WEBVTT - Dr. Lucy McBride: Why Doctors Miss What's Actually Making You Sick 0:00:03.960 --> 0:00:06.560 All right, Lucy McBride. You are a Harvard trained physician, 0:00:06.600 --> 0:00:09.200 you've treated patients for more than two decades. You've got 0:00:09.240 --> 0:00:11.680 a new book out called Beyond the Prescription, which is 0:00:11.720 --> 0:00:16.160 about health and navigating our somewhat imperfect health system. Why 0:00:16.160 --> 0:00:17.440 do you think we need this book now? 0:00:17.640 --> 0:00:19.440 Michael? First of all, thanks for having me on the show. 0:00:19.720 --> 0:00:21.319 You know, I see this scene play out in my 0:00:21.360 --> 0:00:25.000 office all the time. People come in having been dismissed, 0:00:25.160 --> 0:00:29.960 talked over, hurried through a medical appointment, through no fault 0:00:30.160 --> 0:00:34.320 of the doctor. The system just doesn't have time. We 0:00:34.440 --> 0:00:37.400 treat patients like a stead of transactions, like a bag 0:00:37.440 --> 0:00:40.600 of organs, instead of real people with real lives, real 0:00:41.760 --> 0:00:45.080 limitations on what they can do based on what the 0:00:45.080 --> 0:00:47.920 doctor recommends. And then what do people do? What would 0:00:47.960 --> 0:00:50.000 you and I do? Is you go on the internet 0:00:50.040 --> 0:00:52.160 when you don't feel well, of course, and you are 0:00:52.200 --> 0:00:59.760 flooded with information, sometimes good information, but sometimes expensive, aspirational 0:01:00.120 --> 0:01:05.839 and pseudoscientific. So I wrote this book to empower patients 0:01:06.160 --> 0:01:08.640 to squeeze the juice out of that fifteen minute appointment 0:01:08.640 --> 0:01:12.000 with their doctor and first to ask themselves a set 0:01:12.040 --> 0:01:16.440 of more nuanced questions about what health is to begin with, 0:01:17.160 --> 0:01:20.039 and how to bring themselves a sort of a more 0:01:20.040 --> 0:01:24.600 honest rendering of their whole health ecosystem to the medical system. 0:01:24.720 --> 0:01:27.200 To put you on the spot with some numbers. Are 0:01:27.200 --> 0:01:29.399 there any numbers that come to mind that sort of 0:01:29.440 --> 0:01:32.319 indicate where the health system is now as far as 0:01:32.400 --> 0:01:33.480 it affects patients. 0:01:33.720 --> 0:01:36.880 Compared to our wealthy peer nations, we spend the most 0:01:37.440 --> 0:01:41.240 money on healthcare and have the worst outcomes. Six and 0:01:41.280 --> 0:01:44.560 ten Americans are living with a chronic disease. We can 0:01:45.280 --> 0:01:48.920 map the human genome, we can three D print a 0:01:49.000 --> 0:01:54.080 beating human heart, and medicine is extraordinarily good at treating 0:01:54.520 --> 0:01:59.480 diseases at damage control, but it's terrible at sitting with 0:01:59.560 --> 0:02:03.600 the person and who has the disease. So health isn't 0:02:03.720 --> 0:02:09.720 just about you know, diagnosis codes and prescriptions and pills 0:02:09.800 --> 0:02:14.200 and you know, dispensing of advice. It's about understanding that 0:02:14.240 --> 0:02:15.920 what the question is to begin with? Who is this 0:02:15.960 --> 0:02:16.799 person in front of. 0:02:16.760 --> 0:02:19.519 Me and what do they need to be healthy? And 0:02:19.520 --> 0:02:22.399 then your book also gets into what do we even 0:02:22.440 --> 0:02:25.240 mean by the word health? Right, I want to get 0:02:25.280 --> 0:02:26.799 into that. I had that later, but let's get into 0:02:26.800 --> 0:02:29.040 it now because I thought that was fascinating, Like people say, 0:02:29.080 --> 0:02:30.880 I want to be healthy, but what does that even mean? 0:02:31.040 --> 0:02:32.919 And figuring out what that means important. 