Speaker 1: All right, Lucy McBride. You are a Harvard trained physician,
Speaker 1: you've treated patients for more than two decades. You've got
Speaker 1: a new book out called Beyond the Prescription, which is
Speaker 1: about health and navigating our somewhat imperfect health system. Why
Speaker 1: do you think we need this book now?
Speaker 2: Michael? First of all, thanks for having me on the show.
Speaker 2: You know, I see this scene play out in my
Speaker 2: office all the time. People come in having been dismissed,
Speaker 2: talked over, hurried through a medical appointment, through no fault
Speaker 2: of the doctor. The system just doesn't have time. We
Speaker 2: treat patients like a stead of transactions, like a bag
Speaker 2: of organs, instead of real people with real lives, real
Speaker 2: limitations on what they can do based on what the
Speaker 2: doctor recommends. And then what do people do? What would
Speaker 2: you and I do? Is you go on the internet
Speaker 2: when you don't feel well, of course, and you are
Speaker 2: flooded with information, sometimes good information, but sometimes expensive, aspirational
Speaker 2: and pseudoscientific. So I wrote this book to empower patients
Speaker 2: to squeeze the juice out of that fifteen minute appointment
Speaker 2: with their doctor and first to ask themselves a set
Speaker 2: of more nuanced questions about what health is to begin with,
Speaker 2: and how to bring themselves a sort of a more
Speaker 2: honest rendering of their whole health ecosystem to the medical system.
Speaker 1: To put you on the spot with some numbers. Are
Speaker 1: there any numbers that come to mind that sort of
Speaker 1: indicate where the health system is now as far as
Speaker 1: it affects patients.
Speaker 2: Compared to our wealthy peer nations, we spend the most
Speaker 2: money on healthcare and have the worst outcomes. Six and
Speaker 2: ten Americans are living with a chronic disease. We can
Speaker 2: map the human genome, we can three D print a
Speaker 2: beating human heart, and medicine is extraordinarily good at treating
Speaker 2: diseases at damage control, but it's terrible at sitting with
Speaker 2: the person and who has the disease. So health isn't
Speaker 2: just about you know, diagnosis codes and prescriptions and pills
Speaker 2: and you know, dispensing of advice. It's about understanding that
Speaker 2: what the question is to begin with? Who is this
Speaker 2: person in front of.
Speaker 1: Me and what do they need to be healthy? And
Speaker 1: then your book also gets into what do we even
Speaker 1: mean by the word health? Right, I want to get
Speaker 1: into that. I had that later, but let's get into
Speaker 1: it now because I thought that was fascinating, Like people say,
Speaker 1: I want to be healthy, but what does that even mean?
Speaker 1: And figuring out what that means important.
Speaker 2: Yeah, it turns out you really need to know why
Speaker 2: you're alive, and like, what does healthy mean to you?
Speaker 2: It's very easy to default to what someone else's definition
Speaker 2: of health is, particularly in the era of you know,
Speaker 2: social media and online information. You know, for a lot
Speaker 2: of people, health is about a certain set of metrics,
Speaker 2: or a certain body size, or a certain set of labs.
Speaker 2: But health is a uniquely personal phenomenon. So I ask
Speaker 2: patients specifically, like what are you looking for in a year?
Speaker 2: Like what does health look like to you in a year,
Speaker 2: in five years, and ten years, like what do you
Speaker 2: want to be doing? How do you want to be feeling?
Speaker 2: And when you ask people that kind of question, first
Speaker 2: of all, they're often stumped because they're like, well, I
Speaker 2: guess I just want normal cholesterol and I guess I
Speaker 2: want you to give me an a plus on my checkup,
Speaker 2: And I'm like, well, health is not about me. It's
Speaker 2: about you, right, It's about you feeling a sense of
Speaker 2: agency over your health, so that when you're faced with
Speaker 2: a decision like should I get a flu shot, or
Speaker 2: should I take lipidoor or just work on diet and exercise.
Speaker 2: You feel like you have information and you're an informed
Speaker 2: consumer of these decisions. You may be somebody who wants
Speaker 2: to be own natural and you don't want to take
Speaker 2: medicine at all costs. You may be somebody who doesn't
Speaker 2: want to think about the why, the lifestyle factors that
Speaker 2: play into your health, and you just want the pills,
Speaker 2: the prescription see you next year. You don't want to
Speaker 2: deep dive on mechanism. You just want to be told
Speaker 2: what to do. And that's fine, but it's important to
Speaker 2: understand who you are and what your goals are and
Speaker 2: what health actually looks like to you before we operationalize
Speaker 2: a plan around it.
Speaker 1: So that seems to be one of the main potential
Speaker 1: issues with the medical system is like you come in
Speaker 1: and it's just like, oh, labs, labs. It kind of
Speaker 1: the question of what does health actually mean to you?
Speaker 1: Doesn't get asked. What else do you see that you
Speaker 1: think are some of the fundamental problems that we have.
Speaker 2: Well, if you look at the way the system is structured,
Speaker 2: is it rewards patients for volume, for the number of
Speaker 2: patients seeing like RVUS instead of outcomes. Yeah, so the
Speaker 2: commodity that insurance companies value is transactions, prescriptions, procedures. Right.
Speaker 2: We spend ninety five percent of healthcare dollars in the
Speaker 2: US on downstream damage control hospitalizations, er visits, prescription drugs.
Speaker 2: Only five percent is spent on conversation. The conversation between
Speaker 2: primary care doctor and patient. You know, conversation is you know,
Speaker 2: is not what's happening in doctor's offices. Right, Like again
Speaker 2: through no fault of doctors. But when I'm given even
Speaker 2: ten minutes or fifteen minutes with a patient, and I
Speaker 2: can put my pen down and instead of looking at
Speaker 2: my screen, but look at the human and their eyes
Speaker 2: and ask them what's really going on in your life?
Speaker 2: Like what are you embarrassed to say out loud? Or
Speaker 2: what's the worst what's your worst fear? Or you know,
Speaker 2: let's say they come in and they're telling me they
Speaker 2: have chest pain. I can triage that, fine, I can
Speaker 2: order KG, I can order some labs, but you know,
Speaker 2: you have to ask a number of questions first, like
Speaker 2: what's going on? Your chest pain may have started the
Speaker 2: day your spouse will diagnosed with cancer, It may have
Speaker 2: begun when you started taking an anti inflammatory for your
Speaker 2: knee pain and you've got reflocked. Like it takes time
Speaker 2: to surface the actual problem the patient is coming in with.
Speaker 2: It's much easier just to deploy a set of tools
Speaker 2: and like algorithmic sort of investigative tools on a patient
Speaker 2: instead of understanding the why. It turns out you can
Speaker 2: save a ton of money, you improve outcomes, and you
Speaker 2: increase patient's sense of agency and satisfaction when you just
Speaker 2: spend time. But that is not what our system rewards.
Speaker 2: It rewards the doing and not the sitting with people.
Speaker 1: Yeah, so if I'm a patient, what do I do?
Speaker 1: So if my doctor has the fifteen minutes? What's my
Speaker 1: move there? Am I do? I got to sort of
Speaker 1: press them on, hey we need to have a conversation
Speaker 1: or what do you think actually works?
Speaker 2: Well, I mean this is why I wrote a book.
