Alex Evans MD & Candice Caesar PMHNP (00:10)
Well, hello everyone. Welcome to another episode of the Apex Health Podcast. I'm Dr. Alexander Evans, and here my co-host is Candace Caesar, mental health nurse practitioner. I'm a practicing physician, a surgeon at Howard University, but I'm here with Apex Health to talk to you about your health care. Apex Health brings together leaders across the nation to that shape healthcare.

Alex Evans MD & Candice Caesar PMHNP (00:38)
Everything from physicians, nurses, healthcare executives, policymakers, insurers, even researchers and innovators to have real conversations about the issues that impact us. Our goal is simple: to make healthcare easier to understand, and by bringing you trusted voices from fresh perspectives and particularly insights that inform.

Alex Evans MD & Candice Caesar PMHNP (01:06)
inspire and empower you. Absolutely. So thanks for joining us again. I want to talk to you guys today about Dr. A. Mitchell. Dr. Roger A. Mitchell Jr. is a board certified forensic pathologist and nationally recognized healthcare leader whose career spans medicine.

Alex Evans MD & Candice Caesar PMHNP (01:26)
Public safety, hospital administration, and health policy. He recently completed his term as the 126th president of the National Medical Association and previously served as president of Howard University Hospital and Chief Medical Examiner for Washington, D.C. He is also a tenured professor of pathology at Howard University and has led the University's Center of Excellence for Trauma and Violence Prevention.

Alex Evans MD & Candice Caesar PMHNP (01:56)
A leading national voice on deaths in custody, gun violence, health care equity, and the integrity of medical legal deaths investigations. Dr. Mitchell has helped shape policy, strengthen institutions, and reframe violence as a preventable public health crisis. Let's welcome Dr. Mitchell. All right. Dr. Mitchell and one of my mentors and good friends. Absolutely. Yeah. He's a great man.

Roger A Mitchell Jr MD (02:24)
it's

Alex Evans MD & Candice Caesar PMHNP (02:25)
Yeah.

Roger A Mitchell Jr MD (02:25)
it's great to be here. Good to see you all. and be here at

Alex Evans MD & Candice Caesar PMHNP (02:28)
Yeah.

Roger A Mitchell Jr MD (02:29)
at Apex Health. It's great to be here. Thank you.

Alex Evans MD & Candice Caesar PMHNP (02:31)
Yeah. So starting from the top, Dr. Mitchell, you know, we're talking about redefining the hospital. You know, hospitals are traditionally viewed as places where people go to obviously when they become sick to get well, right? Become injured, etc. Your work challenges healthcare leaders to think more broadly. What do you what does it truly mean for a hospital to serve as an anchor institution in a community?

Alex Evans MD & Candice Caesar PMHNP (03:01)
that has at risk people in that community.

Roger A Mitchell Jr MD (03:06)
Well, that's a that's a really good question. And at the end of the day, hospitals, particularly safety net hospitals, whether they're in urban centers or rural communities, serve as that anchor to to health care delivery. And often people equate the access to hospitals as access to care. And some of that is true and some of that's not true. Quite frankly.

Roger A Mitchell Jr MD (03:32)
if there is a good hospital, that hospital is part of a larger primary care provision in a community. It it's not just a place where you get your acute care, but it's part of a larger system where people are getting preventative care. Good health care is access to preventative care, not just the acute care. But when the acute care is needed, you shouldn't have to drive

Roger A Mitchell Jr MD (03:59)
hundreds of miles to get there like we're seeing right now in rural America. And you shouldn't have to wait in long lines in emergency departments like we're seeing in urban America. One of the other big things about being a hospital system that's connected to a primary care provo provision is to be in and about community. So it's not enough just to be there when the patient needs you.

Alex Evans MD & Candice Caesar PMHNP (04:24)
So it's not

Roger A Mitchell Jr MD (04:28)
And patients come to you. A good hospital system is going to patients, is engaging in healthcare, is engaging in back to school book bag drives, is engaging in vaccine vaccination drives, is connected with the local faith leaders and local organizers within community. Because a good healthcare

Alex Evans MD & Candice Caesar PMHNP (04:36)
Because

Roger A Mitchell Jr MD (04:51)
system is part of a community, not just accessed by the community.