0:02:33.360 --> 0:02:35.640 Yeah, it turns out you really need to know why 0:02:35.639 --> 0:02:39.760 you're alive, and like, what does healthy mean to you? 0:02:40.080 --> 0:02:45.359 It's very easy to default to what someone else's definition 0:02:45.400 --> 0:02:48.960 of health is, particularly in the era of you know, 0:02:49.680 --> 0:02:53.359 social media and online information. You know, for a lot 0:02:53.360 --> 0:02:57.079 of people, health is about a certain set of metrics, 0:02:57.120 --> 0:03:00.480 or a certain body size, or a certain set of labs. 0:03:01.560 --> 0:03:04.679 But health is a uniquely personal phenomenon. So I ask 0:03:04.760 --> 0:03:09.920 patients specifically, like what are you looking for in a year? 0:03:10.040 --> 0:03:11.919 Like what does health look like to you in a year, 0:03:12.639 --> 0:03:14.760 in five years, and ten years, like what do you 0:03:14.800 --> 0:03:16.760 want to be doing? How do you want to be feeling? 0:03:17.160 --> 0:03:19.280 And when you ask people that kind of question, first 0:03:19.280 --> 0:03:21.400 of all, they're often stumped because they're like, well, I 0:03:21.400 --> 0:03:23.480 guess I just want normal cholesterol and I guess I 0:03:23.520 --> 0:03:26.600 want you to give me an a plus on my checkup, 0:03:27.320 --> 0:03:28.760 And I'm like, well, health is not about me. It's 0:03:28.800 --> 0:03:32.360 about you, right, It's about you feeling a sense of 0:03:32.360 --> 0:03:34.800 agency over your health, so that when you're faced with 0:03:34.840 --> 0:03:38.680 a decision like should I get a flu shot, or 0:03:38.960 --> 0:03:41.520 should I take lipidoor or just work on diet and exercise. 0:03:41.760 --> 0:03:45.520 You feel like you have information and you're an informed 0:03:45.600 --> 0:03:48.600 consumer of these decisions. You may be somebody who wants 0:03:48.600 --> 0:03:50.240 to be own natural and you don't want to take 0:03:50.280 --> 0:03:53.800 medicine at all costs. You may be somebody who doesn't 0:03:53.800 --> 0:03:57.560 want to think about the why, the lifestyle factors that 0:03:57.600 --> 0:03:59.520 play into your health, and you just want the pills, 0:03:59.520 --> 0:04:02.320 the prescription see you next year. You don't want to 0:04:02.800 --> 0:04:05.240 deep dive on mechanism. You just want to be told 0:04:05.320 --> 0:04:07.160 what to do. And that's fine, but it's important to 0:04:07.200 --> 0:04:09.560 understand who you are and what your goals are and 0:04:09.640 --> 0:04:12.600 what health actually looks like to you before we operationalize 0:04:12.600 --> 0:04:13.600 a plan around it. 0:04:13.720 --> 0:04:16.440 So that seems to be one of the main potential 0:04:16.480 --> 0:04:18.800 issues with the medical system is like you come in 0:04:18.880 --> 0:04:21.159 and it's just like, oh, labs, labs. It kind of 0:04:21.480 --> 0:04:24.120 the question of what does health actually mean to you? 0:04:24.200 --> 0:04:26.000 Doesn't get asked. What else do you see that you 0:04:26.040 --> 0:04:28.080 think are some of the fundamental problems that we have. 0:04:28.400 --> 0:04:31.279 Well, if you look at the way the system is structured, 0:04:31.360 --> 0:04:35.600 is it rewards patients for volume, for the number of 0:04:35.680 --> 0:04:41.880 patients seeing like RVUS instead of outcomes. Yeah, so the 0:04:41.960 --> 0:04:48.920 commodity that insurance companies value is transactions, prescriptions, procedures. Right. 0:04:50.240 --> 0:04:52.920 We spend ninety five percent of healthcare dollars in the 0:04:53.040 --> 0:04:59.000 US on downstream damage control hospitalizations, er visits, prescription drugs. 