Interview: Neil Saley, MD and Author

The below interview with Dr. Neil Saley, author of Medical School: Experience the Journey has been lightly edited for clarity.

Emil Chuck, PhD: My name is Emil Chuck. I’m the Director of Advising Services (for Health Professional Student Association), and I’m happy that you can join us in this Student Doctor Network interview with Dr. Neil Saley, the author of Medical School Experience, the Journey. So welcome, Dr. Saley.

Dr. Neil Saley: Well, thank you. Thank you for having me today. I appreciate it.

Emil Chuck, PhD: Thanks again, we appreciate this interview. Please tell us more about your personal journey before attending medical school and what has happened since.

Dr. Neil Saley: I was born and raised in Eugene, Oregon, and went to college there at the University of Oregon. And I attended for five years where I got degrees in chemistry and honors biology. I then took a period to travel to Europe and ended up working as a ski instructor in Switzerland where I met my future wife. I then came back and got a job doing research at UC San Francisco School of Medicine. We were in the liver studies unit studying toxicology. And then I traveled again with my same friend. We went to Asia, and I went to Nepal and India and China and Thailand and Japan and then returned I, unfortunately, got very sick while I was in India, and I lost nearly 40 pounds. So when I got back to medical school, I was six foot seven and weighed 175 pounds. So that’s how I started.

Emil Chuck, PhD: Oh, wow. <Laugh>. Oh, what a great story. And what an interesting story to get you all the way to the point where you e this is even before starting medical school, right?

Dr. Neil Saley: <Laugh>? Yes, yes, yes.

Emil Chuck, PhD: Oh, wow. Well, I know many students are applicants trying to get into medical school, and for them, it always helps to have some examples. So what are some of your more influential experiences or meaningful experiences that directed you towards deciding upon a career in medicine?

Dr. Neil Saley: Well, unfortunately, when I was eight, my mother developed breast cancer, and she had to have a radical mastectomy followed by chemotherapy and radiation therapy. And at that time, they kept people in the hospital for prolonged periods of time. And after she recovered unfortunately she had a recurrence and had to have another radical mastectomy and more chemo and radiation therapy. And then she passed just before Christmas when I was 12 years old. So (through) that experience, I got to know a lot of doctors and nurses in the process. And then it turned out I had a love for science. By the time when I went into college, I wanted to be an oncologist. And that did change later in my career. But those were the major factors that influenced me.

Emil Chuck, PhD: Obviously, I know we’re going to get a little bit more into the details of what you’re doing now, but in retrospect, what do you think you did before medical school that helped you get that offer of acceptance?

Dr. Neil Saley: Well, I was an undergraduate. I did research and physiology and a biochemistry labs both for a total of three years. And doing that, I think really allowed me to get a better recommendation from my professors. If they’re teaching large classes and don’t really know you very well, it’s hard for them to write a good letter. But when you work with them for a period of time you become intimately acquainted. And I think that helped. And then also when I was in San Francisco, I think showing an interest in medical research was important. A lot of the professors who are interviewing medical students are researchers themselves, and I think there’s probably a bias toward an interest in research. And also, I was working with physicians at UCSF, and so I was able to get recommendations from medical doctors as well as the PhDs from college. And I think both of those had a profound influence on my ability to be accepted. I also, I’m sorry, one more thing. I, I also did volunteer work for the American Cancer Society, the American Red Cross, and the Special Olympics, and I also volunteered in the anesthesia department at UCSF School of Medicine. So I think they’re really looking for people who are really dedicated to being physicians.

Emil Chuck, PhD: How long did you do that clinical assisting or shadowing or volunteering that you were doing?

Dr. Neil Saley: Well, (when) I was at UCSF, I volunteered for about six months, and during those times, I got to intimately see physicians working in the recovery room. And also got a letter of recommendation from my mentor at the program. And when I was volunteering, I found it was really important to always be on time and dress properly and be courteous and confidential and just respect the rights of other people.

Emil Chuck, PhD: Great. Thank you, I appreciate that answer and (want to) go into a little more detail about that. Now granted, let’s go to the other side of the equation in terms of, in retrospect, what have you enjoyed most about your career in medicine?

Dr. Neil Saley: Being a physician enables people to invite you into their intimate life easily. Outside of medicine, it takes a while to really get to know people, but I really enjoyed the fact that people would open up with me and I could become intimately involved with their lives. I chose family medicine as a career because I wanted to see people over and over again, and, and I just loved the feeling of being invited into people’s families and being involved with their lives as time went on. Also, I used to deliver babies, and delivering a healthy baby is perhaps the most joyful thing on earth. If only they would come during daylight hours, <laugh> (instead of) showing up night after night, that’s why I eventually stopped. But I did love delivering babies.

