What do you say to a family when the tests are normal, the pain is real, and medicine has no answer? Dr. Xavier Jimenez, a consultation-liaison psychiatrist board certified in psychiatry, pain medicine and addiction medicine, joins Dr. David Spiro on HuMed to talk about the moments when doctors have to admit what they don't know. About 20 years ago, as a psychiatry resident, Dr. Jimenez was called to see a young man in his 20s with kidney failure who was refusing dialysis. He was homeless, had an intellectual disability and likely schizophrenia, and he ended up stuck in a turf war between medicine, nephrology and psychiatry until a chief medical officer brought everyone back to the table. What fascinated him was not only the patient but how the doctors around him reacted, and it launched a lifelong focus on the humans who deliver care. He and David talk about physicians as humans with an "inner universe," why humility is missing from medical training, shared decision making, how to help children and families living with chronic pain in the ER, and the moral injury of caring for kids in behavioral health crises in a system that can't fix it. He also shares how his hospital trained medical teams to lead behavioral emergency responses, and how he takes care of himself: running, poetry, baseball with his two boys, and cooking dinner with his wife every night. In this episode: – A patient caught in a hospital turf war – Why doctors bring their personal lives to work – Burnout and a system that only reacts – "Physicians are also humans": the inner universe – Paternalism vs. shared decision making – Chronic pain in the pediatric ER: validate, then say "I don't know" – Ping-ponging between pain clinics and psychiatry – Moral injury and "impossible situations" – How COVID changed the way people seek care – Being authentic with young patients in crisis – A 3 a.m. debrief and a new behavioral health simulation – Behavioral emergency teams without a psychiatrist – Self-care in week-long chunks Chapters 00:00 "The moral injury is very high" 00:29 Meet Dr. Javier Jimenez 02:23 The case that shaped his career 05:27 A patient caught in a turf war 07:53 Who brought everyone to the table? 08:50 What happened to him 10:08 Bringing our personal lives to work 11:55 Burnout and the limits of a reactive system 14:19 Cultivating humility in physicians 15:51 What he means by "inner universe" 19:16 Paternalism vs. shared decision making 24:37 Children with chronic pain in the ER 26:12 Step one: validate 27:04 Step two: embrace the ambiguity 28:44 Resources for the front lines 29:57 Ping-ponging between pain and psychiatry 32:04 Giving doctors a humane way out 33:07 Behavioral health emergencies in children 34:21 Moral injury and "impossible situations" 35:45 How COVID changed the way people seek care 37:42 Investing upstream in mental health 39:17 What ER doctors can do: be authentic 40:34 Healthcare deserts and technology 42:19 A debrief David is proud of 45:11 A generational silver lining 46:27 A behavioral emergency team without a psychiatrist 49:00 Swiss Army knife physicians 49:39 How does he take care of himself? 54:04 Community, sleep and food 56:54 Closing This episode is education and storytelling, not individual medical advice. HuMed unveils the human side of medicine, hosted by Dr. David Spiro, MD. New episodes on Apple Podcasts, Spotify, and YouTube — please follow and leave a rating, it helps other listeners find the show.
