Wellness Reimagined: Dr Bob Uslander Of Empowered Endings On 5 Things That Should Be Done To Improve and Reform The Health & Wellness Industry

An Interview With Maria Angelova

People are not being informed about their legal end of life options, so they are forced to live in a state of suffering and misery, unaware that there are options available to mitigate their suffering. Specialized education and support in legal end of life options, including Medical Aid in Dying and Voluntary Stopping Eating and Drinking should be a part of every conversation with terminally ill patients, as long as the patient is open to the conversation.

In our world of constant change, and with life moving faster than ever, topics such as mental health, self-care, and prevention have become popular buzzwords. People are looking to live healthier lives, and there is superb care out there that is being offered. At the same time, there are misconceptions about the meaning of self-care and exercise. Many opt for quick solutions — surgery, pills — to dull the problem without adequately addressing the underlying cause. Meanwhile, many parts of the industry are unregulated and oversaturated. People with years of training are competing with people with weekend training. Many providers are overworked, overwhelmed, and underpaid. The general public is not educated about asking the right questions when selecting a wellness provider. In the face of all this, what can be done to correct the status quo? In this interview series, we are seeking to hear from a variety of leaders in the health and wellness industries who agree that the wellness industry is in need of an overhaul and offer suggestions about what can be done moving forward. As a part of this series, I had the distinct pleasure of interviewing Dr. Bob Uslander.

Bob Uslander, MD, is a co-founder and the medical director of Empowered Endings in San Diego, California. With 30+ years of experience as a physician in emergency medicine, palliative care and hospice care, Dr. Bob is dedicated to supporting patients and families through major health and life challenges, especially as the end-of-life approaches. He strives to foster deep connections with his patients and their families while guiding and empowering them in making the best decisions about their care.

Thank you so much for doing this interview. It is an honor. Can you please share your personal backstory? What has brought you to this point in your life?

My life journey to date has been fairly convoluted. I could never have predicted that I would be where I am today doing what I do, but I can’t imagine being anywhere else or doing anything else.

My childhood was happy and relatively uneventful for the most part. I wasn’t exposed to anyone dying throughout my childhood, but we did have a couple of pets that got old and put to sleep, and my grandfather died unexpectedly when I was 11. It wasn’t until about 30 years later that I learned that he had committed suicide by jumping out of a 30-story window. Looking back, I could see how that impacted everyone in my family, but at the time I couldn’t have known what was happening. I’m still not sure how I feel about my parents’ decision to keep that information from me.

After growing up in a town just north of Chicago, Illinois I attended college at the University of Illinois in Champaign Urbana, with the idea of becoming an architect. Spending time with friends who were premed and seeing how well I did in my science classes altered my course. I changed my major to premed my sophomore year. I wasn’t completely convinced that I wanted to embark on the long and rigorous path to becoming a physician, but I was interested enough to give myself the option. This motivated me to study tirelessly and achieve the best grades possible. I also had a lot of fun and made some lifelong friends at college.

My fate was sealed when I did an eight-week externship program at a major medical center in Chicago during the summer between my junior and senior year of college. I spent a week shadowing eight different doctors from eight different medical specialties. I got a “behind the scenes” look at what it was like to be a physician at that time, and it seemed like a truly magical and meaningful career. After that experience I fully committed to a career in medicine, seeing it as an amazing way to lead a meaningful life, earn a good living, and give back to society.

I was fortunate to be accepted to the UCLA School of Medicine (now the David Geffen School of Medicine at UCLA) and moved from cold and flat Illinois to the sunny beaches and glamor of Los Angeles.

I thoroughly enjoyed being in Southern California and my time at UCLA. I was drawn to many fields of medicine, but when it came time to choose a specialty, I chose Emergency Medicine. I appreciated the diversity of the experience and the ability to make an immediate impact on someone’s life by caring for them during some of the most intense and challenging moments of their existence.

I chose a residency program in Chicago and spent the next five years in training and then practicing as a newly minted physician.