Emil Chuck, PhD: Oh, great. Let’s go a little bit into your book properly. I’m interested in understanding what inspired you to write this book and also to decide to pick the specific timeline of being in medical school between orientation and graduation.

Dr. Neil Saley: Before I started medical school, I knew I wanted to go, but I really did not have an idea what was lying ahead of me. I knew some of the courses, but I didn’t really know all the courses and I didn’t understand the clinical rotations. And I felt it was important to write this book for people who students are considering medical school. And also for people who aren’t sure if they want to go to medical school; there’s a lot of trials and tribulations involved, and there’s lots of alternatives besides being a physician. So if people aren’t sure, I think reading the book would give you a good insight of what lies ahead. And also the other thing is for family members of people who are attending medical school, I think it helps to give them an idea of what their siblings and children are going through. So it really just seemed there was a role for this book.

Emil Chuck, PhD: Well, without necessarily divulging everything about the book, obviously, what in your mind, made medical school challenging?

Dr. Neil Saley: The challenges (for) every medical student (are) different, and the challenges that will face every medical student are different. For me, my biggest challenge was being able to absorb the vast quantity of knowledge that was thrown at us during the first year and a half to two years. Definitely was overwhelming at times, and at times was hard to retain your focus on learning so much knowledge, week after week after week, just going at it. And so for me, that was probably my biggest challenge. Now, other people have challenges like having children or health issues or language barriers or financial obstacles. There’s always plenty of challenges to be had, but mine was really maintaining focus.

Emil Chuck, PhD: Thank you. Yes. Thank you for sharing. And I think I know I’ll mention a little bit of how you decided to really emphasize that in the style of how you wrote your book. But what I’m interested (in) also is the fact that you were in medical school over 30 years ago. What was the hardest part about collecting or gathering your memories of that time?

Dr. Neil Saley: Well, interesting. When I first decided to write this book as you say, it was a long time ago, and a lot of the memories were difficult, but I actually spent about three years working on this book. And over those times as I started to write, more and more would come back to me, and (it) also felt that after practicing medicine, I had a better idea of what I learned in medical school (that) would ultimately become important. So I used those things to go back and select the information that I put in this book to make it clinically relevant.

Emil Chuck, PhD: Understood. Thanks so much. In doing that process, was there a favorite chapter or very favorite story that you reminisced upon and that you were able to document in this book?

Dr. Neil Saley: Well, there was, in fact. If it’s okay, I’d like to share a couple of stories with you. My first story is when I was a third-year medical student; medical students are generally very impressionable and emotional and easy to influence. And I had this young man who developed HIV from injectable drug usage, and I had him on my inpatient medicine service at UCI Medical Center. And although this man had some problems, he was exceptionally nice and had an exceptionally nice family who were involved with him as I was taking care of him. And he had pneumocystis pneumonia as well as cryptococcal meningitis, and he was very sick. And unfortunately at the time, there were no treatments for the HIV virus. All we had to offer was supportive care and treatment of the opportunistic infections.

So I was taking care of this gentleman and one day when I was on call, he took a turn for the worse and went into a coma. And I know his family had just been there a few hours earlier when he was not comatose, but I thought that maybe he (would pass) that evening. So I called them in to be with him, and they got there, and he was very sick. And a couple hours later I came back, and he was awake and alert and talking to his family. And I was stunned, I mean, just grateful and yet stunned. I thought maybe the medicines were working for him. And so we were all very jubilant and (thought) miracles were happening. And I came back later in the evening and he was still awake and talking.

And I came back in the morning for our morning blood draws. We had to draw our own blood on our patients. And as soon as I put the needle in his arm, he had a seizure and coded and went into cardiac arrest. And that was the first time I was ever involved with the code. And a code blue was called, and mayhem erupted and (he) unfortunately did not survive. And I just, the guilt, even though I don’t feel I did anything wrong, the guilt and anxiety and concern that the family members were upset with me was just a traumatic ordeal. So that was kind of one of my more difficult times during medical school. Now, on the other hand, I have what I think is a kind of funny story, and actually happened to my friend Mike, who was on the inpatient VA psychiatry rotation that I had just been on before.

And he took over the service and at the time there were no cell phones, so there was only one phone in the inpatient area. And when Mark was in that area, one of the patients answered the phone after it rang, and Mark came up to him and said “Who’s on the phone?” And the patient answered the President of the United States. And of course, being in a psychiatric unit, Mark assumed that he was hallucinating or had some delusion. So Mark picked up the phone, and sure enough, it was President Ronald Reagan’s office calling <laugh> to speak to an officer from a naval ship who had been brought into the unit with an acute psychiatric breakdown. So we all got a good kick out of that one.