0:05:00.120 --> 0:05:05.800 Only five percent is spent on conversation. The conversation between 0:05:05.920 --> 0:05:12.200 primary care doctor and patient. You know, conversation is you know, 0:05:12.920 --> 0:05:15.520 is not what's happening in doctor's offices. Right, Like again 0:05:15.560 --> 0:05:19.760 through no fault of doctors. But when I'm given even 0:05:20.160 --> 0:05:23.159 ten minutes or fifteen minutes with a patient, and I 0:05:23.160 --> 0:05:25.680 can put my pen down and instead of looking at 0:05:25.720 --> 0:05:27.799 my screen, but look at the human and their eyes 0:05:28.400 --> 0:05:30.279 and ask them what's really going on in your life? 0:05:31.120 --> 0:05:33.000 Like what are you embarrassed to say out loud? Or 0:05:33.240 --> 0:05:36.800 what's the worst what's your worst fear? Or you know, 0:05:36.880 --> 0:05:38.400 let's say they come in and they're telling me they 0:05:38.480 --> 0:05:41.640 have chest pain. I can triage that, fine, I can 0:05:41.720 --> 0:05:44.360 order KG, I can order some labs, but you know, 0:05:45.200 --> 0:05:47.479 you have to ask a number of questions first, like 0:05:47.960 --> 0:05:51.640 what's going on? Your chest pain may have started the 0:05:51.720 --> 0:05:54.800 day your spouse will diagnosed with cancer, It may have 0:05:54.880 --> 0:05:58.400 begun when you started taking an anti inflammatory for your 0:05:58.440 --> 0:06:02.080 knee pain and you've got reflocked. Like it takes time 0:06:02.640 --> 0:06:06.080 to surface the actual problem the patient is coming in with. 0:06:06.320 --> 0:06:10.200 It's much easier just to deploy a set of tools 0:06:10.760 --> 0:06:15.440 and like algorithmic sort of investigative tools on a patient 0:06:15.440 --> 0:06:18.240 instead of understanding the why. It turns out you can 0:06:18.279 --> 0:06:22.919 save a ton of money, you improve outcomes, and you 0:06:23.000 --> 0:06:27.039 increase patient's sense of agency and satisfaction when you just 0:06:27.760 --> 0:06:31.000 spend time. But that is not what our system rewards. 0:06:31.040 --> 0:06:35.760 It rewards the doing and not the sitting with people. 0:06:36.040 --> 0:06:40.000 Yeah, so if I'm a patient, what do I do? 0:06:40.400 --> 0:06:43.599 So if my doctor has the fifteen minutes? What's my 0:06:43.760 --> 0:06:45.720 move there? Am I do? I got to sort of 0:06:45.760 --> 0:06:47.520 press them on, hey we need to have a conversation 0:06:47.760 --> 0:06:49.520 or what do you think actually works? 0:06:49.880 --> 0:06:52.760 Well, I mean this is why I wrote a book. 0:06:53.560 --> 0:06:55.600 Well thanks, I think it is a good book. I 0:06:55.640 --> 0:07:00.359 think it's it's work right. So what I'm asking people 0:07:00.400 --> 0:07:04.480 to do by reading this book is I'm saying, look, 0:07:04.520 --> 0:07:08.000 your doctor doesn't have time. It's aspirational to think that 0:07:08.080 --> 0:07:10.120 your doctor's going to have time to understand how your 0:07:10.160 --> 0:07:12.720 divorce is affecting your sleep, which is affecting your blood 0:07:12.760 --> 0:07:15.520 sugar regulation, which is affecting your diabetes. That stuck's not 0:07:15.520 --> 0:07:18.240 going to happen in my lifetime. Maybe it will. So 0:07:18.320 --> 0:07:20.760 what I'm asking to do with this book is sit down, 0:07:21.080 --> 0:07:24.080 and I want you to map your health ecosystem. I 0:07:24.160 --> 0:07:27.480 want you to take this library of questions I put 0:07:27.480 --> 0:07:31.840 out there to surface the sort of nooks and crannies 0:07:31.840 --> 0:07:35.400 of your health. Not just what you eat, like your 0:07:35.440 --> 0:07:37.320 doctor will say what are you eating or what your 0:07:37.520 --> 0:07:41.080 what's your diet like? Or they'll just say like eat 0:07:41.160 --> 0:07:44.720 less sugar, exercise, more sort of prescriptive advice. I want 0:07:44.720 --> 0:07:47.000 you to map your health ecosystem by asking yourself more 0:07:47.040 --> 0:07:50.080 in depth questions. What's your relationship with food? Do you 0:07:50.120 --> 0:07:54.440 eat when you're hungry or do you eat when you're stressed, boored, 0:07:55.360 --> 0:07:59.840 you know, feeling anxious. Let's talk about exercise. Is it 0:07:59.880 --> 0:08:02.600 a sure? Is it a should? Or is it something 0:08:02.600 --> 0:08:05.480 you enjoy doing? Are you not doing it not because 0:08:05.480 --> 0:08:08.920 I didn't lecture you hard enough, but because your avoidance 0:08:09.000 --> 0:08:12.920 of some pain syndrome that you haven't really thought through. 