I moved to Guam for three years where I was able to help improve the delivery of emergency medicinal care to the island’s residents, and three years later I settled in a small town in the Sierra foothills, not far from Yosemite National Park. During that phase of my life, my children were young and I thoroughly enjoyed having access to mountains and rivers and lakes. I rode horses, and went snowboarding, backpacking, and boating, and I honed my skills as a physician, serving the needs of the small mountain community in which I lived.

In 2001, about 13 years into my emergency medicine career, I had an experience that altered the course of my life forever.

My friend Darren Farwell was diagnosed with metastatic malignant melanoma at the age of 31. He was married with 3 boys under the age of six. Up until the time of this diagnosis he’d been incredibly healthy, so he didn’t have a doctor other than an oncologist. At Darren and his wife Rhonda’s request, I stepped in to provide some support after he stopped the cancer treatments (they were ineffective at slowing the progression of the cancer) and became more ill. As his health declined, we called in the local hospice team for additional support. Since I’d never cared for someone through a terminal illness, I received guidance and mentorship from the hospice physician, who happened to be a friend of mine.

We created a team of support and care for Darren and his family, and for the first time in my life I understood that it was possible to experience the dying process, and even death, as something gentle and beautiful, instead of a traumatic and epic failure.

Looking back, I now understand that even more important than being a doctor to Darren and his family, I was being an educated and informed friend and advocate- a guide- and my role was to walk with them and help navigate them along the journey, avoiding the pitfalls and gaps that many people encounter, so they could all experience the most peace and comfort as he made his way home. I was being a “doula.”

I was with Darren and his family and a few close friends as he sat each of his boys on his lap, told them how much he loved them, and said goodbye. They were too young to understand, but I wasn’t. It was, and still is, one of the saddest, and most beautiful, moments of my life. Darren gently slipped away a few hours later.

That was September 14, 2001- 3 days after 9/11.

Those of us who knew Darren and were with him when he died were convinced that he was the perfect welcoming committee for the thousands of people who lost their lives that horrible day. That gave us all a bit of comfort.

Over the next few years, I started a house call practice for home bound seniors, created a non-medical home care company, founded a nonprofit that operated an adult day healthcare center, helped develop urgent care clinics and an inpatient hospitalist program, and a life coaching program for physicians. I was searching for my ultimate path, and was starting to wonder if I would ever find it.

In 2011 I moved to San Diego and was searching for a career to transition into. Being an ER doctor had become very stressful and I felt called to something different. Something that would utilize more of my skills and allow me to make more of an impact.

I continued working as an ER doctor while I explored and contemplated other possibilities. In April of 2013, I was sitting on a bluff in La Jolla, California, in deep contemplation about my future. Out of nowhere, I heard a voice inside of me say, “You’re here to help people die better.” I actually looked around to see who had spoken, but there was no one near me. The hair on the back of my neck stood up and I felt electrified.

I was surprised by this experience, and a bit shaken. I knew instantly that it was true, but I had no idea what to do about it. I didn’t have to wait long to find out. The universe had my back.

The very next day I had a random encounter with a nurse who had worked in hospice for many years and was part of a developing palliative care program that was associated with a local hospice agency. We struck up a conversation, and I shared with her the revelation I’d had the day before. After a few lunches and meetings with the founders of the company, I became the Medical Director for that budding palliative care program and also served as a hospice medical director. I felt like I was on my true path.

I spent two years in that position and learned a lot about palliative care and hospice. I came to understand the great value those services can provide, and also became aware of many of the gaps that existed in the traditional models of care. Those gaps were causing a substantial amount of struggle for people, and I found it difficult to stand by and just observe that without doing something to change it.

During that time both of my parents developed end stage lung cancer and died within a year of each other. I was privileged to care for each of them at the end of their lives, providing resources and learning from their journeys. Shortly after my father died in 2015, I made the decision to create my own holistic palliative and end of life care practice, with the intention of filling the gaps and eliminating, or at least reducing, the struggle that patients and families are forced to endure through their own journeys with complex and terminal illness.