Emil Chuck, PhD: Wow. <laugh> Admittedly, yes, obviously the first story, (highlights) the power of the human spirit just persisting as best as one can. But yeah, I’ll admit getting a call from the president is…

Dr. Neil Saley: <Laugh> His wife, the patient’s wife, used to work for President Reagan when he was governor of California. So that’s kind of how that happened. <Laugh>.

Emil Chuck, PhD: Oh, wow. <Laugh>. Well, I appreciate it, and I hope other people will read more in the book as a result of just seeing where those stories sort of lie and the other sort of anecdotes and things that you can remember from your period of time as

Dr. Neil Saley: A student. Yeah. In just a few short years, you get a lifetime full story. It’s a really interesting process.

Emil Chuck, PhD: Oh, boy. Well, one of the things to also note at the way that you wrote this book, it seemed to emphasize a lot of very important facts for every single class or every single rotation. It reminded me that it’s like you’re reading your index cards or some index cards that people use to study. Just wondering, was this something that you did purposefully?

Dr. Neil Saley: (Yes), part of it was actually when I wrote the book, I wanted people to get an experience of what it was really like to go through medical school. So I did in fact go through every single class and discuss highlights of them, as well as discussing the social interactions that occurred during the time. Now, in medical school, there’s a huge amount of information to learn, and I found that making lists helped me learn. And so, yeah, there was that, in fact, on my chapter of examining the patient, I kind of intentionally did that to help the reader understand the huge volumes of information that we were expected to know both in our subjective and objective evaluation of the patient. And so even myself rereading that chapter (saw how it) went on and on and on about everything that I needed to know. And I did make it intentionally that way just to kind of emphasize the fact that there was, (as the) common phrase (goes), that you were in taking knowledge. It was like drinking out of a fire hose. It just was so much information. So yeah, I think you’re right. It probably was a lot like index cards. So good pickup on your part.

Emil Chuck, PhD: <Laugh>. No, thank you. And, I agree especially (when) doing an initial history and physical, I know there’s so much (information) you have sort of bombarding your head. It’s, it’s very easy to kind of forget, (to) skip a step and so forth. And that’s something I know many, many students are kind of drilled into learning how to do that the right way.

Dr. Neil Saley: When you walk into a doctor’s office and he looks around and listens, you think, oh, he is just listening to my heart and lungs, but he’s looking at your skin and doing all kinds of stuff and trying to pick up things that are not apparent.

Emil Chuck, PhD: Yeah. I appreciate that. (I want to highlight) another phrase that also is common in any sort of health educational setting. And you mentioned this obviously also in your book, that I think it was the Chancellor or the dean or one of the big administrators really mentioned this favorite phrase that ‘Half of what you learned in medical school will be obsolete when you graduate. We just don’t know which half.” Can you sort of comment a little bit further about how this really became true for you?

Dr. Neil Saley: Oh, well, in fact, a lot has changed. And at the same time, a lot really hasn’t changed. I don’t know if it was 50% or what the percentage was, but the thing that really hasn’t changed is the human body. We still have lungs and hearts and eyes and ears and internal organs, and our chemistry works the same, and a lot of the diseases are the same. There’s a few new ones since I graduated, like Ebola and SARS and now COVID. But most of the diseases that we learned about haven’t changed, the disease hasn’t changed. How we’ve treated them has changed. Some of the medicines have (been) updated, but a lot of things really haven’t changed. Now, the things that have changed the most, of course, are the implementation of computers. And the students these days have a much easier way to access knowledge and information which we didn’t have.

And medical records being electronic now is a huge benefit. Back in the day we just had paper charts, and as doctors have terrible writing for the most part, it was really hard to gather information out of paper charts. So those have made a big difference. In surgery now we’re doing robotic surgery which was developed after laparoscopic surgery was developed. And that has tremendously decreased patient morbidity. In the old days when we used to take out a gallbladder, we had to make about an 18 inch long incision underneath the right ribcage. And now you make it through three little holes, and people were kept in the hospital for two weeks, and now they go home usually the next day. So that has made a difference. Advances in radiology have occurred.

I was just reading that my medical school colleagues who are just starting are now are given a handheld ultrasound to learn to use in their clinical rotation. So that was a big advancement. Of course, medications have improved. The AIDS epidemic was a terrible thing to happen, and it still is occurring, but what we did learn was a lot about the immune system. So now we can enhance or suppress the immune system better than we used to be able to. Also, vaccine development has shown remarkable progress. Children are vaccinated for so many more diseases than they used to be. And considering COVID-19, that vaccine really was developed in just a matter of months and implemented in about a year. And previously, the fastest that had occurred had been seven years. So tens of millions of people in this world (would) have died from COVID that were saved because of the vaccine. So a lot of things have changed, and some really haven’t.