0:08:13.600 --> 0:08:17.960 Or are you over using exercise as a proxy for 0:08:18.400 --> 0:08:21.720 you know, managing anxiety. In other words, I want you 0:08:21.760 --> 0:08:24.280 to sit. What I want you to do is ask 0:08:24.360 --> 0:08:28.840 a little more sophisticated questions of yourself that your doctor 0:08:29.000 --> 0:08:31.440 just doesn't have time to ask you, so that you 0:08:31.520 --> 0:08:35.120 can then have Aha moments in your living room and 0:08:35.240 --> 0:08:37.720 have Aha moments when you're reading the book and say, oh, 0:08:37.720 --> 0:08:41.640 my gosh, I never thought about the football injury I 0:08:41.720 --> 0:08:46.600 had in high school and how I subtly favor this 0:08:46.760 --> 0:08:50.640 side of my body and that makes my whole skeleton off. 0:08:50.800 --> 0:08:54.160 And then my chronic pain is driving my sleep, and 0:08:54.200 --> 0:08:57.200 my sleep is driving my brain fog, and my brain 0:08:57.240 --> 0:09:01.400 fog is making me, you know, inattentive and anxious. Like 0:09:01.600 --> 0:09:04.200 all of these things are related. Yeah, and you need 0:09:04.240 --> 0:09:06.440 to connect the dots on your own. Unfortunately, it's on 0:09:06.559 --> 0:09:09.280 the patient to do a lot of pre work before 0:09:09.280 --> 0:09:10.800 you even show up in the doctor's office. 0:09:11.000 --> 0:09:15.000 Yeah, you have a lot of amazing anecdotes about that 0:09:15.000 --> 0:09:17.040 that never kind of like aha moments for me where 0:09:17.080 --> 0:09:20.560 someone will come in for, you know, one reason, and 0:09:20.600 --> 0:09:23.559 then you start talking to them and it turns out 0:09:23.600 --> 0:09:26.640 there's this whole other thing going on under the surface. Right, 0:09:26.840 --> 0:09:29.280 How did you, like, how did you start to because 0:09:29.320 --> 0:09:31.520 you're in the system, right, like, you have to work 0:09:31.520 --> 0:09:35.360 with patients relatively quickly. So what was your own aha 0:09:35.440 --> 0:09:37.880 moment where you started to realize, Oh, there's all these 0:09:37.920 --> 0:09:40.680 other things going on. It's not just the blood sugar 0:09:40.720 --> 0:09:42.440 or the headache or whatever. It is, Like, what is 0:09:42.480 --> 0:09:44.520 actually all the underlying reasons behind that? 0:09:45.080 --> 0:09:46.880 So, first of all, I'm not in the system. I 0:09:47.960 --> 0:09:51.280 was in the system, and I saw the patients were 0:09:51.280 --> 0:09:54.199 being treated like a set of transactions. So I built 0:09:54.200 --> 0:09:57.520 my own practice in order to be able to have 0:09:57.600 --> 0:10:01.520 time with patients, and I've i brought in a number 0:10:01.520 --> 0:10:06.520 of other doctors who also left academia to be in 0:10:06.559 --> 0:10:09.040 a place where they can actually treat the person, not 0:10:09.160 --> 0:10:13.679 just the diagnosis codes. But I've always been interested in 0:10:13.760 --> 0:10:16.839 Michael in the human experience of illness. I myself was 0:10:16.920 --> 0:10:21.319 a patient. I myself was a patient. I was a 0:10:21.400 --> 0:10:23.760 victim of the same system that we all participate in, 0:10:24.400 --> 0:10:27.240 and by the way, we all need doctors. I was 0:10:27.280 --> 0:10:29.520 somebody who had a number of health problems in her 0:10:29.559 --> 0:10:34.440 twenties who just needed to be asked like how are 0:10:34.480 --> 