My wife Elizabeth joined the practice shortly after it was created, and together we became crystal clear about the gaps we felt able to fill, and created the Empowered Endings Collective as our vehicle to do that.

What is your “why” behind the work that you do? What fuels you?

A number of years ago I attended a seminar where one of the presenters was a man who helps people discover their life’s purpose. Through a series of exercises and explorations I became very clear about what I believe to be my life purpose- to help people eliminate the fear that blocks them from connecting with their inner light so they can experience all of the joy and meaning of life.

That landed for me. I had been an emergency physician for over 20 years at that point, and I realized that eliminating the fear of my patients and their loved ones was one of the primary gifts I offered them. Coming to the emergency room is always scary, and having a doctor who is confident, caring and willing to listen and hold people in their full experience, was critically important. After coming to understand this, I started exploring how else I could fulfill that purpose, in even broader and more impactful ways.

My explorations led me back to sunny Southern California, this time to San Diego, which is where I now call home.

My role now as a palliative care and end-of-life specialist allows me to fulfill my purpose beautifully. Minimizing or eliminating the fear that so often accompanies the experience of illness and dying is profound. The experience can be innately scary for people, because of the many unknowns, and the mystery that surrounds death, but there are ways to minimize or eliminate the fear and allow people to approach this time with greater ease, greater peace and greater courage. This is what drives me.

What are some of the most interesting or exciting new projects you are working on now?

I do have some very exciting projects in the works. My wife and partner Elizabeth and I are trying to shift the paradigm of end-of-life care in our country and beyond. We want to create a society that never again asks the question, “why do we treat our pets better than we treat our people?”

The medical practice that we’ve developed and have been running for the past seven years has proven that people can experience a great degree of peace and empowerment as they live their final days and approach their death. Families and loved ones can be held and supported in ways that eliminate the sense of overwhelm and despair that so often makes the end-of-life journey tumultuous and traumatic. The stream of cards and emails of gratitude we receive from the loved ones of the people we’ve cared for is proof that it’s possible to improve the experience around the end of life.

We are committed to educating, training, mentoring, and supporting other medical practitioners so they can improve their own end of life care and even create similar practice models in their own communities. We have developed an educational platform (The Empowered Endings Institute) and a Management Services Organization (MSO) to provide this support.

Since we have created a model that is currently outside of the traditional insurance model, it is imperative that there will be funding available to provide support for those who can’t afford to pay for it. To this end, we have created a foundation that provides grief and bereavement support, financial assistance, and other valuable resources that further fill the gaps that caused people to suffer needlessly (The Empowered Endings Foundation).

We also have a book in the works titled Permission to Choose, that we hope will be a sort of manifesto about the state of end-of-life care and the ways that it can be done better.

Those are the big rocks that we are filling our days with. We are also enjoying time with our growing family, including our children and new baby grandson, while navigating our own personal and spiritual journeys.

From where you stand, why are you passionate about the topic of Reimagining the Health and Wellness industries? Can you explain what you mean with a story or an example?

This topic is near and dear to my heart. As I’ve previously discussed, after I was guided toward working in palliative and end of life care, I became acutely aware of the gaps that existed in the system. These gaps were causing high levels of stress, overwhelm and suffering for patients and their families, and they existed on many levels, even for people who were highly educated and successful in their lives. As someone who is always searching for solutions to the problems I encounter in life, I began looking for ways to fill these gaps.

One of the gaps that created the most challenges for people was not having a reliable and familiar person to connect with and receive guidance from when there was a concern or change in the patient’s condition. Doctors are often very difficult to reach — especially outside of office hours, and most hospices and palliative care programs have triage lines that connect people with “on call” nurses, or other staff that don’t have a personal connection with, or knowledge about, each individual patient.

The most basic and profound gap I was compelled to fill was being available for and showing up for the patients and the loved ones we took care of — whenever they needed us. The impact of this is enormous. You don’t need to be a rocket scientist to figure out that showing up for people when they need you improves outcomes and also improves everyone’s experience.

