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Speaker 1: It's Night Side with Dan Ray on WBS Boston's news radio.

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Speaker 2: Have you tried to find a new primary care physician?

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Speaker 2: Have you tried to switch primary primary care physicians? Maybe

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Speaker 2: your primary care physician retired and you have to find

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Speaker 2: a new one. Unbelievable how hard it is? Am I right?

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Speaker 2: Have you sense that your primary care physician is burning out?

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Speaker 2: Seeing too many people a little bit stern, kind of

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Speaker 2: not in a good mood, and you feel like.

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Speaker 3: Is it me?

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Speaker 2: Or are they overworked? Because there is a primary care

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Speaker 2: physician crisis? And I will tell you my story. Then

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Speaker 2: we'll talk to our guests, doctor George Claremont and find

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Speaker 2: out what's going on. My story is this, I, uh,

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Speaker 2: my insurance kind of went away. I had to get

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Speaker 2: different insurance and a different doctor, and I searching for

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Speaker 2: a different doctor and called another doctor that I know

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Speaker 2: and said, what is your advice? And that doctor said,

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Speaker 2: you know what, I'm in the same boat. I'm a

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Speaker 2: doctor and I can't find a doctor. I'm considering concierge medicine,

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Speaker 2: which is expensive, but I can afford it. Then they

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Speaker 2: called another person who's a PCP, and that person said,

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Speaker 2: if you have a primary care physician, keep them even

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Speaker 2: if you don't like them, because it's that serious. It's

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Speaker 2: that much of a crisis. And I did find a

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Speaker 2: practice that was taking new patients. Called them and the phone.

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Speaker 2: They never answered the phone. It rang and rang and

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Speaker 2: rang and rang and rang, and I called again, same thing,

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Speaker 2: So that was also kind of sad. What kind of

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Speaker 2: practice is that? To find it? What's going on? We

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Speaker 2: have doctor George Claremont who's very familiar with the situation.

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Speaker 2: He's been in a bus a long time and he's

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Speaker 2: been following what's going on with the PCP crisis, which

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Speaker 2: has been referred to as a dire situation. So thanks

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Speaker 2: for being with us.

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Speaker 4: Thank you so much for the inmitation. Bradley, appreciate that.

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Speaker 4: And your story just resonates with me. I've heard it

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Speaker 4: so many times for my colleagues, from patients of people

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Speaker 4: I come in contact with socially, even if I'm at

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Speaker 4: the gem or playing pickleball, or for my family members.

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Speaker 4: It is a very common problem. And yes, you're right,

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Speaker 4: doctors have trouble finding doctors in primary care and getting

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Speaker 4: care they need, and I can only imagine how difficult

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Speaker 4: this must be for those who have no advocacy, so

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Speaker 4: are in a crisis.

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Speaker 2: So, folks, I'd like you to share your situation. I'm

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Speaker 2: guessing that some of you have had that. Many of

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Speaker 2: you have had similar situations where you need to find

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Speaker 2: a new primary care physician and you cannot and maybe

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Speaker 2: now you're seeing a physician's assistant, which is which is okay,

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Speaker 2: and you're lucky to have that. I have I'm going

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Speaker 2: to have three questions for my guess, doctor Claremont. One

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Speaker 2: how bad is the crisis? Two? How did it get

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Speaker 2: that way? And three how do we fix it? And

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Speaker 2: we can spread those three questions out. We can do

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Speaker 2: you know, twelve minutes each on each of those three,

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Speaker 2: and that I should do it. But I'd love to

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Speaker 2: hear your stories. Maybe you got lucky found a primary

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Speaker 2: care physician. Do you have one that you like? I

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Speaker 2: want to hear that story too. If you're having the

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Speaker 2: same kind of problem that I was having, I want

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Speaker 2: you to share that. I'd like to know how prevalent

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Speaker 2: this is among you. So, doctor Claremont, you're you have

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Speaker 2: a long resume along CV. Tell us what you've been doing,

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Speaker 2: you know, and how you are involved with this.

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Speaker 4: So first, I am a retired primary care physician general interest.

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Speaker 4: I went to school and grew up in Brockton, Massachusett'm

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Speaker 4: a Brockton kid, City of Champions, and I went into

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Speaker 4: medical school at Tufts Medical School. Locally, I did my

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Speaker 4: residency in primary care, internal medicine and Indigenous Hospital which

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Speaker 4: is now part of the Beth Israel. I did public

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Speaker 4: health service for a few years, and I practiced in

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Speaker 4: the South Shore for several decades. I've been very actively

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Speaker 4: involved with the medical Society, and although I'm not here

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Speaker 4: on behalf of the Medical Society, i am involved with

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Speaker 4: the Massachuset Medical Scizes of Trustee and many of his committees.

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Speaker 4: And I've also worked with a couple of our state

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Speaker 4: legislatures legislators on some of the bills, particularly regarding a

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Speaker 4: bill that is facing some public health issues. And finally,

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Speaker 4: I'm a member of the Board of Health at the

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Speaker 4: town of norwal So. I have heard europe problem from many,

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Speaker 4: many directions, and clearly even personally. I will say the

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Speaker 4: most recent example I've heard has been from a dear

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Speaker 4: friend of my wife's who worked for the Federal Garment

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Speaker 4: in Washington, d C. Lived in Virginia, relocated in New

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Speaker 4: Hampshire finally found a primary care doctor in New Hampshire

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Speaker 4: and the appointment is in twenty twenty seven, twenty twenty seven,

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Speaker 4: twenty twenty seven.

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Speaker 2: Why would they even make an appointment, Why would they

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Speaker 2: even accept that as an appointment.

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Speaker 4: I'm so used to during my career of seeing people

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Speaker 4: the same day. We get to know people and build relationships,

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Speaker 4: and unfortunately today we don't have. We have many difficulties.

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Speaker 4: So you asked one of your questions, how did we

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Speaker 4: get there?

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Speaker 2: Well, that's going to be later. Let's start with how

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Speaker 2: bad is the crisis.

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Speaker 3: Let's start with that. It's very bad.

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Speaker 4: The Massachusetts we now have our Health Policy Commission of

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Speaker 4: Publication in January sixteen, twenty twenty five, and they called

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Speaker 4: it a dire diagnosis. As you said, the declining health

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Speaker 4: of primary care in mass chooses. We have a shrinking

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Speaker 4: physician workforce, we have low reimburrasement in primary care relative

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Speaker 4: to specialty care, and we have a very high burnout rate.

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Speaker 4: More than half of our primary care doctors are burned out.

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Speaker 4: And this is due to multiple factors, one of them

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Speaker 4: being the consolidation and the barriers that are being put

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Speaker 4: in place with clerical task work.

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Speaker 2: All right, well, can you explain? Well, I guess I

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Speaker 2: will save the bills that you work you're involved with

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Speaker 2: later till later. You mentioned to me that AI and

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Speaker 2: that computers are making work more difficult for doctors. Intuitively,

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Speaker 2: you would think it would be a labor saving device,

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Speaker 2: but you say that having computerized, digitized medical records and

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Speaker 2: everything is making it more difficult.