Emil Chuck, PhD: Right. This is very timely for the next question because, of course, when we read your book, you did train at a period of time where, as we mentioned, the AIDS epidemic cast a big shadow over your education (and) training. The therapies that are certainly now in existence did not exist at that period of time. And so I did want to ask the question for the current students and trainees who had that period of time where they had to adjust to COVID in terms of their learning or their clinical opportunities, or even the opioid epidemic, which is really widespread of course, as well. Do you have any insights or any words of advice to help all of those students and trainees to kind of sort of keep their focus, especially in light of all of these epidemics going on?

Dr. Neil Saley: Well, the HIV epidemic was truly traumatizing as a student. I actually, when I worked at UCSF, I worked on one of the viral cousins called HTLV-1, and I had to wear a full-body suit and work in a 98.6-degree room with my own air supply and infrared light because regular light would kill it. And at that time HIV had hit, and I was in San Francisco, so it made a big impact. But we didn’t really know a lot about it. So by the time I started medical school, the, the virus was identified and the mechanism of transmission was identified through blood as opposed to (not knowing) if it was a respiratory virus or what it was at the time. So yes, it was terrifying during medical school, and knowing that a lot of people who had HIV didn’t know it, so you had to assume everyones blood was contaminated with it.

And we had to draw blood on our own patients every day. And people do stick themselves with needles as hard as they try not to. And at that time, if you did, it was a death sentence because everyone who developed AIDS died an agonizing, miserable, and socially stigmatized death. So it was really awful. And it wasn’t until 1987, the year before I graduated, that the first HIV drug was developed, which was a reverse transcriptase inhibitor, and the patients had to take it every three hours around the clock. And if you missed a single dose, you lost all of the benefits. So I would have to say that being a doctor is a dangerous profession, and it always has been. And the odds are that you’ll go through your career and be fine, but people do die, and a lot of people have died from COVID.

And it’s just part of the process, at least we are understanding now about it. We have a vaccine for one to help prevent COVID, but also isolation techniques. And it is just part of the deal. So yes, it causes anxiety; a lot of things cause anxiety in medical school. But it’s just the way it is. The opioid epidemic is here now, it actually was (there) where I trained. It was very prevalent even back then. And one night while I was on ICU call, I had 12 overdoses come into the hospital in one evening. If you want to help people, you gotta get in the fire.

Emil Chuck, PhD: Those are great things to keep in mind. So yes, thank you for sharing about that.

Dr. Neil Saley: Certainly.

Emil Chuck, PhD: The other thing also that I know we get a lot of questions about, and certainly anyone who starts a health professional career will all ask about (relationships). You mentioned this a little bit in your book about the relationships you’ve had, finding your wife, and ultimately getting married. And I’m interested in knowing how, in retrospect, you thought it was in terms of how challenging it was to keep up and maintain those relationships with your wife, your family, and your classmates during medical school.

Dr. Neil Saley: Well, you’re exactly right. It was challenging. And if you were to ask my wife, she would tell you that she did all of the maintaining of our relationship. I was so busy and just wasn’t around very much when I started medical school. My wife wasn’t my wife (at the time), she was my girlfriend, and she actually lived in Minnesota, and I lived in California, so we’d only see each other occasionally. And so, I could make a weekend here or there for her to come to visit. But, I couldn’t really get away. Near the end in the third year, she ended up getting transferred in her job to California, and we decided that we should probably live in the same house. Otherwise, we weren’t gonna see each other. So it’s very difficult. The things that are important are that you do make time for yourself and continue to do the things that you like to do. Before you started medical school, I played basketball and tennis and body surfed and windsurfed and learned to scuba dive and did a lot of things to help maintain my sanity and also set aside time for my relationship with my wife.

Emil Chuck, PhD: You need to spend the time, find the time, and spend the time. So I appreciate that too.

Dr. Neil Saley: It’s a tough balance, because at least I felt a desire to learn everything that I could about medicine, and I didn’t wanna miss something that would someday hurt one of my patients. And so even when I did take time, there was that guilt element, I must admit.

Emil Chuck, PhD: Yeah. Obviously, every medical student nowadays, I think we’re all being (told) we need to rest, we need to kind of give ourselves a break, because it doesn’t get any easier if you keep studying and you burn yourself out.

Dr. Neil Saley: No, it doesn’t. It doesn’t, that’s right.