We’ve subsequently identified a number of consistent gaps in the care of people who are very ill and dying, and we’ve developed a model of care that is dedicated to filling those gaps. The result is that more and more people are able to have an Empowered End of Life Experience. Now we are compelled to share what we have learned so that others can offer the same benefits in their own communities.

One of my favorite stories related to a patient named Edward, a very quiet man in his 80s with metastatic cancer who was given two-to-three months to live by his oncologist and referred to home hospice. He lived alone and had no family in the area, so he hired caregivers and a private nurse care manager to provide support. After a month on hospice, he had become bedbound, had a catheter in his bladder, and was in constant pain. He hadn’t seen a doctor since being admitted to hospice, and was being advised by the hospice nurses to take higher doses of morphine and other sedating drugs. When he expressed a desire to have a doctor evaluate him, his care manager contacted me and I went to see him.

I made some adjustments to his medications and, at his request, engaged some team members to provide services and therapies that were not offered by hospice, and surrounded him with loving and caring people who were totally focused on enhancing his quality of life. We engaged him in gentle exercises and physical therapy. Once he was more mobile the bladder catheter was removed, which he was grateful for. He was open to holistic treatments to manage his pain and anxiety, so we began weekly massages and acupuncture, which relieved a great deal of his pain and helped him feel more relaxed and cared for. He actively participated in music therapy and expressive arts therapy, which filled him up spiritually and allowed him to connect more deeply with his own joy and the joy of others.

Within a month he was spending most of his time out of bed and was able to go out for short walks and other enjoyable activities. Over time he began to feel more like his old self, and despite having advanced metastatic cancer he lived for another 18 months. For most of that time he was more connected and engaged and felt that his quality of life was better than any time in his life before. It was magical to see Edward blossom as a result of the compassionate and loving care he received from the amazing team of people who were his companions along his journey. His sister would visit from northern California from time to time, and she was blown away by the transformation that was taking place in front of her eyes. Watching him experience this profound healing and receiving the deep gratitude from Edward and his sister was also deeply moving for each of the team members who participated in his care. This is just one example of the benefits of personalized and holistic approach to caring for people in the final chapter of life.

Can you share a few reasons why the status quo is not working for both providers and patients?

The status quo of health care for people with complex and terminal illnesses results in a highly variable experience for patients, families and providers alike. Sometimes the experience is acceptable or even positive. In far too many cases however (and this is what we are passionate about changing) the experience is challenging, frustrating, traumatizing or even horrific — for everyone involved.

As important as it is to improve the experience for the recipients of care, I believe it is equally important to improve the experience for the providers of that care. Far too many physicians are feeling burned out and depressed. The suicide rate of physicians is staggering. Nurses and social workers working in hospice, and often in hospitals as well, are experiencing high levels of frustration, dissatisfaction and burnout, and often feel that their souls are being crushed by what they observe and are forced to perpetuate in the course of doing their jobs.

I was once a frustrated, disillusioned, stressed-out ER doctor working in a literal sea of pain, anxiety, and despair, and I’m not even talking about the patients — I’m talking about the people I worked with.

Now, 10 years later, as a private palliative and end of life care physician, working collaboratively with a hand-picked team of nurses, doulas, counselors, coordinators and assorted therapists, I couldn’t imagine a more rewarding and satisfying career and I have no intention of stopping anytime soon. Quite a change, I’d say.

My team is composed of people who feel the same way as I do.

We feel privileged to do the work that we do and to know — because we are told by patients and families every day — that we are making a critically important difference in people’s lives. In our weekly team meetings, we frequently find ourselves reflecting on the gratitude we feel for each other, our families, and the patients and families we serve.

This is the kind of environment most committed healers would like to work in. We want to make it more available for more people. We want to live in and help create a world in which “everybody wins.”

Why do you think there is a good opportunity now to improve and reform the health and wellness industry?

I will speak to the two primary opportunities I see in front of us right now and which I’m committed to serving — the opportunity to improve the care for people who are facing the challenges of a complex or terminal illness, and the opportunity to help shift the paradigm of end-of-life care by bringing the Doctors and Doulas model to the forefront.