Alex Evans MD & Candice Caesar PMHNP (04:56)
Wow, that's a great answer. Absolutely. Absolutely. You know, I want to key in here as you you know, with you being a forensic pathologist, you often encounter people and families at the final and the most heartbreaking point in their stories. Yet an autopsy can reveal much more than the cause of death. It can reveal social conditions, you know, and the systemic failures that preceded it. So when you reflect on what the autopsy room revealed.

Alex Evans MD & Candice Caesar PMHNP (05:26)
What did it teach you about the social human conditions that shape who gets the opportunity to live a healthy life and who doesn't? Wow.

Roger A Mitchell Jr MD (05:34)
Well, that again,

Roger A Mitchell Jr MD (05:35)
you guys have done your research. I often say that I see failed policy on my autopsy table. And

Alex Evans MD & Candice Caesar PMHNP (05:42)
Yeah.

Roger A Mitchell Jr MD (05:43)
there are individuals that ask, Well, how does a forensic pathologist become first before I was even a hospital president? I was the chief medical officer for twenty six ambulatory care delivery care delivery system. it's because of that direct point,

Alex Evans MD & Candice Caesar PMHNP (05:55)
It's a delivery. components are looking at

Roger A Mitchell Jr MD (06:02)
Candace that

Roger A Mitchell Jr MD (06:04)
I've seen death and how death shows up when there is a lack of access. And because I saw death showing up when there is a lack of access, I felt it was necessary to try to get on the other side of care to try

Alex Evans MD & Candice Caesar PMHNP (06:20)
Yeah.

Roger A Mitchell Jr MD (06:21)
to impact that. there have been times when I've been performing autopsies and I would see the coronary artery disease, I would see the heart attack.

Roger A Mitchell Jr MD (06:32)
for layman's term or the myocardial infarct. And it's the first time that that individual was diagnosed. And I'm the first physician to have seen the patient. And that's at the autopsy table. And so that's

Alex Evans MD & Candice Caesar PMHNP (06:40)
huh. my goodness. Yeah.

Roger A Mitchell Jr MD (06:45)
a that's a direct relationship to the social determinants of health. Where we live, work, play, and

Alex Evans MD & Candice Caesar PMHNP (06:49)
Mm-hmm.

Roger A Mitchell Jr MD (06:51)
have our being, where where we have access to education, economics, housing, healthcare, and criminal justice, it's it's in that milieu of the social determinants.

Alex Evans MD & Candice Caesar PMHNP (06:56)
I'll see.

Roger A Mitchell Jr MD (07:01)
And the lack of access in those areas that we find premature death, that we pro that we find premature disease and we find higher rates of mort mortality and morbidity. So I think your question answers itself, at least from my standpoint, as a forensic pathologist. I think it's my job as a physician and a public health provider is to translate that mortality data.

Roger A Mitchell Jr MD (07:30)
into actionable policy and programs that decrease disease and injury in our communities.

Alex Evans MD & Candice Caesar PMHNP (07:37)
You know, that's that's an excellent way to look at it. And I I I don't know if in your community, I know across the board as physicians, not all of us look at the what we do and how it impacts so many others, what we do, how it impacts the entire community. And so the fact that you do that from from the death table is is an amazing thing. Absolutely you know.

Alex Evans MD & Candice Caesar PMHNP (08:06)
Speaking of that, you know, looking at you you haven't exam when we examine violence, I mean you you've done a lot in the area of violence and violence prevention. And looking at the lens of medicine and public safety, government and community leadership, too often society responds to violence only after the person is injured or killed. I'm almost wondering, like, what changes would you think?

Alex Evans MD & Candice Caesar PMHNP (08:35)
would have happened if when we begin to treat violence as a preventative public health condition rather than just in the criminal justice issue. Wha what what what do you think there?

Roger A Mitchell Jr MD (08:48)
Well, very similar to what what we've just described. I mean, violence is a public health issue because we know that there are social drivers that increase the potential for violence to be used to resolve conflict in communities. And those social drivers are communities that have a higher incidence of violence, are likely to be communities that use violence to solve conflict.

Roger A Mitchell Jr MD (09:14)
those communities that have lack of access to high paying jobs or lack of access to education, lack of access to food, you know, food deserts, these com communities, whether they're white, black, whether they're rural or urban, communities that have lack of access to those social drivers are more likely to have violence as a part of the social condition.