Speaker 2: Well thanks, I think it is a good book. I
Speaker 2: think it's it's work right. So what I'm asking people
Speaker 2: to do by reading this book is I'm saying, look,
Speaker 2: your doctor doesn't have time. It's aspirational to think that
Speaker 2: your doctor's going to have time to understand how your
Speaker 2: divorce is affecting your sleep, which is affecting your blood
Speaker 2: sugar regulation, which is affecting your diabetes. That stuck's not
Speaker 2: going to happen in my lifetime. Maybe it will. So
Speaker 2: what I'm asking to do with this book is sit down,
Speaker 2: and I want you to map your health ecosystem. I
Speaker 2: want you to take this library of questions I put
Speaker 2: out there to surface the sort of nooks and crannies
Speaker 2: of your health. Not just what you eat, like your
Speaker 2: doctor will say what are you eating or what your
Speaker 2: what's your diet like? Or they'll just say like eat
Speaker 2: less sugar, exercise, more sort of prescriptive advice. I want
Speaker 2: you to map your health ecosystem by asking yourself more
Speaker 2: in depth questions. What's your relationship with food? Do you
Speaker 2: eat when you're hungry or do you eat when you're stressed, boored,
Speaker 2: you know, feeling anxious. Let's talk about exercise. Is it
Speaker 2: a sure? Is it a should? Or is it something
Speaker 2: you enjoy doing? Are you not doing it not because
Speaker 2: I didn't lecture you hard enough, but because your avoidance
Speaker 2: of some pain syndrome that you haven't really thought through.
Speaker 2: Or are you over using exercise as a proxy for
Speaker 2: you know, managing anxiety. In other words, I want you
Speaker 2: to sit. What I want you to do is ask
Speaker 2: a little more sophisticated questions of yourself that your doctor
Speaker 2: just doesn't have time to ask you, so that you
Speaker 2: can then have Aha moments in your living room and
Speaker 2: have Aha moments when you're reading the book and say, oh,
Speaker 2: my gosh, I never thought about the football injury I
Speaker 2: had in high school and how I subtly favor this
Speaker 2: side of my body and that makes my whole skeleton off.
Speaker 2: And then my chronic pain is driving my sleep, and
Speaker 2: my sleep is driving my brain fog, and my brain
Speaker 2: fog is making me, you know, inattentive and anxious. Like
Speaker 2: all of these things are related. Yeah, and you need
Speaker 2: to connect the dots on your own. Unfortunately, it's on
Speaker 2: the patient to do a lot of pre work before
Speaker 2: you even show up in the doctor's office.
Speaker 1: Yeah, you have a lot of amazing anecdotes about that
Speaker 1: that never kind of like aha moments for me where
Speaker 1: someone will come in for, you know, one reason, and
Speaker 1: then you start talking to them and it turns out
Speaker 1: there's this whole other thing going on under the surface. Right,
Speaker 1: How did you, like, how did you start to because
Speaker 1: you're in the system, right, like, you have to work
Speaker 1: with patients relatively quickly. So what was your own aha
Speaker 1: moment where you started to realize, Oh, there's all these
Speaker 1: other things going on. It's not just the blood sugar
Speaker 1: or the headache or whatever. It is, Like, what is
Speaker 1: actually all the underlying reasons behind that?
Speaker 2: So, first of all, I'm not in the system. I
Speaker 2: was in the system, and I saw the patients were
Speaker 2: being treated like a set of transactions. So I built
Speaker 2: my own practice in order to be able to have
Speaker 2: time with patients, and I've i brought in a number
Speaker 2: of other doctors who also left academia to be in
Speaker 2: a place where they can actually treat the person, not
Speaker 2: just the diagnosis codes. But I've always been interested in
Speaker 2: Michael in the human experience of illness. I myself was
Speaker 2: a patient. I myself was a patient. I was a
Speaker 2: victim of the same system that we all participate in,
Speaker 2: and by the way, we all need doctors. I was
Speaker 2: somebody who had a number of health problems in her
Speaker 2: twenties who just needed to be asked like how are
Speaker 2: you doing? Like what's going on? I was tested for
Speaker 2: brain tumors and giardia, I had MRIs. I had every
Speaker 2: lab test in the world, and when I was told
Speaker 2: your labs are normal, you know, pat on the head,
Speaker 2: I felt more crazy and I just got sicker and
Speaker 2: more anxious and sicker and more anxious. And so it
Speaker 2: took me kind of doing some like investigatory work about
Speaker 2: like who am I and what's going on and like
Speaker 2: where to get the help that I realized like, wait
Speaker 2: a minute, this thing that I'm studying, Medicine is excellent
Speaker 2: at ruling things out and damage control and treating disease,
Speaker 2: but it's not great at understanding this person. And if
Speaker 2: we're not as physicians, equipped trained, or given time to,
Speaker 2: you know, elicit what's actually going on in people's lives,
Speaker 2: even a mundane interaction can go completely wrong. Like I
Speaker 2: can recommend lipatore to you because it's the right thing
Speaker 2: to do after a discussion of you know why you're
Speaker 2: cholesterol is high, but you need to trust me enough
Speaker 2: to say, you know what, Doc, I may not take
Speaker 2: that because I'm worried about X. Like you have to
Speaker 2: have trust and rapport with the person who's dispensing advice
Speaker 2: about your health so you can be the best doctor
Speaker 2: in the world. The best trained physician all the tools
Speaker 2: and be appropriately prescribing medications. But unless that person trusts
Speaker 2: you and understands and believes that they have your best
Speaker 2: interest in mind, they're going to do anything you say.
Speaker 2: So you know, I'm sure it's true for you in
Speaker 2: your life and for people listening to this podcast. The
Speaker 2: people in your life who you trust are people who listen,
Speaker 2: who pause, who ask follow up questions, who are humble
Speaker 2: about what they don't know, who are saying, let me
Speaker 2: help you figure that out. They're empathetic and like I
Speaker 2: think doctors are those things, but the system has squashed
Speaker 2: the humanity out of medicine such that it's very hard
Speaker 2: to practice in those conditions. It's hard for patients to
Speaker 2: feel like they're understood. It's hard for patients to believe
Speaker 2: the advice are being given.
Speaker 1: Do you have a sense what sort of share or
Speaker 1: percent of patients come in for a health issue where
Speaker 1: the underlying issue is just kind of a life issue.
Speaker 2: Oh, i'd say. I mean, first of all, every single
Speaker 2: health issue has a life issue attached to it, So
Speaker 2: I'm not saying that like every person with chest pain
Speaker 2: has some like psychological problem underlives, but I will say
Speaker 2: that it's not surprising anymore because I've been doing this
Speaker 2: this long. Everybody has a story. The most important data
Speaker 2: that you have often isn't in your lab tests, you know.