Our healthcare system has been woefully inadequate at addressing end of life care optimally. It’s not good enough to only get it right SOMETIMES. People don’t know what they don’t know. Most people assume that when their health care needs increase because of an illness or injury, the healthcare system will show up for them and meet those needs appropriately. They assume that they will receive guidance and support from the doctors they have relationships with or new providers as needed. They don’t expect to find themselves in a crisis situation.

The reality is that many of those people do not receive the support and guidance they need, and they do find themselves in a crisis situation, feeling adrift and alone, wondering what happened, not knowing where to turn or what to do.

Providing comprehensive, compassionate, in-home support for patients and families that wraps around and complements the services that are available, while taking nothing away, seems like an obvious answer.

It would be wonderful if the healthcare system provided this type of support, and it was included in the insurance reimbursement structure. But just because it’s not, doesn’t mean it shouldn’t exist. We need to provide this type of care, and demonstrate how valuable it is, so that we can influence policy and eventually get it covered by insurance or through other payers. That’s what’s been happening with palliative care over the past decade. The benefits of palliative care are being quantified and presented to policy makers, and it is being recognized as a valuable service and should be reimbursed appropriately (though there is still a long road ahead to achieve this) … More people need to understand what is truly happening- what is missing- in the end-of-life sphere, which is why we are so committed to our educational platform.

The opportunity to train, support and engage end of life Doulas makes great sense. Doulas are increasingly accessible, and willing to work in a capacity that most licensed professionals aren’t. An army of compassionate and devoted people are entering this field and searching for opportunities to serve others in meaningful ways. Their chosen path is to compassionately shepherd people along the end-of-life journey.

We are partnering with end-of-life Doulas and providing them with education, training and resources, and building a community that allows them to inspire and support each other.

As the proliferation of birth midwives and birth doulas changed the landscape of pregnancy and childbirth, the partnership between doctors and end of life doulas will change the landscape of end-of-life care, providing more options, more peace of mind, more Empowered Endings.

Can you please share your “5 Things That Should Be Done to Improve and Reform the Health & Wellness Industry”? Please share an example or story for each if you can.

I’ll do even better and give you six! I’ll also share the ways that we are “re-imagining” care and “re-humanizing” medicine.

The six Gaps in End-of-Life Care that cause the most challenges for people and need to be filled:

1. Physicians are largely disengaged and absent from end-of-life care. At a time when things are changing rapidly, tensions are high, people are afraid and overwhelmed, the medical care is relegated to hospice nurses who, while well-meaning and often very competent, are not physicians and usually don’t engender the same degree of confidence and authority as a compassionate and engaged physician. There needs to be more engaged physicians offering intensive, personalized, trauma-preventative, culturally-competent care and counsel;
2. There is usually no one to navigate patients and families through the complex maze of palliative and end of life care. Most people are completely unfamiliar with what is needed during this challenging time, and figuring it out on their own is fraught with problems. People need companionship and guidance throughout the final chapter and beyond via emotional, spiritual, and grief support provided to patients and their loved ones by experienced health care providers and end-of-life and grief doulas;
3. The healthcare system does not have a mechanism to appropriately support families who are struggling with the emotions around a loved one’s illness or impending death, in addition to being responsible for caring for them and advocating for them. People need and deserve to have 24/7 family support to ensure not only patients, but also families, get their questions answered and anxieties assuaged over the course of care by a committed team of experts;
4. Not enough emphasis is placed on creating soothing and healing experiences for people dealing with complex and terminal illnesses. Life-enhancing options, including traditional, alternative and holistic therapies, are variably available in the insurance-based model and can add immense value to the patient and family’s experience. We encourage and facilitate life-enhancing therapies for the patients and loved ones we care for.
5. People are not being informed about their legal end of life options, so they are forced to live in a state of suffering and misery, unaware that there are options available to mitigate their suffering. Specialized education and support in legal end of life options, including Medical Aid in Dying and Voluntary Stopping Eating and Drinking should be a part of every conversation with terminally ill patients, as long as the patient is open to the conversation.
6. People do not adequately plan for their end of life or have meaningful conversations with their loved ones to ensure that their wishes will be understood and honored when the time comes. If people were encouraged and supported in doing so, many treatments, procedures and hospitalizations would be avoided and a considerable amount of suffering would be as well.