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Speaker 4: It is we have so many steps of clicking and

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Speaker 4: adding and typing that it takes away the eye contact

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Speaker 4: that we have with patients. We're no longer engaged in

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Speaker 4: that dialogue. We're too busy documenting. And then we have

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Speaker 4: other clerical burdens, for example, prior authorization.

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Speaker 2: For me, ask you how did it get documented before?

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Speaker 3: By hand?

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Speaker 2: So you still had to write it down and it

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Speaker 2: was even slower. Then why is it worse now because

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Speaker 2: you just have to what you're writing and creating the

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Speaker 2: document is a lot more key strokes, if.

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Speaker 4: You will, And it's a distraction. Okay, we're documenting words

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Speaker 4: that don't always have full meaning to the story. When

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Speaker 4: I was trained, I was trained to listen to a

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Speaker 4: patient story. The first two to three minutes of the

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Speaker 4: patient story is critical. And the second thing I learned

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Speaker 4: for great mentors I had in my training was to

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Speaker 4: see a patient, to see them move. So it's not

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Speaker 4: just hearing the story, it's looking. Now we are distracted,

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Speaker 4: we're not always engaged. And the observation science medicine is

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Speaker 4: part art and part science. The science is gathering of data,

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Speaker 4: and the gathering of data requires us to listen clearly

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Speaker 4: and to observe things and then be inquisitive so we

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Speaker 4: can gather our findings and come to a reasonable diagnosis.

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Speaker 4: I heard on your show earlier today regarding automobiles about

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Speaker 4: AI giving incorrect information. I see that too, and we

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Speaker 4: think because today we have computers, AI is giving us

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Speaker 4: the correcting answers.

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Speaker 3: It isn't.

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Speaker 4: Many illnesses and problems are still yet to be discovered,

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Speaker 4: so not every round or shaped peg fits in the

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Speaker 4: same hole. We need to be thinking. And that's what

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Speaker 4: we don't reimburse well enough. We in our system of

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Speaker 4: care would rather pay for procedures rather than for thinking.

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Speaker 4: And now we put barriers in the way between our

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Speaker 4: end engagement. And that's why I love being here with you, Brad,

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Speaker 4: because I can see.

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Speaker 2: You and the doctors in the studio clearly, and I

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Speaker 2: like that much better. You know, one thing that reduces

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Speaker 2: my engagement when my doctor is my doctor wears a mask,

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Speaker 2: and I get why they maar a mask. But on

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Speaker 2: the other hand, I can't engage because I can't see them.

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Speaker 2: I can't see their facial expressions.

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Speaker 4: Right, right, Facial expressions are so important how we talk

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Speaker 4: to people and how they understand us. We text now,

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Speaker 4: and how often do we misunderstand text because we miss

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Speaker 4: the color of conversation.

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Speaker 2: I can't see their face. I don't know whether they're

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Speaker 2: smiling and frowning, and I feel like they're being tersed

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Speaker 2: like I did something wrong. I feel I haven't felt

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Speaker 2: good about my you know, doctor experience for a long

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Speaker 2: time because I just see their eyes and I can't

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Speaker 2: tell what's going on. Am I good? You can tell,

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Speaker 2: you know, by a person's expression kind of how things are,

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Speaker 2: how serious things are, And it's missing. It's like a

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Speaker 2: robot or a robot would be better because they would

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Speaker 2: have better facial expressions because there wouldn't be wearing a mask.

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Speaker 2: I digress. We have to break. We'll continue in a

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Speaker 2: moment with doctor George Claremont on WBZ.

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Speaker 1: It's Night's Eide with Dan Ray on WBZ Boston's news radio.

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Speaker 2: Radley for Dan Tonight, Massachusetts people celebrate us as a

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Speaker 2: healthcare powerhouse. I live right in the middle of all

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Speaker 2: those hospitals. I can walk to my surgery. Actually it's

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Speaker 2: home to world class hospitals, top tier medical research. But

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Speaker 2: I can't even get a primary care position. Are you

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Speaker 2: experiencing the same thing? Tell me your story six point seven, two, five, four,

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Speaker 2: ten thirty. We have doctor George Claremont with us to

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Speaker 2: bring some expertise to this problem. Before I go to gym.

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Speaker 2: Things are so bad that you, doctor Claremont, even had

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Speaker 2: a really hard time getting a doctor. And you're a doctor.

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Speaker 2: Friends many a doctor tell us tell us that story.

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Speaker 4: Yes, I did, and my health insurance changed and I

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Speaker 4: had to find a new doctor, and I was blessed

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Speaker 4: to know a physician and had to call the office

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Speaker 4: and he was practice was full, and I asked. I

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Speaker 4: had to literally fortunately beg him to take me, even

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Speaker 4: though I used to work with me, and he did.

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Speaker 2: He begged him, He begs it please, you say, did

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Speaker 2: you say please like that? Really? So doctors are begging

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Speaker 2: for doctors. That's pretty sad. Let's talk to Jim here

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Speaker 2: and see what his story is, and then we'll find

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Speaker 2: out maybe a little bit about some of the factors

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Speaker 2: that have caused this to happen. Will drill down a

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Speaker 2: bit Jim and fall River, Hey, Hi.

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Speaker 5: How you doing.

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Speaker 2: Guys?

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Speaker 5: Listen and about thirty miles away. I used to work

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Speaker 5: in tutor and at the hospital. It was the community hospital.

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Speaker 5: It was affiliated with Brown University, and we trained primary

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Speaker 5: care doctors. I got a lot of my medical services

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Speaker 5: in Patucket and by my primary care doctor in Patucket.

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Speaker 5: But guess what, I haven't seen. He has an NP,

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Speaker 5: which I've seen for three years. I have not seen

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Speaker 5: my primary care doctor. My MP takes care of all

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Speaker 5: my referrals, my prescriptions, et cetera. I have other specialists

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Speaker 5: that I use, but I was when I moved to

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Speaker 5: for a River, I thought I will get a primary

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Speaker 5: care doctor, but I never never tried, and I just

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Speaker 5: keep commuting to this. But that's a situation with me

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Speaker 5: because I have a great NP. But I know the

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Speaker 5: problem friends and stuff that can't get primary care doctors.

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Speaker 2: From what I'm understanding, make sure you hang on to

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Speaker 2: that doctor even if you're seeing ANP.

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Speaker 5: Yeah, she's very good. I mean I have some specialists

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Speaker 5: I need to say, And she did all the referrals

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Speaker 5: and and then I go to her just to you know,

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Speaker 5: check ups, etc. Like that, and she keeps me he

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Speaker 5: is pretty healthy.

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Speaker 2: I appreciate that call. Thanks. Here's a question related to that.

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Speaker 2: If he is happy with his nurse practitioner is there,

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Speaker 2: does that mean that this could be the new model

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Speaker 2: where you have the king doctor or the Queen doctor.