Roger A Mitchell Jr MD (09:41)
And violence begets violence. It's you know, we look at violence as a contagion. Those that have been exposed to violence as a behavior resolver are more prone to use violence to resolve behavior. So those that f come home

Roger A Mitchell Jr MD (09:58)
come up in homes of domestic violence are more apt to use violence to resolve their conflicts. Those that have family members

Alex Evans MD & Candice Caesar PMHNP (10:03)
So the chance

Roger A Mitchell Jr MD (10:06)
that have been incarcerated and have used violence.

Roger A Mitchell Jr MD (10:09)
To resolve their conflict are often using violence to do that. And so the prevention is the flip side of that. access to education, economics, housing, healthcare. WEB Du Bois calls it the five areas of social the social condition that's education, economics, housing, healthcare, and criminal justice. And those higher access

Alex Evans MD & Candice Caesar PMHNP (10:13)
to have a

Alex Evans MD & Candice Caesar PMHNP (10:29)
For accent.

Roger A Mitchell Jr MD (10:30)
in those areas are going to decrease violent behavior. one of our surgeon generals, Dr. David Satcher.

Roger A Mitchell Jr MD (10:37)
wrote a book. we call it the Red Book. It is a a manifesto on youth violence prevention and it talks about those risk and preventative factors. The c the research in this area talks about what is the most stable environment to decrease violence and that is a consist an environment that has a consistent caring adult. and so those those environments that have surrogate family structures are less likely

Alex Evans MD & Candice Caesar PMHNP (10:59)
Ritigator,

Roger A Mitchell Jr MD (11:07)
And that doesn't matter how how old the individual is. You can have you can be 30 years old, and if you have a consistent caring adult, that is a risk mitigator for violent behavior. and so

Alex Evans MD & Candice Caesar PMHNP (11:18)
wow, wow.

Roger A Mitchell Jr MD (11:20)
so we know that that's the that's the case. And so there at Howard University hospital, there is hospital-based violence interruption. And hospital how violence hospital-based violence interruption works.

Roger A Mitchell Jr MD (11:36)
is is that those individuals that have become victims of violence and been injured for violence are at a better best position to hear about and get access to the social need support to decrease maybe retaliation or violence in other parts of the community. So I know that was a long answer, but the reality of it is is that violence, particularly homicidal violence,

Alex Evans MD & Candice Caesar PMHNP (11:58)
How

Roger A Mitchell Jr MD (12:04)
and suicidal violence, both of them are preventable. we even talk much about suicides. You know, in violence, suicide is the number is is more prevalent than homicide violence. In fact, 66% of all violent homicides, I mean all violent deaths are due to suicides, not homicides. And so

Alex Evans MD & Candice Caesar PMHNP (12:10)
can it be correct? Yes.

Roger A Mitchell Jr MD (12:25)
so we need to be talking about violence, both homicides and suicides, because

Roger A Mitchell Jr MD (12:31)
Then it normalizes violence across all communities, no matter what the demographic, particularly racial demographics, more white men commit suicides than anybody else, more black men find themselves in proportion victims of homicide. And so if we talk

Alex Evans MD & Candice Caesar PMHNP (12:48)
On a size. Mm-hmm.

Roger A Mitchell Jr MD (12:50)
about those two things together, then we can really have a comprehensive approach to decreasing violence in this country.

Alex Evans MD & Candice Caesar PMHNP (12:58)
Yeah, that that's an an invaluable answer. I mean, you spoke about learned behaviors, which is amazing, which is what what unfortunately happens a lot of times. We talked about the community s that supports them, someone living in that home as a a caring adult that can guide them. And then we talked about public policy and how that can change things. that that

Alex Evans MD & Candice Caesar PMHNP (13:24)
That's an amazing answer. Yeah, the thing that really caught me too is the fact that, you know, even a 30-year-old who has a caring adult that mitigates their risk. I think that that was something that I didn't know. I learned. Yeah. So thank you. So

Roger A Mitchell Jr MD (13:37)
Well,

Roger A Mitchell Jr MD (13:37)
I I mentor I mentor thirty year olds and I'm fifty fifty two years old. So I mentor well bless you. Bless

Alex Evans MD & Candice Caesar PMHNP (13:40)
Uh-huh. Y you you meant to you meant to older than thirty years too.

Roger A Mitchell Jr MD (13:47)
you. I I mean I mentor, you know, thirty year olds that have just gotten out, you know, are

Alex Evans MD & Candice Caesar PMHNP (13:51)
Mm.