0:10:38.840 you doing? Like what's going on? I was tested for 0:10:38.920 --> 0:10:41.960 brain tumors and giardia, I had MRIs. I had every 0:10:42.000 --> 0:10:43.959 lab test in the world, and when I was told 0:10:44.000 --> 0:10:47.360 your labs are normal, you know, pat on the head, 0:10:47.640 --> 0:10:50.520 I felt more crazy and I just got sicker and 0:10:50.559 --> 0:10:53.960 more anxious and sicker and more anxious. And so it 0:10:54.040 --> 0:10:59.560 took me kind of doing some like investigatory work about 0:11:00.200 --> 0:11:02.080 like who am I and what's going on and like 0:11:02.280 --> 0:11:04.840 where to get the help that I realized like, wait 0:11:04.840 --> 0:11:09.000 a minute, this thing that I'm studying, Medicine is excellent 0:11:10.240 --> 0:11:14.120 at ruling things out and damage control and treating disease, 0:11:14.840 --> 0:11:19.760 but it's not great at understanding this person. And if 0:11:19.800 --> 0:11:26.120 we're not as physicians, equipped trained, or given time to, 0:11:26.520 --> 0:11:29.680 you know, elicit what's actually going on in people's lives, 0:11:31.960 --> 0:11:36.360 even a mundane interaction can go completely wrong. Like I 0:11:36.400 --> 0:11:38.800 can recommend lipatore to you because it's the right thing 0:11:38.800 --> 0:11:41.320 to do after a discussion of you know why you're 0:11:41.360 --> 0:11:45.320 cholesterol is high, but you need to trust me enough 0:11:45.360 --> 0:11:47.160 to say, you know what, Doc, I may not take 0:11:47.200 --> 0:11:51.400 that because I'm worried about X. Like you have to 0:11:51.480 --> 0:11:54.920 have trust and rapport with the person who's dispensing advice 0:11:55.040 --> 0:11:57.679 about your health so you can be the best doctor 0:11:57.679 --> 0:12:00.760 in the world. The best trained physician all the tools 0:12:00.800 --> 0:12:05.760 and be appropriately prescribing medications. But unless that person trusts 0:12:05.760 --> 0:12:08.760 you and understands and believes that they have your best 0:12:08.760 --> 0:12:11.600 interest in mind, they're going to do anything you say. 0:12:12.360 --> 0:12:14.840 So you know, I'm sure it's true for you in 0:12:14.880 --> 0:12:18.240 your life and for people listening to this podcast. The 0:12:18.280 --> 0:12:22.040 people in your life who you trust are people who listen, 0:12:23.559 --> 0:12:28.760 who pause, who ask follow up questions, who are humble 0:12:28.760 --> 0:12:32.440 about what they don't know, who are saying, let me 0:12:32.600 --> 0:12:36.320 help you figure that out. They're empathetic and like I 0:12:36.320 --> 0:12:40.319 think doctors are those things, but the system has squashed 0:12:40.360 --> 0:12:45.080 the humanity out of medicine such that it's very hard 0:12:45.120 --> 0:12:47.719 to practice in those conditions. It's hard for patients to 0:12:47.720 --> 0:12:50.040 feel like they're understood. It's hard for patients to believe 0:12:50.120 --> 0:12:51.199 the advice are being given. 0:12:51.480 --> 0:12:54.160 Do you have a sense what sort of share or 0:12:54.200 --> 0:12:56.560 percent of patients come in for a health issue where 0:12:56.600 --> 0:12:59.440 the underlying issue is just kind of a life issue. 0:12:59.760 --> 0:13:02.720 Oh, i'd say. I mean, first of all, every single 0:13:02.720 --> 0:13:05.960 health issue has a life issue attached to it, So 0:13:06.000 --> 0:13:09.680 I'm not saying that like every person with chest pain 0:13:09.960 --> 0:13:15.720 has some like psychological problem underlives, but I will say 0:13:15.760 --> 0:13:20.200 that it's not surprising anymore because I've been doing this 0:13:20.200 --> 0:13:24.360 this long. Everybody has a story. The most important data 0:13:24.760 --> 0:13:28.080 that you have often isn't in your lab tests, you know. 0:13:28.160 --> 0:13:30.600 I