What do you think are the biggest roadblocks to reforming the industry? What can be done to address those hurdles?

Lack of awareness is one of the biggest obstacles to reforming and improving care for people at the end of their lives. As previously discussed, most people in our country believe that hospice care is all that is required (and all that is available) to adequately meet people’s needs. Most physicians I communicate with are unaware of the many patients and families that are scathed and traumatized by their experience with hospice care. They are often shocked and dismayed to learn that many of the patients they took care of and referred to hospice (or who were referred from the hospital or by a specialist) had a tumultuous and difficult end of life journey as a result of the gaps that exist. Because they are so busy and focused on what’s right in front of them, most physicians don’t receive feedback from patients and families regarding their experience with palliative and hospice care, so they make the assumption that everything went smoothly. This ignorance of what actually transpires is a substantial roadblock to making things better.

Additionally, the healthcare system is an enormous industrial complex that is increasingly focused on improving the bottom line and minimizing liability for the stakeholders — mostly the health care organizations and private insurance companies responsible for delivering and paying for the care. This presents a perpetual conflict for people who are committed to delivering the highest quality care to the people in greatest need.

Things change very slowly in healthcare and the system is straining under the weight of an exponentially increasing number of people who are aging and requiring higher levels of care and support. Innovation and creative thinking are essential, and so is looking back in time to identify some of the “disruptions” that had a positive impact, such as the introduction of birth doulas, midwives and birthing centers as alternatives to the standard medicalized pregnancy and childbirth experience.

Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?

My favorite Life Lesson Quote is probably the simple, but poignant phrase, “It is what it is” which I heard my father say a number of times after being diagnosed with stage 4 lung cancer a short eight months after my mother died from the same disease. I’ve heard it from a number of other patients as well, and when I hear it, I am comforted to know that these individuals have a “healthy acceptance” of their circumstances.

That phrase reminds me of the importance of seeing things as they are — not as we wish them to be or pretend that they are. To me, acceptance of “what is” is paramount to being able to make things better. It doesn’t mean that we should accept that things “should be” that way or need to stay that way if “what is” is not what they want or need to achieve their goals. But denying that “it is what it is” can lead to a great deal of avoidable struggle and challenges.

I’m also a big fan of the simple mantra popularized by The Beatles: “All you need is love.” No explanation is needed for that one. It speaks for itself.

One last question, how can people reach or follow you?

Our website is www.EmpoweredEndings.com

Our phone number is (858) 925–7554 and we almost always have a live person answering the phone to address any questions people might have.

People can follow us on Facebook at https://www.facebook.com/empowerendings or on Instagram at https://www.instagram.com/empowered_endings_/

This was very inspiring. Thank you so much for the time you spent on this. We wish you only continued success.

About The Interviewer: Maria Angelova, MBA is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher and founder and CEO of Rebellious Intl. As a disruptor, Maria is on a mission to change the face of the wellness industry by shifting the self-care mindset for consumers and providers alike. As a mind-body coach, Maria’s superpower is alignment which helps clients create a strong body and a calm mind so they can live a life of freedom, happiness and fulfillment. Prior to founding Rebellious Intl, Maria was a Finance Director and a professional with 17+ years of progressive corporate experience in the Telecommunications, Finance, and Insurance industries. Born in Bulgaria, Maria moved to the United States in 1992. She graduated summa cum laude from both Georgia State University (MBA, Finance) and the University of Georgia (BBA, Finance). Maria’s favorite job is being a mom. Maria enjoys learning, coaching, creating authentic connections, working out, Latin dancing, traveling, and spending time with her tribe. To contact Maria, email her at angelova@rebellious-intl.com. To schedule a free consultation, click here.