Roger A Mitchell Jr MD (13:51)
returning citizens. that that may be navigating, you know, challenges, whether they be economic challenges or emotional challenges, relationship

Alex Evans MD & Candice Caesar PMHNP (14:03)
Mm-hmm.

Roger A Mitchell Jr MD (14:04)
challenges.

Roger A Mitchell Jr MD (14:06)
And and that type of and I've been a 30 year old that

Alex Evans MD & Candice Caesar PMHNP (14:11)
Mm-hmm.

Roger A Mitchell Jr MD (14:14)
that that needed fatherhood, you know,

Alex Evans MD & Candice Caesar PMHNP (14:16)
Guidance. Yeah. Mm-hmm.

Roger A Mitchell Jr MD (14:18)
needed needed a a mother. and even at fifty-two years old, I talk to my mother at least five times a week and and oftentimes it's conversations about the next step or the next decision.

Alex Evans MD & Candice Caesar PMHNP (14:33)
Mm-hmm.

Roger A Mitchell Jr MD (14:35)
I'm a mar I've been married for 24 years and I consider my wife a consistent caring adult. Right. And and so I have

Alex Evans MD & Candice Caesar PMHNP (14:41)
Mm-hmm. Absolutely.

Roger A Mitchell Jr MD (14:43)
I have conversations with her about next steps. And all of those things keep me from being violent. you know,

Alex Evans MD & Candice Caesar PMHNP (14:50)
Yeah.

Roger A Mitchell Jr MD (14:51)
and and and and it's true because

Alex Evans MD & Candice Caesar PMHNP (14:54)
Right.

Roger A Mitchell Jr MD (14:54)
because especially when we talk about those of us that have had adverse childhood experiences. you know, my father was crack cocaine addicted my whole childhood.

Roger A Mitchell Jr MD (15:05)
And so that adverse childhood experience has made me has created a risk factor in me to become violent, to resolve conflict, because an inherent anger that I carry, even as a 52-year-old, I have an inherent anger. And so the joy that I can express

Alex Evans MD & Candice Caesar PMHNP (15:09)
Because it didn't forget.

Roger A Mitchell Jr MD (15:23)
is because I have consistent caring adults and relationships, but also because of the large faith component that plays in that. And that

Roger A Mitchell Jr MD (15:33)
Is not specific to me. In fact, faith and relationships in faith spaces decrease all areas of risk for healthcare, for health outcomes. It improves all health outcomes in across the board, from cardiovascular disease, diabetes, obesity to behavior like mental health and violence.

Alex Evans MD & Candice Caesar PMHNP (15:56)
Absolutely so people out there go to church. Yes. Go to church. Yeah, thank you. Yes, whatever you believe in, that higher power, you know, tap in.

Roger A Mitchell Jr MD (16:00)
That's right. There you go. I love that. PSA. That's right. Or or ma or mosque or or temple. You know, right. That's right. Take take

Roger A Mitchell Jr MD (16:14)
and and and those that don't believe, you know, you call it mindfulness. Right? Whatever whatever

Alex Evans MD & Candice Caesar PMHNP (16:18)
Yeah.

Roger A Mitchell Jr MD (16:19)
you decide that you want to call it. there there is a component of that that releases chemicals, endorphins

Alex Evans MD & Candice Caesar PMHNP (16:26)
All right.

Roger A Mitchell Jr MD (16:27)
in your body that allows for a relief.

Roger A Mitchell Jr MD (16:29)
That's required if you're

Alex Evans MD & Candice Caesar PMHNP (16:30)
that's a club.

Roger A Mitchell Jr MD (16:31)
going to be successful in the human experience.

Alex Evans MD & Candice Caesar PMHNP (16:34)
absolutely. Absolutely. Thank you so much for sharing that. So, going back to the communities at large, so many undeserved communities have experienced generations of neglect, unequal treatment, broken promises from healthcare institutions. So restoring trust requires more than a marketing campaign or an occasional health fare. It requires people to feel genuinely seen and heard and cared for. What does it look like for a hospital to show up with?

Alex Evans MD & Candice Caesar PMHNP (17:02)
humility, with consistency and care, and truly earn the trust of the people it serves rather than being encountered only during a crisis.

Roger A Mitchell Jr MD (17:14)
Yeah, I mean we we we talked about that. I mean,

Alex Evans MD & Candice Caesar PMHNP (17:16)
Yeah.

