this is a great yeah, i it there’s still good people in the world. I would tell people in in when you’re practicing medicine or anything else, and we’ve heard this and you know, and and and I guess I’m I’ve never I don’t think I’ve ever experienced burnout. I you know, somebody asked me the other day, one of the medical students said, Hey, do you know what do do you what do you like merch medicine? I Look I love emergency medicine as much today as it did the first day I walked in residency. I I absolutely love emergency medicine. Now I don’t get as excited about walking in that trauma bay anymore. If if some young doctor wants to go in and and and put the chest tube in or intubate the patient, hey, go I’ll go see the sore throat. Y’all go do that. Now, can I do that? Absolutely. I can go in there and if you have trouble, call me and I’ll come in there and help you. but But I love emergency medicine and but I would tell people to make sure that you get something where that where where you’re not whatever, emergency medicine, internal medicine, C V surgery, whatever, that that is not the only thing you do. I think you do burn out. I get to do an awful lot that probably keeps me from burning out. If all I had to do was go to the emergency department every single day and work. sixteen days a month without anything else, I I would probably more be more apt to to burn out. But I get to do EMS, I get to do some administrative stuff. I I get to do an awful lot. you know, I’ve I’ve been on the on the on the phone every day this week is right before this podcast I was on the phone with the university about planning for tomorrow’s game because of the heat. And while that’s been, you know, everybody is, you know, all up in the air. about this heat. It’s a you know, the the hottest Alabama football game in the history of the University of Alabama tomorrow. And we’re we’ve done lots of things that we are n that we normally don’t do for intimation of this game. Lots of different different operational changes. But I enjoy that and I enjoy solving those problems and I enjoy you know, doing that. So that gives me a little bit of a, know, different look at at things than than just practicing an emergency department. So I would tell people, if I had to give advice, find something that you enjoy that may or may not be related to medicine, but find something that you enjoy and and do that. Don’t don’t get so tied up and in in to whatever field you’re doing that you can’t look at other things and you can’t enjoy other things. So I that That is probably the advice I would give. The hope that I that I have again is is just when I think the world is just out of control and and I think sometimes it obviously is, but but there’s still good people in this world. And I think that gives me hope that there’s still people that that want to do the right thing. Dr. Abraham (31:59) Yeah, and there’s a there’s a thread of what you’re talking about, Dr. Crawford, where you’re using the skills that you have to serve the people that you’re embedded in their community. And that doesn’t necessarily have to be game day operations for, you know, an SEC football team, but it could be coaching cross country like Joe does, right? It’s it’s it’s that everybody’s got unique tools in their tool belt. That sure allow you to be a really good clinician, but what are those other things that you have that can serve the community that you happen to be embedded in? I think is a is a really common thread there. We’ll close it out with this, Dr. Crawford. It’s you know, reading your bio and interacting with you is at at times it can be intimidating because while you alluded to other people being giants in the space. You’re a legend yourself. What’s something people would be surprised to know about you that maybe assures them that you’re a human being too? Dr. Crawford (33:12) Well, I I guess two or three things. I guess, you know, I I like getting on a tractor. I ri I like I like riding a tractor, I like Bush Hogan I’ve I’ve got a a place in Greensboro that and my my father in law’s sick right now, so I’m trying to keep up the place. but I enjoy getting down there and working on that. I like country music. you know, my my kids say that I can’t sing a lick, but I I like country music and Yeah, getting back to one of your your comments about serving the community, I one of the most enjoyable things that I do is I’m on the local you know, I I live just south of Tuscale, so I live in a small community and it just revolves around the church and and several schools there. We have a high school and and I my kids have been pretty involved there and I had one son that played and and played was a pretty good athlete and and but we have there were about six of us daddies that we were on the sideline crew and and we we set up all the sideline we travel with the team and you know and we we set up the sideline, we tore down the sideline and you know it became almost like a small college where we have drones and TVs and fans and heaters during the winter and we carried all their equipment and and you know it was an all day affair. So I enjoyed that and and that was one of the things that that that brought the something I I I look forward to for, you know, you know, twelve, fourteen Friday nights the the the year. So my brother used to joke me and tell me that I’m just glorified water boy, but we we enjoyed that and so I think that’s one a lot of folks wouldn’t wouldn’t know that about me, but but I I truly enjoy you know, being around high school football and and and and with that team and and they were friends of mine, though the other dads and kids that have grown up together and we’re still although our kids are graduating now, we’re still out there lugging stuff on the sidelines now. and and we’re still all friends, you know, we you know, one of the I guess one of the the most I guess one of the the I I I consider the compliment as one somebody told me one day, said, You know, if we didn’t know you were a doctor, we’d never know you were a doctor. You know, and that was one of the the best compliments I’ve ever had because, you know, there’s this stigma associated with the doctors that, you know, they don’t you know, they’re they’re standoffish and, you know, they’re you know, and and and I take, you know, you know, I I think Joe and I both are are probably not like that. And, you know, I’m I’m down there on the sideline with my buddies and, you know, some of my best friends. One’s a one’s a logger and one’s a yeah you know, owns a sporting goods store here. Another one owns a a restoration business. They’re they’re some of my best friends and you know, I’m just I’m I’m just Elwyn to them. I’m not I’m not Doctor Crawford. I’m I’m just Elwyn. And I and that that’s that’s that’s what I like. Dr. Johnsey (36:22) Appreciate you so much spending some time with us this morning, Elwyn. it’s been great to hear that that story of who you are and and all about these leadership roles that that you do so well at, but the the way you got into thank you for for giving us a a moment of your day and letting our audience learn a little bit more about Elwyn Crawford. Dr. Crawford (36:48) I appreciate the opportunity. Dr. Abraham (36:50) Thank you, Dr. Crawford. Dr. Johnsey (36:54) Thank you for joining us on Reliably Well, where we explore the intersection of healthcare and humanity. We hope these conversations inspire you to see the people behind the policies, the passion behind the practice, and the purpose that drives innovation in healthcare. Dr. Abraham (37:10) If you enjoyed this episode, be sure to subscribe, rate, and review our podcast. Your support helps us to continue sharing these important stories. For more insights and updates about what we’re up to at Relias, visit us at reliashealthcare dot com and follow us on your favorite podcasting platform. Dr. Johnsey (37:31) And if you have any stories that help to demonstrate the humanity in healthcare, please let us know at reliablywell at reliashealthcare.com. Dr. Abraham (37:41) We look forward to hearing from you and telling your story. Until next time, stay well, stay inspired, and keep bringing humanity to healthcare.