Speaker 2: I mean, you can take two people with the same
Speaker 2: high blood pressure reading, and one person got there because
Speaker 2: they're in a they're having a tough time in their relationship,
Speaker 2: they're drinking too much alcohol more than they want. They're
Speaker 2: not sleeping while they're stressed at work, they're drinking coffee
Speaker 2: to stay awake and alert, and they're just kind of
Speaker 2: wired and tired and amped up. And their blood pressure
Speaker 2: problem doesn't need more blood pressure medicine. It needs someone
Speaker 2: like me to say, look what's going on, understand it,
Speaker 2: and say, look, let's work on stress management, a plan
Speaker 2: to help you moderate your alcohol without lecturing you and
Speaker 2: making you feel bad. And then another person could have
Speaker 2: a high blood pressure because they are genetically predisposed to
Speaker 2: high blood pressure. They are eating a low salt diet,
Speaker 2: they're exercising every day, they follow the Michael Easter two
Speaker 2: percent plan. They are taking the stairs and not the elevator,
Speaker 2: and they just have high blood pressure and it's not
Speaker 2: there's no psychological element to it. That's that there's always
Speaker 2: psychological element of blood pressure. I have patients come in
Speaker 2: and their blood pressures high just by seeing me.
Speaker 1: That's me, that's me in the doctor's office. It's always
Speaker 1: through the roof when so.
Speaker 2: Psychology is always relevant, right, And then I have patients
Speaker 2: who are anxious about the idea of having high blood pressure,
Speaker 2: and so then they give the high blood pressure when
Speaker 2: we're checking it, and then it's this sort of like cycle.
Speaker 2: I'm like, look, we're not going to check your blood
Speaker 2: pressure in my office ever again. I'm just going to
Speaker 2: have you do it at home. So like you cannot
Speaker 2: separate emotional health from our physical health and the way
Speaker 2: our bodies show themselves in your everyday life or in
Speaker 2: the doctor's office. So it's always relevant.
Speaker 1: Yeah, all right, So, speaking of two percent, you did
Speaker 1: a piece for my sub stack called the comfort Crisis
Speaker 1: in the doctor's office, and I think the big point
Speaker 1: of that because my audience on subsec and also on
Speaker 1: this podcast, they're generally health motivated people. You kind of
Speaker 1: wrote that they're great at pretending that everything is just
Speaker 1: absolutely perfect. They're doing all the right things, but they
Speaker 1: won't really bring up the uncomfortable things that need to
Speaker 1: be unpeeled. What should what should people actually be telling
Speaker 1: their doctor given that?
Speaker 2: So let me cavy up this by saying that it's
Speaker 2: hard for people to talk about hard things. It's hard
Speaker 2: for doctors sometimes to countenance uncomfortable subjects like sexual dysfunction,
Speaker 2: you know, disordered eating addiction. But if I had one
Speaker 2: question to ask people at their annual checkup, like a
Speaker 2: well well person visit, it would be like, what are
Speaker 2: the things you're What's the thing you're most afraid to
Speaker 2: tell me out loud? Or what's the thing you're most
Speaker 2: embarrassed to say to yourself? Because the things that people
Speaker 2: don't say out loud are often the things that are
Speaker 2: sort of eating them up and that are causing them
Speaker 2: to have that gravitational pull towards alcohol or sugar or
Speaker 2: doom scrolling or just some other avoidance behavior, some behavior
Speaker 2: that's causing them to numb out or dissociate. And you know,
Speaker 2: our health is informed by our behaviors, right like behavioral
Speaker 2: health like the way we eat, the way we sleep,
Speaker 2: the way we exercise, the way we move, the way
Speaker 2: we relate to other people is inforigned by our thoughts
Speaker 2: and our feelings. So like, unless you elicit like what's
Speaker 2: actually going on inside, you're really kind of nibbling around
Speaker 2: the edges of understanding that person. Yeah, so it's a
Speaker 2: great moment when a patient can tell me, like, you
Speaker 2: know what I am feeling, like really, I'm perhassed by
Speaker 2: my boss, or I am worried that I haven't had
Speaker 2: sex with my partner in five years. And that opens
Speaker 2: up a whole conversation that is empowering to the patient
Speaker 2: because there are things you can actually do about that.
Speaker 2: There are things you can actually help people with. I
Speaker 2: mean there's you know, from relationship based counseling to vaginal
Speaker 2: estrogen and hormone therapy to just normalizing the experience of
Speaker 2: someone feeling vulnerable in their workplace. I mean we're all
Speaker 2: walking around like feeling vulnerable and scared, and you know,
Speaker 2: we self medicate in many different ways.
Speaker 1: Yeah, it's like that opens up what the what the
Speaker 1: real underlying problem is. Just trying to do some other
Speaker 1: stuff on the side is not going to fix I mean,
Speaker 1: you're just kind of like, you know, trying to add
Speaker 1: tire to the wheel that has a giant hole in it.
Speaker 2: That's right. So It's not that every disease process has
Speaker 2: some like psychological underpinning. It's that he human beings have
Speaker 2: thoughts and feelings and behaviors that have to be woven
Speaker 2: into the conversation about health. Even when you think about
Speaker 2: like compliance with medications, or you know, I can tell
Speaker 2: people all day long, eat less sugar, exercise more, lose
Speaker 2: ten pounds, see an next year, right, and that's a
Speaker 2: lot of doctor's appointments, right. Yeah, But unless someone's given
Speaker 2: a roadmap and sort of a pathway and also like
Speaker 2: interval check ins, it's really unrealistic to think someone's going
Speaker 2: to make a behavioral change. I mean, behavioral change is
Speaker 2: arguably the most difficult thing to do, like in ourselves.
Speaker 2: And when you're advising someone else, it sounds really good
Speaker 2: to say, look, take this prescription, lose ten pounds, get
Speaker 2: more cardio, get more strength, work sleep eight hours flows
Speaker 2: after every meal. But unless that person is a trusting
Speaker 2: of my advice, believes that this is actually going to
Speaker 2: help them, it has a realistic, sustainable plan laid out
Speaker 2: for them, it just doesn't happen.
Speaker 1: Yeah, totally. I mean that's one of those things where
Speaker 1: you know the government has been giving that advice for
Speaker 1: free since about nineteen fifty, and so just hearing it
Speaker 1: one more time probably is again to move dile. You
Speaker 1: need some sort of okay, well, how do I actually
Speaker 1: put it in my life. We'll take a break and
Speaker 1: then Lucy will explain the upsides and the downsides of
Speaker 1: the wellness movement. If I go online, say on Twitter,
Speaker 1: there's a lot of people in the wellness sphere who
Speaker 1: say that doctors just push medications today. What is your
Speaker 1: response to that. I feel like doctors are taking a
Speaker 1: lot of heat today.
Speaker 2: Yeah, we're taking a lot of heat. And I think,
Speaker 2: you know, I understand that. I mean, people are really
Speaker 2: really feeling disenfranchised from the medical establishment. They're feeling disenfranchised
Speaker 2: from their own bodies. But again, I will say this
Speaker 2: from the hilltops, like it's not doctor's fault, right, This
Speaker 2: system is anti doctor, anti patient. Your question is about
Speaker 2: the wellness industry. By the way, I am pro wellness.
Speaker 2: I'm wellness adjacent, like I welcome wellness. In fact, that's
Speaker 2: what medicine needs to adopt is the concept of wellness,
Speaker 2: which includes helping people, meeting them where they are and
Speaker 2: understanding who they are, and then empowering them with tools
Speaker 2: and information that apply to their actual situation. But because
Speaker 2: medicine can't do that well, the wellness industry has taken
Speaker 2: its place in many ways. So your question was about
Speaker 2: when you see like a wellness influencer talking about doctors
Speaker 2: just prescribe medications. I think it's true that doctor's default
Speaker 2: to prescription writing you're crying in my office. Here's prozac
Speaker 2: high cholesterol, here's lebataire high blood pressure, here's a beta blocker.