Roger A Mitchell Jr MD (17:17)
really at the helm, it's it's about leadership, you know. Does the leadership commute in? parachute in? Are there big skywalks that from from your from from your parking lot to to your C suite and you don't have to touch the pavement of the community that you serve,

Alex Evans MD & Candice Caesar PMHNP (17:34)
yeah.

Roger A Mitchell Jr MD (17:36)
right? you know, whether it's in the rural or urban centers.

Roger A Mitchell Jr MD (17:41)
are you do you have a cousin that lives close by, a a mother, uncle, a mama, whoever it is? who are you to the community that you're serving? And and that identity and that relationship, not and I'm not saying it you have to be the same majority race of the individuals that you serve, but do you do you see yourself in the community that you serve as the leader of the hospital, as the leader of

Roger A Mitchell Jr MD (18:10)
as the chief nursing officer or the COO or the CEO, do you see yourself in that community for that community? And that translates in the type of love and support and the type of investment that you're gonna place in that community to see prevention occur before people get to your doorstep. You know, in trauma surgery and Dr. Evans is better better at this than I

Roger A Mitchell Jr MD (18:39)
But in to in order to be accredited as a level one trauma center, you have to have a robust community engagement strategy decreasing that trauma that's coming in your doors. Well, not all disciplines require that level of community investment in order to be accredited. So it's up to leadership to make that decision.

Roger A Mitchell Jr MD (19:06)
It's up to medical schools to make sure that they're admitting individuals that look like the communities that that that are intended to be served across this country. I've been I've been I've traveled this this nation for this past year as its 126th president of the National Medical Association. And what's most important to me and what I found is that the investment in our medical students, the investment in the future of our nurses and physicians and

Roger A Mitchell Jr MD (19:35)
advanced practitioners, that investment is more critical now than than ever. And the diversity in that investment, so that it is not just one group of people that can serve the nation, but all groups of people must be representative to serve. And I think those things translate into end up having the

Alex Evans MD & Candice Caesar PMHNP (19:42)
I end up having

Roger A Mitchell Jr MD (20:00)
hospital

Roger A Mitchell Jr MD (20:02)
be a place that is not just the shiny building on a hill. To your to your question, Candace, it is it is when that that group of professionals that fill the walls of that hospital care for the community deeply. It's when those individuals truly care is when the actual system will care the most. Now you can create policy, you can create programs.

Alex Evans MD & Candice Caesar PMHNP (20:24)
Other says.

Roger A Mitchell Jr MD (20:31)
You can create thresholds, you can create check boxes, you can create all of these things that try to make sure that you are in community objectively and carefully. But it's it's the former when you truly when the people in the building truly care about community

Alex Evans MD & Candice Caesar PMHNP (20:49)
Mm-hmm.

Roger A Mitchell Jr MD (20:50)
is when it truly it truly makes a difference.

Alex Evans MD & Candice Caesar PMHNP (20:53)
Absolutely. Yeah, and that's that's spot on. It's you know, if you as a group of individuals, as if the culture, I guess that's the best word, the

Roger A Mitchell Jr MD (21:03)
Yeah.

Alex Evans MD & Candice Caesar PMHNP (21:03)
culture of the hospital is not about outreach and prevention, then no matter what you put in place, it will still be a cold wall to everyone else. Yeah. But

Roger A Mitchell Jr MD (21:15)
That's right.

Alex Evans MD & Candice Caesar PMHNP (21:16)
like looking at that, let's say the hospital now is reaching out or trying to be

Alex Evans MD & Candice Caesar PMHNP (21:23)
preventable and reach out to community. The challenge that one faces is how do you protect or how do you stay afloat? How do you continue to have revenue come in when you're expending everything? How does that require government assistance? is there program? What what do you think as as an ex CEO and leader of a hospital hospital system? Well how how do you

Alex Evans MD & Candice Caesar PMHNP (21:53)
How do you bring those two together? Well i I mean it's

Roger A Mitchell Jr MD (21:55)
Well, i I mean it's it's it's truly

Roger A Mitchell Jr MD (21:57)
difficult, especially, you know, I I ran a safety net and you know, s over ninety percent, you know, government subsidized health care. private insurance, you know, will pay up to a a dollar twenty for each dollar spent and you know, government subsidy will pay thirty to forty cents on each dollar spent. And communities

Alex Evans MD & Candice Caesar PMHNP (22:22)
Hmm.