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Speaker 3: So with.

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Speaker 2: A number of interests drones or not drones, but you

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Speaker 2: know what I mean, underlings are nurse practitioners actually giving

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Speaker 2: the care.

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Speaker 4: Jim brings up a good point that we use a

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Speaker 4: lot of other individuals, nurse practitioners, physician assistants, and a

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Speaker 4: team care based model nowadays because we don't have enough

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Speaker 4: physicians to do the one on one care, and there's

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Speaker 4: a great role for nurse practitioners physician assistants. And I

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Speaker 4: would even say to expand that team as we evolved

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Speaker 4: these care models by adding maybe a pharmacist or behavioral

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Speaker 4: therapists into the program. Having said that, I personally have

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Speaker 4: worked with nurse practitioners since my public health service days

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Speaker 4: as well as physician sitistens in the nineteen eighties and

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Speaker 4: they've been great, I would say appendages of myself. But

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Speaker 4: we would meet regularly to talk about the care of

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Speaker 4: the people we took care of that day. So we

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Speaker 4: had a team meeting, so there were any questions, we

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Speaker 4: could share that with each other. Having said that, there

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Speaker 4: is a difference between an NP and a physician, or

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Speaker 4: a PA and a physician, and we have to recognize

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Speaker 4: that physicians have much greater training than the nurse pactors

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Speaker 4: and peace and not everyone fits in the same paradigm

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Speaker 4: a story. We know that there are many conditions that

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Speaker 4: are yet to be diagnosed, and in fact, AI has

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Speaker 4: yet to fill a need here in the fact that

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Speaker 4: they've tested AI, and AI has sometimes made incorrect diagnoses.

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Speaker 4: So I think we look at the evolution that you

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Speaker 4: bring up of having access to a team of basic

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Speaker 4: primary care and being able to have your conditions with

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Speaker 4: the right individual.

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Speaker 3: Of that team.

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Speaker 4: Simple things don't necessarily need the expertise of an internest.

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Speaker 4: But if you're a complex patient with diabetes, cornia disease, hypertension,

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Speaker 4: and maybe additional other conditions, you need to have time.

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Speaker 4: You need to be thinking about all these diagnoses and

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Speaker 4: how they may interplay, and that requires a level of

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Speaker 4: expertise that often only occurs with much more advanced training.

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Speaker 2: Also, if it's an NP, they might not have the

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Speaker 2: experience of the expertise to notice a problem that's outside

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Speaker 2: the box of their regular checking the labs, outside of

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Speaker 2: the routine, whereas an experienced physician might notice it a

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Speaker 2: little someone's color being off right or something like that.

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Speaker 3: So I have a great story there, okay, Brad.

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Speaker 4: It goes back to well a few years ago, and

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Speaker 4: I was working in an urgent care clinic on a

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Speaker 4: Friday evening and a mother brings in their old, young

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Speaker 4: adult child and says, he is depressed and needs some help.

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Speaker 4: And I remember from my great mentors, you need to

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Speaker 4: watch people. And I listened to the story, and then

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Speaker 4: I asked one simple thing, can I see you walk?

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Speaker 4: And there was asymmetry in his gait. There was asymmetry, asymmetry.

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Speaker 4: He wasn't moving symmetrical, he wasn't depressed. He had a

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Speaker 4: brain lesion and an unfortunate type of brain lesion. But

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Speaker 4: that would not be something I could gather without a

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Speaker 4: without my knowledge and wisdom from teachers that have taught

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Speaker 4: me over time from listening and watching people and having

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Speaker 4: a face to face examination that could only have happened

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Speaker 4: when I saw them in person.

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Speaker 2: Okay, ten twenty, a couple more minutes, I think I'll

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Speaker 2: start with getting into the next phase of this, and

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Speaker 2: that is the why we touched upon it. But really

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Speaker 2: it's not very complicated. The reason is PCPs don't make

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Speaker 2: enough money. If they made more money, more people would

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Speaker 2: want to do it, and there would be more of them,

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Speaker 2: and it wouldn't be such a dearth of them, and

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Speaker 2: they wouldn't be so overworked. They'd be people clamoring to

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Speaker 2: be PCPs. And so in this society we live in,

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Speaker 2: that means that our society does not value the PCP

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Speaker 2: enough to pay them enough. But here we are complaining,

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Speaker 2: obviously we do value that them. How do you make

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Speaker 2: it so they get paid enough?

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Speaker 3: Well?

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Speaker 2: And I suppose that means we'd all have to pay

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Speaker 2: more for insurance. The whole by the way, the whole

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Speaker 2: insurance thing is so so broken, Yes it is. You

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Speaker 2: know you get your bill? How about this everyone, if

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Speaker 2: you've already always you've all seen this, and you always

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Speaker 2: see it when you get your bill, the charge one

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Speaker 2: million dollars the amount allowed twenty nine ninety nine.

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Speaker 3: You know, so true?

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Speaker 2: What kind of charade is that? And then you pay

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Speaker 2: in five ninety nine you get this just for regular

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Speaker 2: little checkup eight and twenty nine dollars the amount allowed

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Speaker 2: three fifty and then you pay I don't know, fifty bucks.

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Speaker 2: What that should just be swept away and start from scratch.

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Speaker 4: It should be you're looking at There are several plus

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Speaker 4: your statement here, one being what was some of the

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Speaker 4: root causes that led to this problem? And I will

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Speaker 4: say this problem has been growing since the nineteen nineties,

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Speaker 4: and in fact, you mentioned the issue of all the

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Speaker 4: work force sish about money. It's not just that the

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Speaker 4: federal government decided in the nineteen nineties not to fund

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Speaker 4: enough slots and residency training programs to the hospitals and

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Speaker 4: schools to train primary care doctors. And then what you

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Speaker 4: see is the burden of the tasking work that goes

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Speaker 4: in there, and particularly with the insurance companies requiring more hoops.

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Speaker 4: Look at how difficult it can be to get an

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Speaker 4: MRI done for a patient.

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Speaker 3: Every mind's scheduled.

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Speaker 4: You have to request an MRI, you have to get

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Speaker 4: approval for the MRI. You have to say why you

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Speaker 4: need the MRI. Then you might get you might get

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Speaker 4: a reviewed for why you did these things before you

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Speaker 4: can even schedule it. And how many as much time

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Speaker 4: has gone by, you have to hire a whole nother

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Speaker 4: staff person just to keep track of this. It is

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Speaker 4: a tremendous burden for us.

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Speaker 2: This is a rhetorical question, doesn't require an answer until

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Speaker 2: after the break. It's rhetorical until after the break. Why

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Speaker 2: not do this instead of having a arance and paying

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Speaker 2: from the time you're twenty or eighteen or whatever quite

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Speaker 2: a lot all your life. Why not not do that

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Speaker 2: and save that money for health care? Or this? Don't

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Speaker 2: even save that money, and if you get something serious,

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Speaker 2: go on a payment plan and pay one hundred and

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Speaker 2: twenty nine a month if you need it rather than

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Speaker 2: paying one hundred and twenty nine a month or x

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Speaker 2: amount a month for the insurance. You can pay ahead

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Speaker 2: by paying insurance, or you could just pay only if

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Speaker 2: you need it by paying a payment plan forever as

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Speaker 2: long as you live. Does anybody just do that? Let's

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Speaker 2: wait till after the break and get the answer to that.