Emil Chuck, PhD: So obviously, you kind of allude to it at the end of the book, and you didn’t cover it, of course, in this part, in this book anyway. How did you do in your internship, in residency, and all the way up to where you are now?

Dr. Neil Saley: Because I did research during my summer break, after my first year of medical school, I did research on a malaria vaccine at the University of Hawaii, and I got credit for it. And in my senior year of medical school, I also set up rotations in Hawaii and in Thailand. So I was able to take a nice long break before I started residency. So I felt somewhat refreshed. However, that lasted about six hours after I got back into residency. I did it at Ventura Medical Center, (where) we were the only residents in the hospital and we were expected to really cover the whole hospital. We did a lot of ICU medicine and a lot of obstetrics, a lot of surgery and a whole lot of emergency medicine. All of our call the first year was in emergency room.

We had to be ATLS and ACLS and PALS and NALS certified, and (we) also became instructors in those courses, so (we) could teach fellow students. We ran the paramedic base station radio, and so directed all the paramedics in Ventura County. And starting the second and third year, our night calls were, we were in the emergency room, or in OB, or in the ICU. And when we were in the emergency room, there were no other attending physicians in the hospital, so we had to run the place by ourselves. So my second month was neonatal intensive care unit, and I was expected to take call every third night with the two attendings. And they called it baptism by fire. And by the time I finished, though, I felt very well-trained.

And after my three years in Ventura, I went to small town in central Oregon and joined a family medicine group where we also did full-spectrum OB, ran the county ER at nighttime, and did full-spectrum obstetrics. And I did cesarean sections, and I assisted the orthopedic doctor on surgery all the time. So it was very, very busy and very challenging, and unfortunately, it had a dramatic influence on my ability to see my wife and children. And after three years, I decided that I needed a little better life. And so I moved to suburb of Salt Lake City and joined a multi-specialty group where I did mostly office based family medicine. I did take call at three different hospitals. I taught medical students in Utah, as I did in Oregon.

I was the chairman of family medicine for a time in Utah. I was the medical laboratory director there as well as in Oregon. So fairly busy. In fact, I had the busiest family medicine practice after one year. So it just grew by leaps and bounds. Unfortunately, our clinic had financial troubles after going into a partnership with a hospital chain. And things kind of got ugly. And my wife, being from Minnesota, we decided to move to Minnesota, and I got a job in north-central Minnesota in a small town, and I only practiced urgent care. Now, our urgent care was sort of like an emergency room because we were the only clinic in town. There was a hospital emergency room, but all of our patients would prefer to come into urgent care rather than emergency. So I’d see chest pains and abdominal pains on a daily basis. But the good thing was that I worked only 45 hours a week over seven days, and then had the next week off. And I made this commitment to see my children who were growing and growing up without me because I was so busy. And that really allowed me a lot of time to focus on my family, and it was a wonderful change.

Emil Chuck, PhD: How old were your kids at the time when you finally moved into that practice in Minnesota?

Dr. Neil Saley: They were in middle school and just starting high school, and I have three daughters.

Emil Chuck, PhD: Oh, wow. I’m sure you appreciated that period of time when you could be with them.

Dr. Neil Saley: I, I did. Yeah.

Emil Chuck, PhD: I know you mentioned (traveling internationally) in the book a little bit, and I’m curious whether even after you began your practice, if you had the opportunity to go back to other countries (you visited). We already talked about the different environments (you worked in) as you were moving along, but were you able to go back (where you went) before you were a medical student? So I’m interested if you’d had chances to go back, while you were a practitioner?

Dr. Neil Saley: I didn’t travel overseas when my kids were young. I just kind of felt it was important. I have observed medical practices in India where they have a different type of medicine called Ayurvedic Medicine, which emphasizes more meditation and yoga and herbal supplements. And I also was able to observe medicine in China where herbal medicines are certainly more common. And unfortunately, a lot of these things seem to have heavy metals in them. And I’ve seen people over the years that have had kidney and liver toxicity as a result of it. However, the flip side is if it’s been happening for 3000 years, there’s obviously some benefit to that type of medicine as well. So, I certainly don’t claim that allopathic physicians have all the answers.

Emil Chuck, PhD: Sure. No, I understood about that. I know we talked a little bit earlier before this interview that you’re not currently practicing anymore. Disclose whatever you feel you comfortable with, but what’s, what is your current situation?