Roger A Mitchell Jr MD (22:23)
that are disenfranchised often need a dollar fifty worth of worth of care because they come

Alex Evans MD & Candice Caesar PMHNP (22:28)
Exactly.

Roger A Mitchell Jr MD (22:31)
to care so late in the progression of disease because of a myriad of barriers. So it's hard to have systems and so that's why there's big conglomerates. you'll see that there's multiple hospitals in a single system because they're able to to use dollars across the system to serve

Roger A Mitchell Jr MD (22:53)
community that may not be as as affluent or as equally insured. And even today, now that there's so many more that are losing or have lost because of the big beautiful bill or HR one,

Alex Evans MD & Candice Caesar PMHNP (23:06)
Mm-hmm.

Roger A Mitchell Jr MD (23:07)
there's going to be more people that are coming to care much later and utilizing the emergency department as their axis of care. So the real way to do it is a system that has a robust primary care doorway.

Roger A Mitchell Jr MD (23:23)
and ensuring that there's a value based approach, a value based approach that does not penalize primary care providers when patients aren't meeting meeting threshold because of of social barriers, but are benefiting the primary care provider when they can really engage in prevention and education and access. And so, you know, these systems, hospitals really can't be standalone.

Roger A Mitchell Jr MD (23:52)
Hospitals have to have good relationships with the primary care. And then and then, you know, you gotta have a a large surgical environment for any hospital to be successful. And and and that's the bread and butter type surgeries like gallbladders and appendices and GI. and so and then cardiovascular.

Alex Evans MD & Candice Caesar PMHNP (24:11)
All better than that.

Roger A Mitchell Jr MD (24:18)
it's really service lines within, not to get too technical, but service lines within hospitals that lead to small, you know, high procedures but low inpatient stays that are going to keep hospitals afloat. And those that are doing that well have har high cardiovascular and high same-day surgery work are the w hospitals that are gonna do the best in today's climate. it's the urban and rural centers that are

Roger A Mitchell Jr MD (24:47)
the only source of health care for a community that are going to suffer the worst in today's climate largely because of the effects of HR one and today's today's far right policies.

Alex Evans MD & Candice Caesar PMHNP (25:05)
Wow, wow. You know, here at Apex Health, one of the things that we launched recently is an application that we're putting through one of our clients, which is a healthcare a healthcare clinic and healthcare policy self-insured group. And they they basically give their the all the employees.

Alex Evans MD & Candice Caesar PMHNP (25:28)
and the application so they can reach out to providers immediately from their phone constantly and that actually decreases their their use of the emergency room, decreases their use of of running to urgent care centers, et cetera. So to actually and then and obviously remote patient monitoring is available. So all these things come into play. And I see that as something that I think hospitals in general can

Alex Evans MD & Candice Caesar PMHNP (25:57)
Help to use because these are pennies, these these costs in in comparison to the insurance cost, pennies on the dollar, as you know, prevention is thousand times better than anything else. And so just to be able to allow any individual access via, because everybody has a phone nowadays, access on their phone.

Alex Evans MD & Candice Caesar PMHNP (26:19)
to talk to a provider, to talk to a mental health provider, to talk to any any of these about their children, about themselves, et cetera, about their blood pressure medicine, because they don't understand it. All these things I think are are v key in in what you're saying. So I I I do understand and yeah, it's a difficult nut to crack, but I think that, you know, if we put our heads together, you know, as a country, I think we can we can make a dent. Mm-hmm. Yeah.

Roger A Mitchell Jr MD (26:46)
Yeah, yeah, I I agree. I mean, at the end of the day,

Roger A Mitchell Jr MD (26:49)
technology is going to kind of bridge the gap. but

Alex Evans MD & Candice Caesar PMHNP (26:53)
Mm-hmm.

Roger A Mitchell Jr MD (26:55)
you know, just from a baseline, we're gonna have to change the way healthcare is provided. And that's why,

Alex Evans MD & Candice Caesar PMHNP (27:03)
Yeah.

Roger A Mitchell Jr MD (27:03)
you know, I've said through over the last year is that the debate that we've been having has it really even brought in care delivery as a as a core component of the

Roger A Mitchell Jr MD (27:15)
the debate. We've only been talking about cost. And we've only been talking

Alex Evans MD & Candice Caesar PMHNP (27:17)
Right.