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Speaker 2: Big Ta's there, WBZ.

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Speaker 1: It's night side with Dan Ray on WBZ Boston's news radio.

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Speaker 2: Thank you for the news out, Bradley J. For Dan.

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Speaker 2: We're with doctor George Claremont talking about the PCP crisis,

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Speaker 2: the healthcare crisis. It's really difficult even for doctors to

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Speaker 2: find healthcare primary care physicians. And if you've had a

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Speaker 2: difficult time, we'd love to hear your story. At six one, seven, two, five, four,

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Speaker 2: ten thirty before the break, I asked the doctor something

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Speaker 2: wild here because insurance, as you may remember, I was saying,

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Speaker 2: how out of whack insurances? What about somebody? Just I asked,

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Speaker 2: what about somebody who doesn't do that and just says,

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Speaker 2: if I get sick, I will just pay a you know,

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Speaker 2: a monthly payment towards my what I owe to the hospital,

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Speaker 2: rather than pay the insurance up front. The other thing

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Speaker 2: is sometimes if you pay cash, you can make a

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Speaker 2: deal with the hospital.

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Speaker 3: Right sometimes, but not of it.

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Speaker 2: Okay, tell me why. My idea is obviously nobody does it,

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Speaker 2: so it's obviously not a good idea.

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Speaker 4: But so you mentioned something earlier about concierge medicine and

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Speaker 4: you pay a membership fee and have your doctor, and

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Speaker 4: that's not cheap. The issue is not just about reimbursement.

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Speaker 4: Is a trying to do some reforms. There are several

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Speaker 4: bills in our current Master's legislature to try and do that,

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Speaker 4: not quite the way you're describing it, but to give

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Speaker 4: what we call a prospective payment for the care of

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Speaker 4: patients to the doctors to manage their care. Having said that,

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Speaker 4: I see. Having said that, that's one part of the problem.

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Speaker 4: A significant part of the problem is the burden of

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Speaker 4: the clerical and paperwork. If I see a patient eight

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Speaker 4: hours a day, I have probably another eight plus hours,

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Speaker 4: and some estimates have put for an eight hour day

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Speaker 4: of patient contact, you need twenty seven hours a day's

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Speaker 4: because of the clerical paperwork, paperwork, the administrative hurdles, the

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Speaker 4: insurance hurdles, and documentation that required.

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Speaker 2: So why not have somebody that's not a doctor in

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Speaker 2: there with the doctor to do all that. While the

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Speaker 2: doctor's just talking and listening, this person is typing in

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Speaker 2: the records. And that's pretty cheap. You could, you know,

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Speaker 2: twenty bucks an hour probably take care of that.

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Speaker 4: Right, you're talking about a scribe ascribe exactly. I didn't

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Speaker 4: mean to point I recently sawry during my dermatologists and

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Speaker 4: everything was by the scribe and he had a little

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Speaker 4: microphone and Describe wasn't even in the room.

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Speaker 2: So the scribe is out of the room. Describe was

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Speaker 2: out of the room hearing everything.

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Speaker 3: Hearing everything.

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Speaker 2: Well, that's genius and kying it.

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Speaker 3: But that requires an investment.

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Speaker 4: So if you increase the reimbursement to primary care, then

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Speaker 4: that has to be used not only to support the

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Speaker 4: salary of the physician, but to improve the system around

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Speaker 4: the physic care system.

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Speaker 2: So with a scribe, though that the practice could see

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Speaker 2: more patients and the would think can they would make

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Speaker 2: more money with a scribe and get better healthcare at

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Speaker 2: the same time.

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Speaker 3: Yes and no.

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Speaker 4: So yes, if we're on the old model of what

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Speaker 4: we call fee for service, you get paid for the

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Speaker 4: piece of work you're doing. Yeah, But everything's evolved since

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Speaker 4: the nineteen nineties into what we call a commonal care

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Speaker 4: organizations or capitation models are pre payment models, and these

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Speaker 4: models of pair are paying for a new your care,

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Speaker 4: not necessarily how frequently you use it or even if

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Speaker 4: you do use it, but for that you it's available

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Speaker 4: for the care of your conditions. And those models are

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Speaker 4: still evolving, and those part of the several of the

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Speaker 4: bills before our state legislature.

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Speaker 2: Can you talk more about the bills specifically.

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Speaker 4: Well, I'm actually going to be attending a meeting later

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Speaker 4: in March to learn more about these bills. But there

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Speaker 4: is a Master's House Built thirteen seventy, House Built twenty

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Speaker 4: five thirty seven, and Cene Bill eight sixty seven, which

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Speaker 4: you're looking at these types of payment models, amongst other things.

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Speaker 4: Another thing they're trying to do is looking at it

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Speaker 4: and this is Centate Bill fourteen oh three, which is

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Speaker 4: looking at decreasing administrative administrative birden that doctors have to do,

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Speaker 4: particularly what we call prior authorization.

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Speaker 2: Ooh approvals, good gun. Yeah.

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Speaker 3: Prior authorization, yes, big, big issue.

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Speaker 2: It sure is. With some types of insurance you don't

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Speaker 2: need that, right, like a PPO, you don't need the

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Speaker 2: prior authorization generally correct, generally correct. With that HMO, you do.

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Speaker 2: And that's why I just stare away from an HMO,

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Speaker 2: because what if you have the procedure before you get

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Speaker 2: the authorization and they don't authorize it, you're on the hook.

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Speaker 2: That doctor told me to go get physical therapy on

438
00:25:21,200 --> 00:25:25,119
Speaker 2: my ankle. I made the appointment doctor told me to,

439
00:25:25,960 --> 00:25:28,920
Speaker 2: but they said, well, you know, we still need the

440
00:25:28,920 --> 00:25:31,840
Speaker 2: prior authorization, and I said, okay, I'm canceling my appointment

441
00:25:31,880 --> 00:25:33,520
Speaker 2: until it comes in, and they go, oh, no, no, no,

442
00:25:33,560 --> 00:25:36,200
Speaker 2: it'll probably be good, and I thought, no, I don't

443
00:25:36,200 --> 00:25:38,399
Speaker 2: operate on probably be good. I don't want to be

444
00:25:38,440 --> 00:25:39,880
Speaker 2: on the hook for this if it doesn't come through

445
00:25:41,560 --> 00:25:43,560
Speaker 2: getting me. The prior authorization would be great.

446
00:25:43,800 --> 00:25:45,640
Speaker 4: There would be and there is a bill to try

447
00:25:45,680 --> 00:25:49,399
Speaker 4: and improve prior authorization bills that are currently in a

448
00:25:49,480 --> 00:25:51,840
Speaker 4: state leticiation. But you also bring up the other part.