Dr. Neil Saley: Oh, sure. And yeah, I don’t mind talking about it because it has been a long time now. While I was in Minnesota, we actually had an exchange student with us, so my four girls and my wife and I went on a cruise. Interestingly enough, I had a few months before gotten very sick with what I think was an adenovirus. And then I went to Africa, and then I came back, but I didn’t get sick in Africa. But when we were on this cruise, I developed an acute illness where I had severe pain without an apparent etiology. I had been mountain biking in Jamaica, and my shoulders honestly felt like somebody was trying to pull my arms out of the socket. And I developed pain in my feet and in my ribs and in my scapular areas.

And I got home. And they immediately did all kinds of MRI scans without an apparent etiology. And the worst part was the severe pain. You hear people talking about 10 out of 10 pain. Well, my pain was severe. The first 60 days I was ill, I did not sleep for more than 15 minutes in a row. And the sleep deprivation was just terrible. They sent me to a physical therapist who put me in traction, which made it terribly worse. And I saw a neurologist and then went to a neuromuscular clinic down in the Twin Cities, and they did a nerve biopsy. And unfortunately, they really weren’t able to tell me what was causing my problem. And in the process, I was fired for not being able to work. I lost my job, I lost my ability to take care of my family. My wife went back to work as a waitress, and then renewed her teaching license and got a job teaching.

And it just changed my life forever. The internet was really non-existent at the time. And the way that I found out what I actually have was I asked the librarian to do a medical search, and they found a group of similar patients in Holland. And it turns out it likely is an underlying genetic disease, although my genetic tests have been negative, but they also think that it was probably stimulated by exposure to something that caused an immune reaction. So it’s been very different, seeing life on the other side. I actually was considering writing a book about this called Doctor Inside Out to give people a perspective on the difference. I really felt like I was an insider and then I was an outsider

Emil Chuck, PhD: Well, you don’t have to completely write the book now, but certainly that was the question. That was the question I did want ask – it does take quite an effort to go from thinking like a doctor and having all that education to now having to be a patient. So, from your standpoint, what was that process like? And what insights can you give, especially for those who have to care for chronically ill family members?

Dr. Neil Saley: Well, like I said, it did feel like I went from Dr. Inside to Dr. Outside. Also being a doctor, you tend to know more medicine than the average patient. So every time I would see a new doctor, they would sort of criticize me for bringing up my medical knowledge. The neurologist at the neuromuscular clinic in particular. I told him about this article I found that identified what I had, and he really got quite upset. In fact, he got so up upset that he kicked me out of his clinic and said he had no more to offer me. So I guess the biggest insight that I might provide as being a patient is, doctor, listen to your patient and listen to what they have to say and don’t think of them as just another body that you have to get through in the next 15 minutes, because we are people, just like you are who need help and are coming to you for help. And please always keep that in mind and be respectful to your patients and courteous to your patients and listen to what they have to say. One of the hardest things that I learned in medical school was not pre-judging anyone. I met so many people from so many different backgrounds. You really have to just forget your stereotypes and treat people as people and not just as patients.

Emil Chuck, PhD: That’s such a true philosophy to stand by for anybody in general as well, but certainly for being a physician.

Dr. Neil Saley: Well, that’s right. It would just be awful if I ever treated anyone disrespectfully because of the way they looked or the way they acted. And that goes for drug abusers and people with psychiatric illnesses and just around the board. Just don’t think of yourself as being better than anybody. Just think of yourself as trying to help everybody.

Emil Chuck, PhD: Absolutely. Did that encounter with that neurologist occur during the internet phase?  Because obviously nowadays, technology, the internet is sort of everywhere, and I can certainly tell you <laugh> a lot of Dr. WebMDs who might be patients come up, and I’m sure those conversations get to be very interesting. So if you’re able to comment a little bit on how technology may have helped you and how it may have kind of hurt you in the process in terms of providing care.

Dr. Neil Saley: Well, technology obviously has made a huge difference in a lot of things. When I was a resident, laparoscopic surgery came in and people seem to get a lot better results with it and have a lot less morbidity and mortality. I think in general, I don’t have a lot of negative things to say about the technology except for the following. Number one, a lot of people these days choose to believe alternative facts, and they get information off the internet that is not always true and is propagated by groups, like I just read that only 18% of Americans have had their bivalent booster and there’s so much misinformation going around now that, that I think that’s probably the major limitation of technology. The other possibility I guess is if you take so much interest in technology that you forget that people are people and don’t treat them as people. When I’ve gone to the doctor, when I used to go in before electronic health records, the doctor would look at me and maybe write a little note to himself once in a while and go out. Now it seems like the doctor’s sitting on the computer and worried about filling in all the blanks on this health record, and it’s kind of distracting as a patient to be sitting there and having them sit there and stare at the computer so much.