Roger A Mitchell Jr MD (27:20)
about decreasing costs, which we know we need to. As a country, we spend a lot of money on health care and don't have the the outcomes that we would expect from the amount of money that we're spending. But the debate has never been about how do we improve the care of of of community. It's been about how do we

Roger A Mitchell Jr MD (27:45)
decrease access to save dollars. And so fundamentally we need to be talking about how do we structure a brand new way of delivering care and a brand new healthcare system for this country. And that's, you know, hopefully Apex Health can can tackle some of those questions.

Alex Evans MD & Candice Caesar PMHNP (28:04)
Absolutely. And that's that's a the key fundamental is that being able to be on the preventative side, then that's what reduces costs. And it has to the the way of thinking from the the business leaders to the politicians has to be flipped. Yeah, it we have to make the make make that shift. Yeah. We definitely need to use AI to our advantage. Well I I definitely sure.

Roger A Mitchell Jr MD (28:25)
Yeah, well well I I tell you, I you know, we

Roger A Mitchell Jr MD (28:29)
say it all the time, healthy people cost less to care for.

Alex Evans MD & Candice Caesar PMHNP (28:33)
100%. Absolutely. Yeah. So your career has taken you from the autopsy room to the hospital leadership and then again to public service. You have led the community through violence, COVID-19, financial pressures, and significant organizational change. Leading through death and crisis requires strength, but it also requires compassion.

Alex Evans MD & Candice Caesar PMHNP (28:59)
What have those experiences taught you about leading people through uncertainty while protecting their humanity and caring for your own?

Roger A Mitchell Jr MD (29:08)
Wow. I think, you know one of the things I I pride myself on is having real relationships. you know, I I I you know I'm I will be a friend and no matter if we're we're we're we're I'm leading or I'm following or we're leading together or we're following together, the

Roger A Mitchell Jr MD (29:38)
compassion comes out for me when when we have to do it together. and and I think that that those types of relationships build trust. And when you have trust leadership becomes easy because

Alex Evans MD & Candice Caesar PMHNP (29:56)
Mm.

Roger A Mitchell Jr MD (29:57)
you tell the truth about where we are and and then you tell the truth about where we want to be and then you tell the truth about

Roger A Mitchell Jr MD (30:06)
What's going to take us to get there?

Alex Evans MD & Candice Caesar PMHNP (30:09)
Yeah.

Roger A Mitchell Jr MD (30:09)
And then you turn to the people that are smarter than you, that sit next

Alex Evans MD & Candice Caesar PMHNP (30:13)
Mm-hmm.

Roger A Mitchell Jr MD (30:13)
to you, like Alex Evans, and say, you know, is that right? Or how can we approve that? Or what would you

Alex Evans MD & Candice Caesar PMHNP (30:21)
Mm-hmm.

Roger A Mitchell Jr MD (30:21)
do differently? And those people that are sitting next to you say, you know, this is probably a better approach, or can we incorporate

Alex Evans MD & Candice Caesar PMHNP (30:29)
Yeah.

Roger A Mitchell Jr MD (30:30)
this? And then once you do that, then it really allows for people to feel.

Roger A Mitchell Jr MD (30:36)
like we're all in it together. One of my philosophies in leadership

Roger A Mitchell Jr MD (30:40)
is that we hang mirrors, not pictures. And so my

Alex Evans MD & Candice Caesar PMHNP (30:44)
Yeah, sure.

Roger A Mitchell Jr MD (30:45)
goal in leadership is to is to allow people to see themselves in the work. so, you know, we don't say, well, Dr. Mitchell is you've been so this is the way we're going 'cause you are the leader. No, we hang pictures

Alex Evans MD & Candice Caesar PMHNP (31:01)
Okay.

Roger A Mitchell Jr MD (31:01)
and say, well, you're who do you see? And if

Roger A Mitchell Jr MD (31:05)
If you hang if you hang a mirror, people often see themselves. And what's

Alex Evans MD & Candice Caesar PMHNP (31:08)
Why do you

Roger A Mitchell Jr MD (31:09)
the first thing people do when they look in a mirror? They start fixing their face. They start they start making sure, you know, they they look good. They they they start

Alex Evans MD & Candice Caesar PMHNP (31:15)
Here is right. Mm-hmm.

Roger A Mitchell Jr MD (31:20)
shifting around. They want to get the best approach. And so that's that's what it is. I mean, there's this is hard work. You know, caring for people, whether it's the individual patient or caring for communities.