Speaker 2: When what's empowering to patients is aunderstanding where lifestyle factors
Speaker 2: may play a role in lowering blood pressure, lowering cholesterol,
Speaker 2: improving mood, and then using medications as a tool, just
Speaker 2: like you know, exercises. I also think the wellness industry
Speaker 2: can be equally prescriptive. You know, it's like, got bloating,
Speaker 2: Take this supplement, got you know, brain fog. Try this
Speaker 2: when the bloating maybe because they're constipated and they need
Speaker 2: to have more dietary fiber, or their brain fog maybe
Speaker 2: because of metopause and they need hormone replacement therapy. So
Speaker 2: it's not an either or, it's a both. And the
Speaker 2: question isn't do people need prescriptions, and you know sometimes
Speaker 2: supplements they do, it's whether that advice matches the individual's
Speaker 2: actual problem.
Speaker 1: Yeah, where have you seen wellness help patients? Some might
Speaker 1: be obvious. I think you'd probably say, like exercise, eating, Well,
Speaker 1: where have you seen it actually harm them? Because you
Speaker 1: had some interesting anecdotes in the book about people who
Speaker 1: tried some wellness things that backfired.
Speaker 2: Well, first of all, nature doesn't always have our back, right,
Speaker 2: I love, I mean, nature is wonderful, right like, but
Speaker 2: but like, arsenic comes from nature. And I've seen patients
Speaker 2: have liver failure from green tea extract. I've seen people
Speaker 2: overdose on vitamin D. You know, if one is good,
Speaker 2: then five is better, and then they're vitamin D toxic.
Speaker 2: I've also seen people be so anti prescription that they
Speaker 2: think they can kind of like out exercise their genetic
Speaker 2: coronary arter or disease. So take my patient who's in
Speaker 2: his mid fifties, who is a lifelong athlete, and I
Speaker 2: think it's great that he comes in every year with
Speaker 2: like spreadsheets on his you know, he's got his CGM,
Speaker 2: he's got his step tracker, he's got his like you know,
Speaker 2: personal records for various.
Speaker 1: Time, whoop scores, mild time, exactly everything, and that's awesome.
Speaker 2: That floats his boat like that. For someone else would
Speaker 2: be like, you know, too much surveillance on the bodily system.
Speaker 2: But for him, it works. So he couldn't believe it
Speaker 2: when I said, I think we should do a coronary
Speaker 2: artery calcium score to look for the presence of cholesterol
Speaker 2: plaque because guess what, your cholesterol is high despite being
Speaker 2: a significant like exerciser. He was like, there's no way,
Speaker 2: So we did it. He has coronary artery disease, and
Speaker 2: all of the evidence in cardiovascular medicine says, if you
Speaker 2: have a non zero cholesterol scorer, we have a stricter
Speaker 2: LDL cholesterol goal. So he wanted to exercise his way
Speaker 2: out of that, and I understand that I love people
Speaker 2: who want to do the work. The problem is you
Speaker 2: cannot scrub the insides of your arteries with like cold
Speaker 2: plunges and more running right. You actually need both. You
Speaker 2: need libertoor you may need one of these new medications
Speaker 2: to drop his LPA, which is high his lipeoprotein the
Speaker 2: lay and exercise. So what I see is this false
Speaker 2: dichomy between like medicine and wellness when actually they go
Speaker 2: hand in hand. And I wish that wellness influencers trusted
Speaker 2: you know, evidence based medicine more, and that doctors weren't
Speaker 2: so snooty about wellness practitioners who are helping people every day.
Speaker 2: I think the movement to help understand mental health is wonderful.
Speaker 2: I think the sort of democratization of information about diet
Speaker 2: and protein and fiber and healthy fats is wonderful. I
Speaker 2: think cgms can be wonderful even for non diabetics. I
Speaker 2: think that there's a lot of good being done in
Speaker 2: the wellness space. I think that work is necessary, just
Speaker 2: not sufficient for health. You can't meditate your way out
Speaker 2: of you know, breast cancer. You can't. There's there's no
Speaker 2: amount of quen, waw or kale that can help you
Speaker 2: with your genetic predisposition towards you know, dementia. Those things
Speaker 2: are important, but they're not sufficient.
Speaker 1: What sort of conversations you have with patients who are
Speaker 1: really interested in wellness, like what do you guide them into?
Speaker 1: Are people coming to you with well have you heard
Speaker 1: of this, I'm thinking of doing this? Or are they
Speaker 1: already on things? Since one thing that I thought was interesting,
Speaker 1: is you noted in the book that a significant amount
Speaker 1: of people don't list supplements or tell their doctor about
Speaker 1: supplements they're taking. So if they end up going on
Speaker 1: a prescription, those can react in a bad way. So
Speaker 1: what sort of conversation should people have?
Speaker 2: So I want people to be honest about what they're taking.
Speaker 2: I think the reason people don't tell their doctors what
Speaker 2: they're taking is because they don't want to be shamed
Speaker 2: for taking a supplement. Yeah, right, Like I think doctors
Speaker 2: are notorious at, you know, looking down their nose and
Speaker 2: being like, well, you don't need that crap, when first
Speaker 2: of all, we don't know a lot of these things.
Speaker 2: And secondly, I'd never want to shame a patient that
Speaker 2: does not do anything for our sense of like, you know,
Speaker 2: our rapport. Over the past two years, patients have you know,
Speaker 2: come to my exam room increasingly with answers from a chatbot,
Speaker 2: like you know, interpretations of their lab results, and recommendations
Speaker 2: for various supplements. And I welcome an informed consumer. I
Speaker 2: just want people to know that just because something's natural
Speaker 2: doesn't mean it's going to be a panacea. You know,
Speaker 2: if you have depression. We have abundant evidence on the
Speaker 2: ways in which we should we can treat depression such
Speaker 2: that you don't need to turn to you know, Saint
Speaker 2: John's Wort and you know alternative treatments. Like there's still
Speaker 2: a box. Like I love thinking outside the box, but
Speaker 2: there's still a box. There's still evidence based medicine. I
Speaker 2: don't want to worship at the altar of evidence based
Speaker 2: medicine at the exclusion of thinking outside the box. But
Speaker 2: there's still a box.
Speaker 1: We're going to break. And then Lucy is going to
Speaker 1: explain the five steps you need to take to become
Speaker 1: what she calls the CEO of your own health. So,
Speaker 1: given what we talked about so far, you have this
Speaker 1: idea that we should become the CEO of our own health,
Speaker 1: and then you have these five steps to do that.
Speaker 1: So I want to get into the steps before we
Speaker 1: do what is sort of the big picture on this
Speaker 1: idea of becoming CEO of your own health.
Speaker 2: The big picture idea here is that we are all
Speaker 2: too commonly passive consumers of health information and advice from
Speaker 2: our doctors and from wellness influencers. What I'm trying to
Speaker 2: help people do by reading this book is get in
Speaker 2: the driver's seat of their health, to be more proactive
Speaker 2: instead of reactive, and to be a critical thinker when
Speaker 2: it comes to what you need, where to get it,
Speaker 2: who to trust, and how to ask better questions of
Speaker 2: yourself and the people responsible for your care. Becoming healthy
Speaker 2: is an active process. It's not passive. And I don't
Speaker 2: mean like getting healthy by just starting exercise and eating better.