Emil Chuck, PhD: Yeah. The EMR really has kind of become the barrier between the doctor and the patient in a lot of cases.

Dr. Neil Saley: Yeah, I, I feel the same. My daughter got really sick, and she went to the hospital, and they put in that her chief medical complaint was a fever, which in fact it was. But when they misdiagnosed her and missed her infected hematoma, they said, “Oh, well, we didn’t know she had a fever”, even though it said that was the chief complaint. So it’s really like…

Emil Chuck, PhD: Attention, attention, attention. Exactly. We covered a little bit about this question before, especially about health and wellness. So what insights have you had about maintaining your own health and wellness, either during and even after medical training?

Dr. Neil Saley: Probably the best advice that I was given was when I started internship and our chief resident said, “Don’t forget that medicine is a marathon. It’s not a sprint. You don’t want sprint until pass out. You want to jog, and you want to jog for years and years and years.”

So, as I mentioned, taking time for yourself, keeping an interest in things that you like, establishing relationships, and maintaining them. Mental health is a big deal, and if you are not mentally fit, you are not going do your patients as much good as you could if you’re mentally fit.

That chief resident also gave me some (more) very good advice. He said, “Be nice to everyone. Be kind to everyone and be kind to yourself.” And I took that to heart, and when I was in my residency, I made very good friends with one of the cleaning ladies on the second-floor medical ward, and we talked almost every day for three years, and I was leaving when I was leaving. I said, it’s great to know you. And she goes, “I wanted to let you know that my brother is the hospital administrator. I didn’t want tell you that because I didn’t want influence our relationship.” So, be nice to everyone, be kind to everyone, and be kind to yourself.

Emil Chuck, PhD: That’s a great point. And I know you mentioned actually a little bit about some of these opportunities where you’ve worked interprofessionally and gained respect for working in interprofessional teams. So in addition to being nice and kind to the janitorial staff, talk a little bit more about what it was like to work with people from different professions in the healthcare system.

Dr. Neil Saley: Well, you’re exactly right. There are a lot of different professions that are all involved in helping your patient. And it’s critically important to, I think maybe I’m naive, but from the minute I started, I knew that the nursing staff were going be my best friends, they were going be the patient advocate, they’re there with the patient, the patient tells them things they don’t tell you in the minute or two or three that you run through and do your morning rounds and, just respect, respect, respect. In addition to the nursing staff, there’s a lot of other people that are involved with helping: the pharmacist, the respiratory therapists, physical therapists, occupational therapists, social workers. My goodness, when you’re trying to get a patient out of the hospital whom you don’t think needs to be there, the social worker is your friend.

Physician’s assistants and nurse practitioners, it’s all part of the healthcare team, and they all are caring for your patients. And I cannot tell you how many times that I have been saved by advice from the other healthcare members. And the other thing to consider is, and I don’t mean to, I know this is a group who’s trying to get into medical school, but a lot of people try to get into medical school and don’t get into medical school. I think I read a statistic that one out of 37 applicants is accepted in California to a medical school. And so you ought to probably be thinking of alternatives along the way: A pharmacist, a dentist, a PA, a nurse practitioner – all of them help patients, and they’re all science-based. At least consider alternatives if plan A fails, and maybe take classes and do things that will help you learn about those things in the process.

Emil Chuck, PhD: Sure. And yeah our group definitely wants to make sure everybody on a healthcare team, especially those working in underserved environments, gets supported. So you’re right, anyone who’s a pharmacist, the nursing profession, anybody who works with (patients), and dentists for sure – we need everybody there. It can’t just be all doctors <laugh>.

Dr. Neil Saley: Oh, that, well, that’s right. In fact, it would be, excuse me, quite a disaster if it was all doctors <laugh> to tell you the truth.

Emil Chuck, PhD: I understand. No, sure. I’m moving over to this question, which is, as we are talking about shadowing in general in any sort of clinical environment, whether you want to be a PA, physical therapist, or whatever else: What are your insights or advice about what should students know about healthcare delivery while they’re shadowing or during their shadowing or clinical exposure? And this does not just include those that are getting into health professions programs but also current students that are doing their rotations. What should they be paying attention to about healthcare delivery and the system?

Dr. Neil Saley: Probably for people new to the system is to remember that everything you see and do is confidential and protected by law. And it’s critically important to name that confidentiality. When setting up a mentoring situation, you can’t always get what you want, but you would certainly prefer to do something (like) that.