449
00:25:52,000 --> 00:25:54,639
Speaker 4: You should not be surprised about your bill. You should

450
00:25:54,640 --> 00:25:58,760
Speaker 4: not be surprised these costs exists, and come to this,

451
00:25:59,040 --> 00:26:01,840
Speaker 4: Oh my god, I look for thousands of dollars and

452
00:26:01,920 --> 00:26:05,240
Speaker 4: now who do I negotiate with. I'm not the insurance company.

453
00:26:05,240 --> 00:26:07,840
Speaker 4: You as an individual don't have that leverage. And there

454
00:26:07,880 --> 00:26:10,440
Speaker 4: is a federal law called the No Surprise Act. Who

455
00:26:10,480 --> 00:26:13,040
Speaker 4: but there is a and the Massachusetts has passed a

456
00:26:13,040 --> 00:26:15,600
Speaker 4: No Surprise Act but is still waiting for some regulatory

457
00:26:16,480 --> 00:26:17,880
Speaker 4: guidelines for that, so.

458
00:26:17,800 --> 00:26:19,560
Speaker 2: We do have what does that mean? No surprise?

459
00:26:19,640 --> 00:26:22,440
Speaker 4: Though you should never be surprised, you should be informed

460
00:26:22,440 --> 00:26:23,000
Speaker 4: in advance.

461
00:26:23,160 --> 00:26:24,120
Speaker 2: I'm always surprised.

462
00:26:24,359 --> 00:26:26,520
Speaker 4: I am too, and I look at the EOB and

463
00:26:26,600 --> 00:26:28,080
Speaker 4: I am totally shocked at what I see.

464
00:26:28,160 --> 00:26:30,760
Speaker 2: So that would mean that when I go to the doctor,

465
00:26:30,760 --> 00:26:34,560
Speaker 2: they're going to say, Okay, your routine checkup is going

466
00:26:34,600 --> 00:26:36,720
Speaker 2: to be one hundred and fifty bucks. But they don't

467
00:26:37,119 --> 00:26:38,320
Speaker 2: right right.

468
00:26:38,640 --> 00:26:41,800
Speaker 4: Right, And you can imagine if you really spending an

469
00:26:41,800 --> 00:26:44,639
Speaker 4: hour with a patient and you only get paid one

470
00:26:44,680 --> 00:26:49,520
Speaker 4: hundred dollars, and then you have four people working in your.

471
00:26:49,440 --> 00:26:51,480
Speaker 2: Office who's spending an hour with a patient.

472
00:26:52,000 --> 00:26:52,960
Speaker 3: That's what it used to be.

473
00:26:53,119 --> 00:26:55,879
Speaker 2: Like, Wow, I get ten to twelve minutes, and I

474
00:26:55,880 --> 00:26:58,639
Speaker 2: feel guilty if they start to get irritated if I

475
00:26:58,680 --> 00:26:59,399
Speaker 2: ask them questions.

476
00:26:59,400 --> 00:27:00,879
Speaker 4: And now we're prize that we have a ten to

477
00:27:00,920 --> 00:27:03,680
Speaker 4: twelve minute visit, and we shouldn't be because it hasn't

478
00:27:03,880 --> 00:27:06,720
Speaker 4: the mismash that has grown so we need So you

479
00:27:06,760 --> 00:27:11,080
Speaker 4: come back to several things, one being re engineering healthcare

480
00:27:11,440 --> 00:27:13,840
Speaker 4: and we're looking at primary care as the foundation for

481
00:27:13,920 --> 00:27:16,879
Speaker 4: our entire system of healthcare. And the quarterback bring your

482
00:27:16,880 --> 00:27:17,919
Speaker 4: primary care doctor.

483
00:27:18,920 --> 00:27:20,480
Speaker 3: If you had the new England.

484
00:27:20,240 --> 00:27:25,119
Speaker 4: Pagers paid the exact back the lowest salary of the team,

485
00:27:25,280 --> 00:27:29,000
Speaker 4: any team member, what kind of team would you have?

486
00:27:29,920 --> 00:27:31,920
Speaker 2: The quarterback PCP is your quarterback.

487
00:27:32,000 --> 00:27:32,920
Speaker 3: ECP is your QUARTERBA.

488
00:27:32,960 --> 00:27:34,440
Speaker 2: You don't want to cheap out on the quarterback.

489
00:27:34,640 --> 00:27:37,200
Speaker 4: You should not be cheaping out on the quarterback, and

490
00:27:37,560 --> 00:27:39,680
Speaker 4: you should be surrounding that quarterback with good player.

491
00:27:39,760 --> 00:27:42,679
Speaker 2: Okay, I'm getting some finite answers here. First, we have

492
00:27:42,800 --> 00:27:47,000
Speaker 2: established that really society doesn't value the PCP. They don't

493
00:27:47,080 --> 00:27:50,280
Speaker 2: get it, and therefore PCs don't make as much money.

494
00:27:50,920 --> 00:27:55,520
Speaker 2: And that's partly because there's not the federal funding to

495
00:27:55,520 --> 00:28:00,720
Speaker 2: train residents, et cetera. So we need to that seems

496
00:28:00,720 --> 00:28:02,480
Speaker 2: like a legit thing to get the federal government to

497
00:28:02,480 --> 00:28:04,440
Speaker 2: spend money on that and not some other dumb things

498
00:28:04,440 --> 00:28:08,560
Speaker 2: they spend it on. And we need to in general

499
00:28:08,560 --> 00:28:11,920
Speaker 2: as a society realized that the PCP is more valuable. Secondly,

500
00:28:12,280 --> 00:28:16,320
Speaker 2: you need to reduce administrative paperwork. Doctors shouldn't have to

501
00:28:16,359 --> 00:28:19,480
Speaker 2: do that stuff. A scribe should do it. But I

502
00:28:19,480 --> 00:28:21,680
Speaker 2: don't think you need to. I think that's an easy fix.

503
00:28:22,000 --> 00:28:25,199
Speaker 2: Any any practice should just have a scribe in the

504
00:28:25,240 --> 00:28:29,080
Speaker 2: other room listening on the headphones and to the microphones. Okay,

505
00:28:29,119 --> 00:28:34,080
Speaker 2: why not? There's two finite things. And then the No

506
00:28:34,200 --> 00:28:39,200
Speaker 2: Surprise Bill was that a bill coming up no surprises

507
00:28:39,240 --> 00:28:40,240
Speaker 2: or does that already exist?