Speaker 2: I mean the act of understanding your whole health, the biological, psychological,
Speaker 2: and social elements of your health that are relevant today
Speaker 2: and ten years from now.
Speaker 1: So step one and we kind of we kind of
Speaker 1: touched on this earlier, but Step one is redefine health
Speaker 1: on your own terms. Because we already sort of explained
Speaker 1: what that means, how do you tell people how to
Speaker 1: actually do that and what's the process look like?
Speaker 2: So ask yourself some basic questions like what do I
Speaker 2: want my health and life to look like in a
Speaker 2: year or five years or ten years? You know. So
Speaker 2: this is particularly relevant for my older patients where we're
Speaker 2: deciding on how to streamline their medication lists and how
Speaker 2: many appointments do they want to go to, Like do
Speaker 2: they want to be sort of doctor surfing or do
Speaker 2: they want to trim the trees and triage and think about, like,
Speaker 2: what's the most important set of medical sort of appointments
Speaker 2: they need to keep, and where can they sort of
Speaker 2: let go that hinges entirely on what their goals are
Speaker 2: and what their tolerance for risk is and what they're
Speaker 2: looking for. Right Because just because you can sort of
Speaker 2: dot every eye and cross every tee of someone's health
Speaker 2: in the medical system we live in, doesn't mean you should.
Speaker 1: Yeah so, but.
Speaker 2: When you're a young person, even if you're thirty, and
Speaker 2: you're listening to this, like, I don't want the average
Speaker 2: thirty year old to assume that health is about someone
Speaker 2: else's idea of health, like these kind of look smaxers
Speaker 2: or these like people who are following these prescriptive you know,
Speaker 2: diets or prescriptive types of exercise, Like I love exercise.
Speaker 2: I think eating healthy is crucial. I think, you know,
Speaker 2: doctors are woefully ill equipped to help people understand how
Speaker 2: they're nutritional. You know factors affect their health. But you
Speaker 2: need to define what you want first. Are you looking
Speaker 2: to have more energy or are you looking to lose weight?
Speaker 2: Are you looking to build muscle or are you looking
Speaker 2: to get rid of that hip pain. Know what you're
Speaker 2: trying to get out of your health before you try
Speaker 2: to operationalize a plan, especially if it's someone else's plan.
Speaker 1: Yeah, that makes sense. So step two is map your ecosystem.
Speaker 1: Walk me through what that looks like.
Speaker 2: Yeah, So I think of health as having four main quadrants.
Speaker 2: The first eye, it's the four eyes. The first eye
Speaker 2: is informatics, So we think of health as information like
Speaker 2: your lab test data, right, your cholesterol, your blood sugar,
Speaker 2: your BMI. When just as important as your biometric data
Speaker 2: is your biographic data. So your story, the elements of
Speaker 2: your story that have everything to do with your health,
Speaker 2: like were you raised by an alcoholic parent? Were you
Speaker 2: raised in poverty? Like what are the limitations of your
Speaker 2: life that keep you from activating on the recommendations you
Speaker 2: know you should participate in? So that's number one I informatics.
Speaker 2: Number two is inputs. Inputs is everything you put in
Speaker 2: your body, from kale and quinwa to alcohol and marijuana,
Speaker 2: to all the supplements you.
Speaker 1: Take and prescriptions as well.
Speaker 2: A prascripture medications. The third eye is infrastructure, so literally
Speaker 2: the container you drive through your life, this vehicle, right,
Speaker 2: you only have one vehicle, you can't trade it in
Speaker 2: like you can your Honda. Right, you have to treat
Speaker 2: it like you would your car. People treat their skeletons
Speaker 2: with less care than they do their cars.
Speaker 1: Right, totally right, like so good. Right.
Speaker 2: We need to use physical therapy as a as a
Speaker 2: as a maintenance. We need to think about exercise, not
Speaker 2: just to fit in our genes or to like win
Speaker 2: a race solthether that's fine if that's your goal, but
Speaker 2: rather as maintenance so that when you're ninety you can
Speaker 2: still walk around the nursing home or you know, put
Speaker 2: your luggage in the overhead compartment like you have to
Speaker 2: maintain your skeleton. And then the fourth eye is insight.
Speaker 2: Insight is the unconscious mind, the stories we tell ourselves,
Speaker 2: you know, our anxiety, our moods, our relationships with food, alcohol,
Speaker 2: other people, and how those things inform the other eyes.
Speaker 2: What we eat, how we move, how we take advice
Speaker 2: from our doctors, whether we take the prescription or not.
Speaker 2: And so the interesting part about the four eyes to
Speaker 2: me and the health map and the health ecosystem is
Speaker 2: not just the components those four eyes, it's how they
Speaker 2: talk to each other. So the bulk of the book
Speaker 2: is helping people map those those parts of their ecosystem
Speaker 2: by pulling information out of them and then thinking about
Speaker 2: the interconnect of this to have some aha moments.
Speaker 1: Yeah, I definitely had some AHA moments with my own health.
Speaker 1: As I read your book, I was like, Oh, that's
Speaker 1: a really interesting way to look at it and useful.
Speaker 1: I thought it was great. So I love that three
Speaker 1: is understand your patient personality. And I enjoyed this too
Speaker 1: because I definitely was like, oh, I think I fall
Speaker 1: into that camp. So are the what are the types?
Speaker 2: So patient personality is basically this is this is my idea, right,
Speaker 2: It's like how you show up in medical encounters in
Speaker 2: a vulnerable position, like as a patient, whether you're sick
Speaker 2: or well. So are you the optimizer who thinks that
Speaker 2: if you can like will power guarantees outcomes and you're
Speaker 2: loath to accept vulnerabilities that are out of your control?
Speaker 2: Are you the people pleaser patient who thinks that if
Speaker 2: you just dazzle the doctor and you you know, quit
Speaker 2: drinking the week before your appointment or lose weight before
Speaker 2: your appointment, then you're going to be okay. Like you've
Speaker 2: kind of outsourced your intuition to like someone else your doctor,
Speaker 2: Or are you the internet warrior who comes into the
Speaker 2: doctor's appointment with like reams and realms of data and
Speaker 2: spreadsheets and a hefty dose of anxiety. Or are you
Speaker 2: the outsourcer who doesn't really care about mechanism, who isn't
Speaker 2: interested in the why, but just wants the prescription, the pill,
Speaker 2: the tasks like, just tell me what to do, what
Speaker 2: to do. So the reason these matter is because health
Speaker 2: and healthcare, the delivery of health care, it's a relationship.
Speaker 2: So it's just about self awareness. It's about holding a
Speaker 2: mirror up to yourself and understanding how you relate to authority,
Speaker 2: how you behave and feel when you're in a vulnerable position,
Speaker 2: so you can be honest with yourself and with your doctor.