You’d actually be really surprised that as a practicing physician, I loved having students with me and mentoring people and it really is good for the ego, and so I really loved it. But the things that I was looking for in the people who shadowed with me were being kind and respectful to the patient and courteous. It’s okay to ask questions even in front of the patient. If you don’t know something, it’s better to ask. And, by all means, do not be shy about asking these mentors for letters of recommendation when you need to move on. In my experience, they’re all happy to do so, and being afraid and shy to ask is something you have to get over. I was actually really shy before I started medical school and it just doesn’t work in medicine. You have to lose it. So that’s something that I worked on my personal development with while I was in medical training, and people would not call me shy anymore.

Emil Chuck, PhD: Oh, absolutely. A little bit of a semi-personal question, as we’re sort of wrapping up this interview, just wondering, did any of your children ever want to work in healthcare or even as a physician?

Dr. Neil Saley: Yeah. Well, I’m, I’m going to take this opportunity and talk about all three of my kids because I’m exceedingly proud of all of them. My oldest, Megan was a researcher for the Environmental Protection Agency. And she studied toxicology and studied PFAS, the forever chemical, and recently published a very big paper along with her mentor and some colleagues on that. And now, she works for the Minnesota Pollution Control Agency. So she’s a tree hugger, and I think it’s wonderful.

My second daughter is the one that went into a medically related field. After a biology degree, she got a master’s degree in health informatics, and she now works for a cardiovascular research company. They’re developing what’s called an ALTA valve, which is an implantable valve that can be placed non-invasively basically through the groin or through the neck. And not having your chest cracked open to have a new heart valve is a big deal, especially for critically ill patients. So they’re developing this valve, and she is in charge of European site operation data from clinical trials and keeping track of that. And they have numerous sites in Europe, so I’m very, very proud of her. And her husband works for Roche Diagnostics as a repair technician and service technician for medical equipment. So he’s my son too, so I count him.

And then my youngest child actually was interested in medical school, but she changed her mind, and then she went into a PhD program in biology. After getting a master’s in biology, she changed her mind again and went into environmental engineer engineering. And now she’s in charge of trying to make the company she works for Carbon Neutral and she works in Utah. So I’m very proud of all of my children.

Emil Chuck, PhD: Cool. And your wife is, she’s still teaching? Or what is she doing now?

Dr. Neil Saley: She’s retired. We had our first grandbaby in December, and because both my (daughter) and son-in-law work, she is basically a full-time caregiver for my granddaughter, and she is the happiest she’s been in a long time. She loves babies. I love babies too. I like ’em a little more after they can start running and talking. Not my wife. She likes the little ones, so she is just in heaven.

Emil Chuck, PhD: Oh, that’s wonderful. I’m glad that obviously in spite of a lot of the challenges that certainly have happened, I’m glad things are working, working themselves out for you, as best as they possibly can. As we wrap up this interview, I just give you an opportunity, any sort of encouraging words, especially for pre-med students who want to become doctors as well as any current students, medical students, and residents who are just beginning their journey also in, in the profession.

Dr. Neil Saley: I loved my career in medicine. I loved being a doctor. I hope that you’re all successful in your endeavors. It is a magnificent experience. The relationships that you’re able to make with patients are so deep and so important. I’m going to just throw out one little story at the end here. When I was in Oregon, I was walking through the obstetric floor and on my way to take care of one of my pediatric patients, and a nurse came running out, frantic, we need you, we need you. And I ran in the room and there was basically a lifeless child lying on the table, being resuscitated. The one-minute Apgar score was one. I did a lot of NICU and now’s and I was now an instructor. I knew just what to do, and they’re just about to give the kid epinephrine.

And I said, no, the first three drugs you used in neonatal life support are oxygen, oxygen, and oxygen. And I ventilated that kid, right? And his five-minute Apgar was nine. And I saved a life. I saved a life just because of what I knew. I’ve saved lots of lives, hundreds, or thousands of lives. The lady, the mother worked in our clinic, and to this day, I read her Facebook comments, and she calls her son Miracle Baby. And I feel awfully good about myself for that. Medicine is awesome. It’s hard. (But) if you want to do it, go for it. It’s just a wonderful, wonderful experience.

Emil Chuck, PhD: Wow, thank you so much. I appreciate the opportunity to interview you, and I thank you for us ending this interview on such a high note. So once again, Dr. Sale, thank you so much on behalf of the Health Professional Student Association and Student Doctor Network. Again, the book is Medical School: Experience, the Journey. Where can people actually get copies of the book just to make sure we have that on record too?

Dr. Neil Saley: Oh, well, thank you. It’s on Amazon, and the search directory is not really kind to me on Amazon, so you have to go to Amazon books and then either type in my name or the full title. We’re working on other sources, but for now it’s just on Amazon. So thank you, and thank you so much for taking the time to read my book and get my message out there. Thank you.