Roger A Mitchell Jr MD (31:35)
the larger community or are are caring for, you know, full systems, that's that's not easy. And if you try to do it by yourself, you'll be you'll you'll you'll you might succeed, but you'll you won't have the relationships to to enjoy the success. So you you wanna

Alex Evans MD & Candice Caesar PMHNP (31:55)
Sustain so

Roger A Mitchell Jr MD (31:58)
you wanna have relationships and I think that's the that's the key to to strong leadership.

Alex Evans MD & Candice Caesar PMHNP (32:05)
Wow. Yeah. So more philos philosophical question for you. When future generations look back on your life's work, what do you hope they will say that you changed about your world?

Roger A Mitchell Jr MD (32:24)
No. Well listen,

Roger A Mitchell Jr MD (32:27)
you know, I tell my kids I have a twenty-three year old, a a twenty-one year old, and a and a and a nineteen year old, and you know in twenty twenty-six it's not too different than nineteen sixty-six. and or nineteen six. It's it's it's it's it's not

Alex Evans MD & Candice Caesar PMHNP (32:49)
Mm, unfortunately.

Roger A Mitchell Jr MD (32:52)
it's not

Roger A Mitchell Jr MD (32:53)
too different than 1866 or 1926.

Alex Evans MD & Candice Caesar PMHNP (32:56)
Wow.

Roger A Mitchell Jr MD (33:00)
and so, you know, when my when my triple great grandkids, first of all, I would hope they would know my name, right?

Alex Evans MD & Candice Caesar PMHNP (33:10)
Ha ha ha.

Roger A Mitchell Jr MD (33:11)
but they ask, you know, the question would be what did he do? You know, when it was all going down when

Roger A Mitchell Jr MD (33:19)
You know, everything was happening in twenty twenty five, twenty twenty six, in twenty twenty, in twenty twenty one, when when all was happening, what was he doing? And I I think that

Roger A Mitchell Jr MD (33:37)
there will be a response that

Alex Evans MD & Candice Caesar PMHNP (33:37)
Yeah, we'll just

Roger A Mitchell Jr MD (33:38)
he was doing something. And and I think that's the impact is that in my career I've not sat on the sidelines

Alex Evans MD & Candice Caesar PMHNP (33:47)
I'm not style on the side.

Roger A Mitchell Jr MD (33:49)
in any of the big questions. I've been on the I've been on the field. I've been in the game. and quite frankly at the highest level. And so, you know, I I pray that that we're impactful.

Roger A Mitchell Jr MD (34:06)
Not not for me, but that the work that we've done and and the work that we continue to do will lead to at the end of the day freedom for people that are disenfranchised and disinherited.

Alex Evans MD & Candice Caesar PMHNP (34:22)
Wow. I don't know if I could have answered that question. Any better. That's that's amazing. Yeah. so I'm I'm going to steal something from another podcast and ask you a question. So we obviously have several guests that they're coming on in different disciplines, all related to healthcare.

Alex Evans MD & Candice Caesar PMHNP (34:48)
And if you I'd like you to give me a question that you'd like to ask the next guest when they come on.

Roger A Mitchell Jr MD (34:57)
I like that. I think I think if you if you were to ask the next your next guest,

Roger A Mitchell Jr MD (35:09)
I would ask them how could they improve? Right? What what what thing what what thing are they working on to improve themselves, not for themselves, but for the community that they serve. Because invariably the next person that you'll have on will be some type of servant to community. but there's

Roger A Mitchell Jr MD (35:37)
what gap are they trying to fill in themselves so that they can better serve

Alex Evans MD & Candice Caesar PMHNP (35:42)
Wow, that's good. I like that. You gotta remember that question. We will. All right.

Roger A Mitchell Jr MD (35:47)
That's good.

Alex Evans MD & Candice Caesar PMHNP (35:48)
So this wraps up another episode of the Apex Health Podcast. We'd like to thank our guests for sharing their time, their expertise and insights with us today.

Alex Evans MD & Candice Caesar PMHNP (35:59)
And thank you for joining us in this conversation. If you found today's episode valuable, please like, subscribe, and share it with someone who could benefit. If it helps us continue bringing meaningful conversations with leaders shaping the future of healthcare, to learn more about today's guests, access any resources mentioned in this episode or connect with the Apex Health team, visit links in the episode description. And until next time, stay informed, stay empowered.

Alex Evans MD & Candice Caesar PMHNP (36:29)
And take care. Bye. Thank you, Doc. Yeah. Yeah.