508
00:28:40,760 --> 00:28:44,120
Speaker 4: We got all the payment mechanisms. But the other thing

509
00:28:44,160 --> 00:28:45,840
Speaker 4: we need to do is we need to leverage technology

510
00:28:45,880 --> 00:28:49,200
Speaker 4: better than we have. So we knew we do have telehealth,

511
00:28:49,400 --> 00:28:52,400
Speaker 4: and we could use that in the right circumstances. If

512
00:28:52,440 --> 00:28:55,760
Speaker 4: you had a procedure on your leg, your ankle, for example,

513
00:28:55,800 --> 00:28:58,360
Speaker 4: got injured and you got heard surgically, you don't need

514
00:28:58,360 --> 00:29:00,920
Speaker 4: to necessarily drive in for that visit. You could be

515
00:29:00,960 --> 00:29:05,600
Speaker 4: doing that mostly remotely. Yeah, however, and there's been great

516
00:29:05,680 --> 00:29:08,720
Speaker 4: experiments done with that type of health in other parts

517
00:29:08,760 --> 00:29:12,240
Speaker 4: of our country. And we need to use AI. And

518
00:29:12,560 --> 00:29:15,920
Speaker 4: but we can't replace here with AI.

519
00:29:16,000 --> 00:29:16,920
Speaker 2: How do you use AI?

520
00:29:17,360 --> 00:29:18,120
Speaker 3: We need that to.

521
00:29:18,040 --> 00:29:23,240
Speaker 4: Help us better document document Right as you said, I

522
00:29:23,280 --> 00:29:25,960
Speaker 4: heard it on your earlier show. You looked at a

523
00:29:26,080 --> 00:29:29,280
Speaker 4: good copilot of Google AI. And sometimes they give you

524
00:29:29,320 --> 00:29:33,240
Speaker 4: the writing answer something, but it's great at summarizing, yet.

525
00:29:33,080 --> 00:29:35,920
Speaker 2: You can't trust it in matters of fact. The question

526
00:29:36,040 --> 00:29:39,120
Speaker 2: is a fact quick question before the break. This is

527
00:29:39,160 --> 00:29:41,720
Speaker 2: off the topic. Are people always asking you to look

528
00:29:41,720 --> 00:29:44,560
Speaker 2: at their you know, hey, Doug, when you look at

529
00:29:44,560 --> 00:29:45,520
Speaker 2: my wrist, like when you go to.

530
00:29:45,480 --> 00:29:48,240
Speaker 3: A party, did they see it happens all the time.

531
00:29:48,280 --> 00:29:49,840
Speaker 3: It does, it does.

532
00:29:49,800 --> 00:29:52,000
Speaker 2: Okay, and is that all right with you? What do

533
00:29:52,040 --> 00:29:54,280
Speaker 2: you do? It's kind of not cool, and you just

534
00:29:54,800 --> 00:29:59,000
Speaker 2: you don't say anything, but it's like, really, Dave, don't you.

535
00:29:59,320 --> 00:30:03,160
Speaker 3: No, I don't say really Dave or or Bradley, I

536
00:30:03,160 --> 00:30:03,520
Speaker 3: don't do it.

537
00:30:03,520 --> 00:30:05,200
Speaker 2: If you're a mechanic, it wouldn't be a problem.

538
00:30:05,240 --> 00:30:05,400
Speaker 3: Right.

539
00:30:05,560 --> 00:30:07,880
Speaker 2: If you're a mechanics, someone say, I got this funny

540
00:30:07,920 --> 00:30:09,640
Speaker 2: sound in my well.

541
00:30:09,840 --> 00:30:11,480
Speaker 4: I'm a retired physicis so I will not make a

542
00:30:11,520 --> 00:30:15,440
Speaker 4: diagnosis on individuals, right, but I will say, you know, listen,

543
00:30:15,520 --> 00:30:18,760
Speaker 4: you may need a second opinion. Classic example I had

544
00:30:18,760 --> 00:30:21,640
Speaker 4: with my car. Yeah, I had a problem and the

545
00:30:21,720 --> 00:30:23,640
Speaker 4: light came on. I bring it to one place and

546
00:30:23,640 --> 00:30:25,840
Speaker 4: then they tell me I need four thousand dollars worth

547
00:30:25,880 --> 00:30:28,040
Speaker 4: of work. I bring it to another place and they

548
00:30:28,080 --> 00:30:30,400
Speaker 4: top off the floors, reset the light on front.

549
00:30:30,640 --> 00:30:32,560
Speaker 2: So imagine if you took that same exact thing and

550
00:30:33,160 --> 00:30:36,280
Speaker 2: the conversation was about medicine exactly. My light went on,

551
00:30:36,840 --> 00:30:39,840
Speaker 2: I went to the doctor. He topped off my fluids

552
00:30:40,000 --> 00:30:42,120
Speaker 2: and said it still had a problem, so I had

553
00:30:42,120 --> 00:30:44,200
Speaker 2: to go check out another doctor. We have one more

554
00:30:44,240 --> 00:30:48,479
Speaker 2: segment left. And if you have any anything close to

555
00:30:48,760 --> 00:30:53,360
Speaker 2: a question on this topic of the scarcity of primary

556
00:30:53,400 --> 00:30:56,960
Speaker 2: care physicians or our healthcare system in general, please give

557
00:30:57,040 --> 00:31:00,640
Speaker 2: us a shout at six one seven two. As you know,

558
00:31:00,680 --> 00:31:01,480
Speaker 2: it's WBZ.

559
00:31:03,120 --> 00:31:07,400
Speaker 1: You're on Night Side with Dan Ray on WBZ Boston's

560
00:31:07,440 --> 00:31:08,080
Speaker 1: news Radio.

561
00:31:08,920 --> 00:31:13,360
Speaker 2: We're talking healthcare with doctor George Claremont and primarily who

562
00:31:13,360 --> 00:31:18,280
Speaker 2: are examining the the PCP, the primary care position shortage.

563
00:31:18,440 --> 00:31:21,080
Speaker 2: We really have covered that pretty solidly. I'm going to

564
00:31:21,160 --> 00:31:25,080
Speaker 2: open it up a little bit. Let you ask questions

565
00:31:25,080 --> 00:31:32,520
Speaker 2: that are outside that strict guideline. For example, doctor, how

566
00:31:32,560 --> 00:31:37,160
Speaker 2: much of an issue is people who look stuff up

567
00:31:37,200 --> 00:31:41,840
Speaker 2: on Google and feel like they know the answer and

568
00:31:41,880 --> 00:31:45,720
Speaker 2: they come into you with the wrong knowledge. That must

569
00:31:45,760 --> 00:31:49,520
Speaker 2: take some time dis explaining them.

570
00:31:49,680 --> 00:31:52,400
Speaker 4: So we've we've come to rely upon the Internet as

571
00:31:52,760 --> 00:31:56,200
Speaker 4: as the truth and in the final arbiter of.

572
00:31:57,720 --> 00:31:59,880
Speaker 3: Many things, and.

573
00:31:59,760 --> 00:32:06,160
Speaker 4: It's not always right. Having said that, medicine evolves, and

574
00:32:06,440 --> 00:32:08,719
Speaker 4: when I was younger, I was taught that the knowledge

575
00:32:08,760 --> 00:32:11,840
Speaker 4: of medicine will change by fifty percent of fifty years.