Speaker 2: So you can come into the doctor and say, hey, doc,
Speaker 2: I'm a people pleaser. I believe that if you're happy
Speaker 2: with my test results, then i'm good health wise. So
Speaker 2: just know that that I tend to minimize my symptoms
Speaker 2: to make you happy. And then, honestly, I don't know
Speaker 2: a single doctor who doesn't love a self aware patient
Speaker 2: who can say those things, because then that invites the
Speaker 2: conversation and not this sort of one way, you know,
Speaker 2: conversation from the doctor and saying do this, do this,
Speaker 2: do this, do this, do this. A self aware patient
Speaker 2: is an empowered patient, and it's someone who I want
Speaker 2: to have a relationship with.
Speaker 1: Yeah. The fourth one is to ask for help. What
Speaker 1: is asking well sound like versus asking badly? I think
Speaker 1: this one's hard too, because well.
Speaker 2: First of all, like we live in a world where
Speaker 2: we think that chat GPT and Claude can be our doctors,
Speaker 2: and I understand that, and often they'd give more succinct,
Speaker 2: quick and empathetic advice than doctors do. But you still
Speaker 2: need a doctor, and you still need to ask for help.
Speaker 2: I mean, if I teach my young adult children nothing else,
Speaker 2: asking for help with the strength. And people are loath
Speaker 2: to ask for help. So the point of this chapter
Speaker 2: is to understand what your questions are, reframe your questions
Speaker 2: to make sure you're getting to the actual problem you're
Speaker 2: trying to solve, and then ask the right person. This
Speaker 2: is as simple as like don't ask a nutritionist for
Speaker 2: advice on your heart failure, Like don't rely on your
Speaker 2: guests orineurologists to help you with weight loss. You know,
Speaker 2: like make sure you're asking the right person, the person
Speaker 2: who's credentialed and has time to ask to answer the
Speaker 2: question you actually have, and then like simple strategies like
Speaker 2: instead of saying like should I take a GLP one?
Speaker 2: Great question want to get every day, ask it in
Speaker 2: a more sophisticated way so your doctor knows that you're
Speaker 2: understanding the concept of trade offs. Doc, what are the
Speaker 2: risks and benefits of a GLP one for me? And
Speaker 2: what are the risk risks and benefits of not taking
Speaker 2: a GLP one for me? It acknowledges the trade offs
Speaker 2: and there's no right answer if you just say should
Speaker 2: I do this? Can I do this? It's like a
Speaker 2: permission giving and that's that's not what we're here for.
Speaker 2: We're here for discussion about the pros and cons.
Speaker 1: And if a doctor is I would imagine every doctor
Speaker 1: wants to answer should I take a GLP one with
Speaker 1: a long discussion, tons of follow ups to get into
Speaker 1: those costs and benefits. But when you got ten minutes,
Speaker 1: it's yeah, I think you should Here you go without
Speaker 1: the patient actually knowing the underlying Okay, why am I
Speaker 1: doing this in the first place?
Speaker 2: Right? It's too easy for us as physicians to be like, oh,
Speaker 2: that's a layup question for me, like should I Nope?
Speaker 2: And by the way, when it comes to hormone replacement
Speaker 2: therapy as an example, when someone says, you know, for
Speaker 2: decades women have said should I be on HRT? And
Speaker 2: doctor said no, end of conversation. Now I want women
Speaker 2: to go in and say, should I not? Should I
Speaker 2: be on HRT? What are the risks and benefits of HRT?
Speaker 2: What are the risks and benefits of not being HRT?
Speaker 2: On HRT? And if you get a cold look and
Speaker 2: like you can't do it, then then leave. You need
Speaker 2: a conversation. Health is not about yes or no. It's
Speaker 2: about trade offs because risk lives on both sides.
Speaker 1: Of every decision totally. The final one is practice acceptance.
Speaker 1: That's a hard one. That's a hard one for me.
Speaker 1: How does not actually play out among your patients? And
Speaker 1: why do you put that in the book?
Speaker 2: Because it turns out that the hardest part of being
Speaker 2: human is accepting things we can't control. Like we love control, right,
Speaker 2: We want to predict future outcomes. We want to protect
Speaker 2: ourselves from pain and suffering. We want to believe that
Speaker 2: our effort guarantees outcomes and that our behaviors. If we're
Speaker 2: a good patient, then that will yield result, and it
Speaker 2: often does. I'm the first person to say that lifestyle
Speaker 2: medicine is like the name of the game. At the
Speaker 2: same time, there's a lot of parts of our health
Speaker 2: we can't control. So acceptance is a bit right. Accepting mortality,
Speaker 2: for starters, is really difficult. But when you start to
Speaker 2: accept these things you cannot control, and you stop fighting
Speaker 2: unwinnable battles like a genetic predisposition to disease or like
Speaker 2: something that happened to in your past that you're ruminating
Speaker 2: about and trying to sort of outrun, and you accept
Speaker 2: those unpleasant realities, then you can redirect your energy to
Speaker 2: the things where you do have agency. So I see
Speaker 2: people all the time, like my guy I told you
Speaker 2: about earlier, who's trying to outrun his corinary disease and
Speaker 2: there's just no more exercise that he can do. He
Speaker 2: just needs to be on the appropriate medications to prevent
Speaker 2: a heart attack and keep exercising. So acceptance is a process.
Speaker 2: It's a lifelong process, and it's only in accepting the
Speaker 2: things we can't role that we truly have agency over
Speaker 2: the things we can it sounds it's like the serenity
Speaker 2: prayer will break.
Speaker 1: And then Lucy is going to give her thoughts on
Speaker 1: patients using AI and how doctors could potentially use AI
Speaker 1: to lead to better health outcomes in their patients. Okay,
Speaker 1: let's get into AI. How can a regular person use
Speaker 1: AI in a way that's helpful and where do you
Speaker 1: see it go totally wrong?
Speaker 2: I mean, I think AI is a wonderful tool. I
Speaker 2: use it all the time in my office. I use
Speaker 2: it to draft letters to insurance companies to wrangle with
Speaker 2: them about you know, reimbursement. I use it to draft
Speaker 2: patients summary letters. I used to you know, type everything out.
Speaker 2: What I fear, though, is that the healthcare system in
Speaker 2: ten years will be AI plus you know, physicians assistance
Speaker 2: just for their license, and that will be called healthcare.
Speaker 2: The beautiful thing is that AI is wonderful at answering
Speaker 2: the question it is asked, but you have to make
Speaker 2: sure you're asking it the right question. And it's a
Speaker 2: uniquely human thing to surface what the question actually is
Speaker 2: and to ask the question beneath the question. But for
Speaker 2: the average person who's listening, how can you use AI?
Speaker 2: It's great for like simple transactional questions like is amoxicillin
Speaker 2: the right antibiotic for strapped throat? Yes? Or you know
Speaker 2: what are the potential side effects of GLP wants. Great,
Speaker 2: it'll answer that question, it'll answer it well. But it
Speaker 2: can't answer the question of why your weight is going
Speaker 2: up or why you're having metagabolic dysfunction. It's not going
Speaker 2: to know to ask you unless you're really sophisticated and
Speaker 2: you're really empowered. Maybe you're reading a book to identify
Speaker 2: your relationship with alcohol, your sleeplessness, your genetic predisposition to
Speaker 2: metabolic dysfunction, plus your work stress as playing a role
Speaker 2: in why your metabolism is slow. But Italy answer the
Speaker 2: question of what does cause constunation? It certainly does. What
Speaker 2: to do about it? It depends when we talk.