576
00:32:11,840 --> 00:32:16,320
Speaker 4: That's been accelerating much faster than that. So we're looking

577
00:32:16,320 --> 00:32:19,400
Speaker 4: at a turnover, right and the data that is being

578
00:32:19,520 --> 00:32:24,080
Speaker 4: mined by Google or other sources becomes old and not

579
00:32:24,120 --> 00:32:30,040
Speaker 4: necessarily accurate. Secondly, we have a conditions that are yet

580
00:32:30,080 --> 00:32:33,840
Speaker 4: to be discovered. We don't know everything. If we meet

581
00:32:33,880 --> 00:32:36,360
Speaker 4: a doctor who's saying thinks they know everything, that is

582
00:32:36,400 --> 00:32:39,880
Speaker 4: a problem we don't. We need to be open minded

583
00:32:40,160 --> 00:32:42,400
Speaker 4: to things we are not fluent. I had that particular

584
00:32:42,440 --> 00:32:47,320
Speaker 4: example myself and during my own journey through health.

585
00:32:47,680 --> 00:32:48,840
Speaker 3: But clearly.

586
00:32:50,120 --> 00:32:52,960
Speaker 4: We can use it as a resource to ask questions,

587
00:32:54,320 --> 00:32:56,840
Speaker 4: but we shouldn't rely our diagnosis on that.

588
00:32:57,040 --> 00:32:59,880
Speaker 2: The patients can come up the system by making appointments

589
00:32:59,880 --> 00:33:03,200
Speaker 2: because they have some symptom and they look up that

590
00:33:03,240 --> 00:33:05,240
Speaker 2: symptom and they decide, oh, I have a brain to it,

591
00:33:08,120 --> 00:33:09,880
Speaker 2: and they come in and they didn't need to make

592
00:33:09,880 --> 00:33:13,000
Speaker 2: that visit.

593
00:33:13,120 --> 00:33:17,880
Speaker 4: Really so true, we all worry about the worst things.

594
00:33:18,160 --> 00:33:21,840
Speaker 4: That's normal, and part of the job is to be

595
00:33:21,880 --> 00:33:25,240
Speaker 4: able to distinguish between what is worrisome and what is

596
00:33:25,280 --> 00:33:29,000
Speaker 4: not so worrisome as a physician. And of course, if

597
00:33:29,000 --> 00:33:32,240
Speaker 4: something's worrisome, it takes a priority and we need to

598
00:33:32,280 --> 00:33:35,600
Speaker 4: get it done timely, and we need to remove the

599
00:33:35,720 --> 00:33:40,400
Speaker 4: barriers from that happening. But the regular stuff we need

600
00:33:40,440 --> 00:33:43,080
Speaker 4: to be able to explain that in common language. I

601
00:33:43,120 --> 00:33:46,040
Speaker 4: remember a physician who would write down simple things on

602
00:33:46,080 --> 00:33:48,800
Speaker 4: a piece of paper that wasn't on his prescription pad

603
00:33:48,800 --> 00:33:53,120
Speaker 4: when we wrote prescriptions, and he would write, go to bed, Yeah,

604
00:33:53,280 --> 00:33:56,720
Speaker 4: take some aspirin or tile them all, you know, drink

605
00:33:56,800 --> 00:33:59,680
Speaker 4: your fluids and you will get better. And he wrote

606
00:33:59,680 --> 00:34:03,440
Speaker 4: that on a prescription and that were made of it.

607
00:34:03,520 --> 00:34:07,280
Speaker 4: So clearly we need to be able to engage with

608
00:34:07,440 --> 00:34:12,560
Speaker 4: the patients and relay their fears while explaining why.

609
00:34:12,280 --> 00:34:13,040
Speaker 3: We need to do this.

610
00:34:13,160 --> 00:34:16,640
Speaker 2: My personal advice to everyone out there is say, if

611
00:34:16,719 --> 00:34:18,760
Speaker 2: you have a headacho, you have some symptom of something,

612
00:34:19,239 --> 00:34:23,399
Speaker 2: never ever, ever, ever go to Google and say here's

613
00:34:23,440 --> 00:34:25,400
Speaker 2: my symptom, what do I have? Because they're going to

614
00:34:25,480 --> 00:34:28,360
Speaker 2: give you a list of stuff that's, you know, horrific,

615
00:34:29,000 --> 00:34:30,560
Speaker 2: and you're going to go right to the worst one

616
00:34:30,560 --> 00:34:34,719
Speaker 2: and think you have that, Whereas if you speak to

617
00:34:34,760 --> 00:34:38,600
Speaker 2: a doctor, they're gonna know, they'll eliminate so many of them,

618
00:34:38,800 --> 00:34:42,279
Speaker 2: so many of them right away, and so there you go.

619
00:34:42,440 --> 00:34:45,200
Speaker 2: Never there. There are medical uses for the Internet to

620
00:34:45,200 --> 00:34:50,680
Speaker 2: get information like drug interactions, perhaps clearly, but don't go

621
00:34:50,840 --> 00:34:59,400
Speaker 2: looking for a diagnosis on Google. You you will suffer. Okay, next,

622
00:35:00,320 --> 00:35:04,759
Speaker 2: primary care physicians in my experience, don't dare tell you

623
00:35:04,800 --> 00:35:10,440
Speaker 2: to lose weight. Uh you have somebody clearly obeys yes,

624
00:35:10,960 --> 00:35:13,799
Speaker 2: and they don't say anything. They will, you know, give

625
00:35:13,840 --> 00:35:15,600
Speaker 2: you a blood pressure pill. They won't say you got

626
00:35:15,600 --> 00:35:19,560
Speaker 2: to lose weight? Why? And can that stop?

627
00:35:19,960 --> 00:35:20,160
Speaker 3: Yeah?

628
00:35:20,520 --> 00:35:22,680
Speaker 4: Well I hope it has stopped. And of course now

629
00:35:22,680 --> 00:35:24,640
Speaker 4: with the newer drugs we want to push a magic

630
00:35:24,680 --> 00:35:26,120
Speaker 4: pill in magic injection.

631
00:35:26,600 --> 00:35:28,239
Speaker 2: Is there a conflict of interest? Is that why it

632
00:35:28,280 --> 00:35:30,759
Speaker 2: is they want to sell pills? Do they? Or is

633
00:35:30,800 --> 00:35:35,800
Speaker 2: it that society can't take, you know, being told you're overweight?

634
00:35:36,239 --> 00:35:39,680
Speaker 4: So I think there's several points here. One is how

635
00:35:39,719 --> 00:35:44,880
Speaker 4: do we deal with the factors that you have that

636
00:35:44,920 --> 00:35:49,200
Speaker 4: are un drive medical conditions and a polite way? And

637
00:35:49,280 --> 00:35:52,200
Speaker 4: yet we have a point now in society where we

638
00:35:52,320 --> 00:35:56,279
Speaker 4: got to be politically polite or too polite, and we

639
00:35:56,320 --> 00:35:59,840
Speaker 4: don't want to be confrontational. We need to learn that

640
00:36:00,239 --> 00:36:03,760
Speaker 4: somethings have to be direct about the certain things. I

641
00:36:03,840 --> 00:36:07,920
Speaker 4: certainly would educate my patients about their body mass index

642
00:36:08,360 --> 00:36:11,120
Speaker 4: and how it contributed to their conditions, just like I

643
00:36:11,120 --> 00:36:15,759
Speaker 4: would have a conversation how smoking would great problems, and

644
00:36:16,120 --> 00:36:21,160
Speaker 4: eating incorrectly worsens diabetes. But we have to find what

645
00:36:21,320 --> 00:36:24,960
Speaker 4: is in your value set. What's important to each individual

646
00:36:25,120 --> 00:36:26,920
Speaker 4: is may not be what is important to me.

647
00:36:27,040 --> 00:36:29,719
Speaker 2: The common denominator is survival. If you say I had

648
00:36:29,719 --> 00:36:32,919
Speaker 2: a doctor say to me, lose weight, get to this weight,

649
00:36:33,040 --> 00:36:38,120
Speaker 2: you'll live longer. Yeah. Uh, but how how how lose it?

650
00:36:38,320 --> 00:36:40,400
Speaker 2: How is that the question? How to lose it? Well,

651
00:36:40,400 --> 00:36:42,000
Speaker 2: that would be nice if they would take the next step,

652
00:36:42,239 --> 00:36:46,240
Speaker 2: But at least they're telling oh, really, it's that's serious. Okay,

653
00:36:46,520 --> 00:36:48,879
Speaker 2: that wake up call for me worked.

654
00:36:49,600 --> 00:36:53,680
Speaker 4: So we don't translate that well into our behavior. How

655
00:36:53,760 --> 00:36:55,880
Speaker 4: much do we really need to eat in calories? And

656
00:36:56,080 --> 00:36:58,600
Speaker 4: how much our physical activity actually burned those gus?

657
00:36:58,640 --> 00:37:01,400
Speaker 2: So the doctor really should say, look, I want you

658
00:37:01,480 --> 00:37:04,320
Speaker 2: to sign up for this plan, I'm recommending, I'm prescribing

659
00:37:04,320 --> 00:37:06,120
Speaker 2: to you to sign up for this weight loss program

660
00:37:06,440 --> 00:37:07,080
Speaker 2: something like that.

661
00:37:07,680 --> 00:37:11,640
Speaker 4: No, what I'm saying is education. How many calories does

662
00:37:11,680 --> 00:37:13,200
Speaker 4: it take to burn a pound of fat?

663
00:37:13,840 --> 00:37:14,560
Speaker 2: Are you asking me?

664
00:37:15,120 --> 00:37:18,480
Speaker 4: I'm not asking this is an educational potcast you don't have.

665
00:37:18,520 --> 00:37:20,759
Speaker 4: I'm asking you to give me any answer. And how

666
00:37:20,920 --> 00:37:23,000
Speaker 4: money calories? Says do we burn when we actually walk

667
00:37:23,040 --> 00:37:27,040
Speaker 4: a mile or run a mile. Surprisingly few, very few discussing.

668
00:37:27,560 --> 00:37:31,400
Speaker 4: I've run a number of marathons, including Boston. None of

669
00:37:31,440 --> 00:37:35,520
Speaker 4: those Maritimes marathons, will I ever burn enough calories to

670
00:37:35,520 --> 00:37:38,080
Speaker 4: burn one pound of fat. I may lose weight because

671
00:37:38,120 --> 00:37:40,920
Speaker 4: I get dehydrated, but not because I lost weight.

672
00:37:41,120 --> 00:37:43,239
Speaker 2: And my doctor said it, man, when you get to

673
00:37:43,239 --> 00:37:44,680
Speaker 2: a certain aids, I don't know what it is. It's

674
00:37:44,680 --> 00:37:46,719
Speaker 2: all about what you eat. You need to do the

675
00:37:46,760 --> 00:37:49,319
Speaker 2: aerobic exercise for your heart, et cetera. But that's not

676
00:37:49,360 --> 00:37:52,239
Speaker 2: a weight weights, not a way what.

677
00:37:52,160 --> 00:37:54,800
Speaker 4: We put in for calories. It's a simple map of

678
00:37:54,920 --> 00:37:57,600
Speaker 4: what we put in and what we burn. And if

679
00:37:57,640 --> 00:37:59,200
Speaker 4: we want to lose weight, we got to burn more

680
00:37:59,239 --> 00:38:01,600
Speaker 4: calories or in less calories one of the two.

681
00:38:01,719 --> 00:38:04,600
Speaker 2: I got about sixty seconds to ask you about cannabis

682
00:38:04,640 --> 00:38:08,360
Speaker 2: and it's placed in primary health care or not.

683
00:38:09,880 --> 00:38:14,080
Speaker 4: So I never prescribed cannabis when I was practicing. I

684
00:38:14,120 --> 00:38:15,719
Speaker 4: know that it's used a lot, and I can be

685
00:38:15,800 --> 00:38:18,719
Speaker 4: overused by a number of people, and I've seen some

686
00:38:18,840 --> 00:38:22,719
Speaker 4: consequences of overuse of cannabis. I think we often look

687
00:38:22,760 --> 00:38:25,480
Speaker 4: for the magic pill, and what we need to do

688
00:38:25,600 --> 00:38:29,360
Speaker 4: is say how can I change behavior? And when I

689
00:38:29,480 --> 00:38:33,799
Speaker 4: change behavior? That is a very deep conversation. And you're

690
00:38:33,840 --> 00:38:35,560
Speaker 4: coming into those value sets.

691
00:38:35,440 --> 00:38:38,239
Speaker 2: Which brings us back to the time it takes to

692
00:38:38,280 --> 00:38:40,640
Speaker 2: really take care of a patience. You need, You need

693
00:38:40,680 --> 00:38:43,839
Speaker 2: to speak to them for a long time to make

694
00:38:43,840 --> 00:38:47,280
Speaker 2: them understand the lifestyle changes they need. Trust, time and trust.

695
00:38:47,840 --> 00:38:50,319
Speaker 2: That's a good place to end. I can't thank you

696
00:38:50,400 --> 00:38:52,279
Speaker 2: enough for coming into the studio. It's great to meet

697
00:38:52,280 --> 00:38:53,759
Speaker 2: you in person. Thank you so much.

698
00:38:54,120 --> 00:38:55,960
Speaker 4: You're very welcome and pleasure meeting you.

699
00:38:56,120 --> 00:38:59,320
Speaker 2: Doctor George Claremont. Coming up, we get a call from

700
00:39:00,719 --> 00:39:04,799
Speaker 2: who is a presidential historian who's got some funny I

701
00:39:04,800 --> 00:39:08,279
Speaker 2: guess weird slash funny stories and I might share my

702
00:39:08,320 --> 00:39:11,439
Speaker 2: George Washington knowledge with you and hopefully impress you as well.

703
00:39:11,719 --> 00:39:14,160
Speaker 2: Coming up on WBZ News Radio ten thirty