Speaker 1: One time, I thought, what was really fascinating is that
Speaker 1: don't you use it when you meet with a patient
Speaker 1: and so instead of having to sit there and write
Speaker 1: down every single note and your faces in the notebook
Speaker 1: half the time, like, you record the conversation and then
Speaker 1: you are able to have AI analyze that, and then
Speaker 1: you're able to basically have better outcomes for the patient
Speaker 1: because you can do them.
Speaker 2: You can use it with patient's permission to ambient ambient
Speaker 2: transcription and then help draft a note. And those technologies
Speaker 2: are getting better and better every day. So yes, it
Speaker 2: does potentially mean the doctors will have increasingly more time
Speaker 2: to look at the patient and not just a screen.
Speaker 2: So that's that's But again I worry that if we
Speaker 2: point AI at the wrong thing, which is the patient
Speaker 2: doctor relationship, and we ask you to do the things
Speaker 2: that I'm supposed to do or that a doctor who
Speaker 2: has time is supposed to do, then we're really just
Speaker 2: supercharging like the kind of crappy medical care that's transactional
Speaker 2: and not providing the kind of healthcare that people actually
Speaker 2: need to feel empowered.
Speaker 1: Yeah, I thought of you this morning because I had
Speaker 1: to take my dog to the vet. Now, when I
Speaker 1: take my dog to the vet, I come with a
Speaker 1: folder of every vet visit and everything that's ever happened
Speaker 1: to that dog.
Speaker 2: Oh.
Speaker 1: Now, the thing is, I don't do that for myself.
Speaker 1: And you have this amazing section in the book about
Speaker 1: how medical record keeping is a mess, and so I
Speaker 1: want to hear how should be patients thinking? How should
Speaker 1: patients be thinking about the information that they take down
Speaker 1: once they see a doctor so they can bring it
Speaker 1: to another because there's not a lot of cross talk
Speaker 1: between there's.
Speaker 2: Until we have socialized metas in the US, which we
Speaker 2: never will. I don't believe you have a different digital
Speaker 2: avatar of yourself in every medical space you've been in.
Speaker 2: So your primary care doctor has this set of information
Speaker 2: on you. The urgent care clinic where you got your
Speaker 2: tetnis shot on vacation has this digital avatar about you.
Speaker 2: Your insurance company has this kind of digital avatar of you.
Speaker 2: I just got a fax this morning from a hospital
Speaker 2: where a patient of mine was admitted over the course
Speaker 2: of her vacation in another state, and it was twenty
Speaker 2: five pages a kid you not of like her driver's license,
Speaker 2: front and back, all this, all these questionnaires like do
Speaker 2: you have guns in the house. I mean, she was
Speaker 2: there for diverticulitis. It didn't matter if she had guns
Speaker 2: in her house at that moment. If I just simply
Speaker 2: imported all of that junk into her electronic record, the
Speaker 2: electronic record would just be junk, junk, junk, just like
Speaker 2: your grandmother's attic. So what you can do as a
Speaker 2: patient before you know, until you're primary care doctor has
Speaker 2: time like I do, to curate all the incoming information
Speaker 2: and collect all the data from other doctors and put
Speaker 2: it into a central place. You can do that yourself,
Speaker 2: so just put it on a Google doc or put
Speaker 2: it on your phone. Yeah, all your medications. You take
Speaker 2: all of your known drug allergies, your past medical history,
Speaker 2: your past surgical history, write down like how much alcohol
Speaker 2: do you drink, cigarette smoking history, recreational drug use, all
Speaker 2: your supplements, your family history, and then update it in
Speaker 2: real time. So that's the work of a good primary
Speaker 2: care doctor's office. And that's what AI someday could deliver
Speaker 2: for us, is record reconciliation, because no doctor has time
Speaker 2: to in advance of the patient's annual physical call. The
Speaker 2: cardiologists call the GI doctor, get their COLONASKI report. We
Speaker 2: do that here because I made a point of doing it.
Speaker 2: But that is an enormous endeavor that takes humans right now,
Speaker 2: and that should just be done by a computer.
Speaker 1: Yeah. So for the average patient who is going to
Speaker 1: be saying they're for twelve minutes now, ideally they've read
Speaker 1: your book, they've mapped out their goals their health. What
Speaker 1: should they do in that twelve minutes.
Speaker 2: Though I think they should. First of all, make sure
Speaker 2: that that's the doctor you want, right, like you want
Speaker 2: to make sure that this person is someone who can listen.
Speaker 2: Doctors in studies tend to interrupt patients in the first
Speaker 2: eleven seconds, so you know, do a little like sort
Speaker 2: of gut check on like whether this is the person
Speaker 2: who's the right doctor for you. And number two, make
Speaker 2: sure that you are thinking even while you're parking your car,
Speaker 2: like if I leave with nothing else answered, what is
Speaker 2: my top burning question? And then have two three on
Speaker 2: deck in case you have time. And then be sure
Speaker 2: to leave with a follow up appointment because you're not
Speaker 2: going to get all your questions answered, and you're entitled
Speaker 2: to follow ups and asking more questions. And ideally, you know,
Speaker 2: as you're in the parking lot and thinking about what
Speaker 2: your questions are, you know, write everything down and make
Speaker 2: sure that you are honest with yourself about what your
Speaker 2: health questions are and you're not hiding things. I mean,
Speaker 2: these are just the basics, but that's a place.
Speaker 1: To start, and that come in with the uncomfortable answer
Speaker 1: to the question. You said, what's the most uncomfortable question
Speaker 1: I could ask you? However you put it, just lead
Speaker 1: with that.
Speaker 2: That's right, That's right.
Speaker 1: There you go. I love it. Okay, So as a doctor,
Speaker 1: you obviously have to spend some money on your own health.
Speaker 1: What do you actually spend money on yourself?
Speaker 2: So I will tell you I just bought a standing
Speaker 2: desk and a treadmill pad so you would be proud.
Speaker 2: So because I have this like neck pain and because
Speaker 2: I'm sitting all the time, I spent money on Amazon.
Speaker 2: It's like it was like two hundred and fifty bucks
Speaker 2: and I'm committing myself to walking while I'm on the
Speaker 2: phone talking to patients amazing, or just doing paperwork. I
Speaker 2: spend money on yoga classes. I think yoga is a
Speaker 2: fantastic You know, when I was in my twenties, I
Speaker 2: thought it was just a waste of time because I
Speaker 2: was a runner and I was like, I'm not even
Speaker 2: sweating is for the birds. And now I'm like, it's
Speaker 2: a necessity of for my mental health, my physical health,
Speaker 2: for all the whole thing otherwise health wise, Like I
Speaker 2: don't I mean, I don't take supplements. I mean, I'm
Speaker 2: fortunate to be pretty healthy, but I'm very critical of
Speaker 2: taking things that I don't absolutely need.
Speaker 1: And you're basing that on lab work. I would imagine
Speaker 1: what's that you're basing that on if I don't absolutely
Speaker 1: need them, that's based on.
Speaker 2: Lab work or a particular complaint, Like even if you
Speaker 2: have a normal magnesium level, you still may benefit from
Speaker 2: magnesium for muscle tension and insomnia or constipation. So it's
Speaker 2: based on like need, I see a lot of people
Speaker 2: taking supplements just because they can, and they're spending a
Speaker 2: lot of money on things they don't actually need. I
Speaker 2: spend money on therapy. I lost my brother two years ago.
Speaker 2: We don't have to talk about it, although I'm comfortable
Speaker 2: talking about it, and you know, grief is a process,
Speaker 2: talking about the ultimate active acceptance. So I've done some
Speaker 2: therapy throughout my life intermntly for various things, and I
Speaker 2: think that's a really good investment. I wish that it
Speaker 2: wasn't so expensive. I wish it was accessible to all people,
Speaker 2: because mental health is health. But that's to be an
Speaker 2: important investment in myself. It just feels healthy to be
Speaker 2: thinking about mental health, especially as a caregiver, a mother,
Speaker 2: you know, a daughter. So those are the things I
Speaker 2: spend money on. I mean I think some of the
Speaker 2: most important interventions are free, you know, like taking my
Speaker 2: phone out of my bedroom before I go to sleep, Yeah,
Speaker 2: for an hour, like you know, sitting and stretching for
Speaker 2: ten minutes before I go to bed, taking a walk
Speaker 2: with my friends. It's a two for right, it's social.
Speaker 2: It's actually a three for it's social, it's outside, and
Speaker 2: it's movement. Yeah, all that is free, totally, all right.
Speaker 1: I want to do to close out. I want to
Speaker 1: do a rapid fire.
Speaker 2: Oh great.
Speaker 1: I want you to give us a verse whether these
Speaker 1: things are worth it or not, quick thoughts on them
Speaker 1: and go. You can take it wherever you want. Number
Speaker 1: One preventative whole body cancer scans like pernuvo don't do it?
Speaker 1: Why is that? Do it?
Speaker 2: If you found five thousand dollars lying on the ground,
Speaker 2: you're doctor phobic and you haven't seen a doctor in
Speaker 2: twenty years and you just need something. Love it because
Speaker 2: it gives you a lot of information you don't need,
Speaker 2: and it tends to spin up people's anxiety. I understand, though,
Speaker 2: why people do it. I would save your money.
Speaker 1: Direct to consumer blood tests like inside Tracker.
Speaker 2: I don't love it.
Speaker 1: Why is that?
Speaker 2: Because it's not asking the great questions necessarily first, right,
Speaker 2: just because you can doesn't mean you should. Like, there's
Speaker 2: a whole lot of testing you can do, but you
Speaker 2: have to have context around it. You have to understand
Speaker 2: what your question is first, So we don't you know,
Speaker 2: doctoring isn't about phishing expedition. It's about asking a specific
Speaker 2: question and then ordering tests if tests are needed to
Speaker 2: answer it.
Speaker 1: Because someone's a symptoms, they don't have anything wrong with them,
Speaker 1: and so we're going into just probe things that are fine.
Speaker 2: Well, it's not that I don't order tests for people
Speaker 2: who are asymptomatic, it's that they have to have a
Speaker 2: There has to be a reason for it. For example,
Speaker 2: I don't tell everyone just to go out and get
Speaker 2: an apoe four, a gene test that's a mutation and
Speaker 2: a gene that can predispose to Alzheimer's because having that information,
Speaker 2: even though you can get it in someone who may
Speaker 2: never develop Alzheimer's and for which there's no targeted treatment,
Speaker 2: just spins up anxiety. So test results done without asking
Speaker 2: what the reason is for doing in the first place,
Speaker 2: is just a test result that you're stuck with handling.
Speaker 2: So you need a Shepherd. You need a context, you
Speaker 2: need a reason to do the test in the first place.
Speaker 1: CGMS continuous glucose monitors for those who don't.
Speaker 2: Know, I think they're great. For some people, they feel
Speaker 2: like an albatross, like a bad boyfriend or girlfriend, like
Speaker 2: judging them and shaming them. For other people, they're empowering.
Speaker 2: I mean, I see people who discover that they're insomnia's
Speaker 2: driving their spikes and blood sugar during the day or
Speaker 2: there you know that this food spikes their sugar and
Speaker 2: this food doesn't, or it just helps them be accountable
Speaker 2: to their goals to reduce dietary sugar and simple starches.
Speaker 2: I think it can be very empowering, but you have
Speaker 2: to know yourself and know how you're going to react
Speaker 2: to having this like dood ad stuck to your arm
Speaker 2: and be under surveillance. But in general, if you know
Speaker 2: yourself and you know what it can do for you,
Speaker 2: and you're willing to fork over the money, I think
Speaker 2: it's interesting.
Speaker 1: All right. Final final question? I lied, this is actually
Speaker 1: the final question. How does someone find a doctor like you?
Speaker 2: Unfortunately, it's expensive to have a doctor who will give
Speaker 2: you the time you really need. Those of us in
Speaker 2: direct primary care have taken matters into our own hands
Speaker 2: to have time with patients, so I can do the
Speaker 2: very kind of thing that I talk about in my book,
Speaker 2: which is why I wrote the book to help dispense
Speaker 2: what I've been doing with patients for twenty five years.
Speaker 2: I think you have to shop around, ask your friends,
Speaker 2: ask people you trust who they use. For some people,
Speaker 2: if they can afford it, direct primary care could be
Speaker 2: a wonderful thing. It's not to say that direct primary
Speaker 2: care doctors are always well intentioned or better than doctors
Speaker 2: in the system. It's just they have more time. I
Speaker 2: think rapport matters more than people often realize, and I
Speaker 2: think it's acceptable and normal for you to demand nothing
Speaker 2: less than a doctor who looks you in the eye
Speaker 2: and seems to take an interest in who you are
Speaker 2: as a person. They're out there even in the system.
Speaker 2: I mean, there are tons of doctors. They're my friends.
Speaker 2: They just don't have time. It's not their fault. So
Speaker 2: I wouldn't want you to confuse someone rushing as not caring,
Speaker 2: but it can certainly feel like that. So I think
Speaker 2: one thing you can say to a doctor is, doc,
Speaker 2: I know the system is oppressive. For you, and I
Speaker 2: know you don't have much time. I am really interested
Speaker 2: in being a partner with you. And maybe that just
Speaker 2: means we have more appointments. But what is that? How
Speaker 2: does that haate with you or something like that, and
Speaker 2: see how they respond and ee, they're like, dude, I'm
Speaker 2: just a lab checker and interpreter. That's not your doctor.
Speaker 2: And if they say something like that's exactly the kind
Speaker 2: of patient. I want. Someone who's willing to partner with
Speaker 2: me and think of health as a longitudinal process together.
Speaker 2: That's your person.
Speaker 1: That's your person. I love it. Well, Lucy, thanks so
Speaker 1: much for coming on.
Speaker 2: Thank you so much with Michael for having me. It's
Speaker 2: a pleasure.
Speaker 1: Thanks for checking out the show, and thanks to Lucy
Speaker 1: for coming on. As a reminder, the book is Beyond
Speaker 1: the Prescription, a Doctor's Guide to take in control of
Speaker 1: your health, and it is on sale now, so please
Speaker 1: do check it out. New episodes they are dropping twice
Speaker 1: a week in your feed, so please keep an eye
Speaker 1: out for more. Don't forget to hit subscribe and give
Speaker 1: us a review that gives you updates on when new
Speaker 1: episodes are out. And as always, have fun, don't die