mean, you can take two people with the same 0:13:31.080 --> 0:13:35.400 high blood pressure reading, and one person got there because 0:13:36.800 --> 0:13:39.280 they're in a they're having a tough time in their relationship, 0:13:39.320 --> 0:13:42.120 they're drinking too much alcohol more than they want. They're 0:13:42.160 --> 0:13:44.440 not sleeping while they're stressed at work, they're drinking coffee 0:13:44.520 --> 0:13:47.240 to stay awake and alert, and they're just kind of 0:13:47.240 --> 0:13:50.760 wired and tired and amped up. And their blood pressure 0:13:51.880 --> 0:13:56.280 problem doesn't need more blood pressure medicine. It needs someone 0:13:56.320 --> 0:13:59.440 like me to say, look what's going on, understand it, 0:13:59.520 --> 0:14:03.520 and say, look, let's work on stress management, a plan 0:14:03.679 --> 0:14:08.880 to help you moderate your alcohol without lecturing you and 0:14:08.920 --> 0:14:11.160 making you feel bad. And then another person could have 0:14:11.200 --> 0:14:14.480 a high blood pressure because they are genetically predisposed to 0:14:14.520 --> 0:14:16.680 high blood pressure. They are eating a low salt diet, 0:14:16.720 --> 0:14:20.040 they're exercising every day, they follow the Michael Easter two 0:14:20.120 --> 0:14:23.600 percent plan. They are taking the stairs and not the elevator, 0:14:24.000 --> 0:14:26.560 and they just have high blood pressure and it's not 0:14:27.120 --> 0:14:29.920 there's no psychological element to it. That's that there's always 0:14:29.920 --> 0:14:32.120 psychological element of blood pressure. I have patients come in 0:14:32.120 --> 0:14:34.840 and their blood pressures high just by seeing me. 0:14:35.320 --> 0:14:37.560 That's me, that's me in the doctor's office. It's always 0:14:37.560 --> 0:14:39.480 through the roof when so. 0:14:39.360 --> 0:14:42.160 Psychology is always relevant, right, And then I have patients 0:14:42.160 --> 0:14:45.320 who are anxious about the idea of having high blood pressure, 0:14:46.320 --> 0:14:48.800 and so then they give the high blood pressure when 0:14:48.800 --> 0:14:50.840 we're checking it, and then it's this sort of like cycle. 0:14:50.880 --> 0:14:52.200 I'm like, look, we're not going to check your blood 0:14:52.200 --> 0:14:53.760 pressure in my office ever again. I'm just going to 0:14:53.840 --> 0:14:57.400 have you do it at home. So like you cannot 0:14:57.440 --> 0:15:01.120 separate emotional health from our physical health and the way 0:15:01.120 --> 0:15:04.680 our bodies show themselves in your everyday life or in 0:15:04.680 --> 0:15:07.000 the doctor's office. So it's always relevant. 0:15:07.200 --> 0:15:10.120 Yeah, all right, So, speaking of two percent, you did 0:15:10.160 --> 0:15:13.120 a piece for my sub stack called the comfort Crisis 0:15:13.120 --> 0:15:15.880 in the doctor's office, and I think the big point 0:15:15.880 --> 0:15:18.720 of that because my audience on subsec and also on 0:15:18.720 --> 0:15:22.000 this podcast, they're generally health motivated people. You kind of 0:15:22.000 --> 0:15:24.600 wrote that they're great at pretending that everything is just 0:15:24.680 --> 0:15:27.360 absolutely perfect. They're doing all the right things, but they 0:15:27.400 --> 0:15:29.960 won't really bring up the uncomfortable things that need to 0:15:30.000 --> 0:15:34.720 be unpeeled. What should what should people actually be telling 0:15:34.760 --> 0:15:36.040 their doctor given that? 0:15:36.520 --> 0:15:39.720 So let me cavy up this by saying that it's 0:15:39.760 --> 0:15:41.960 hard for people to talk about hard things. It's hard 0:15:42.000 --> 0:15:48.760 for doctors sometimes to countenance uncomfortable subjects like sexual dysfunction, 0:15:49.680 --> 0:15:56.280 you know, disordered eating addiction. But if I had one 0:15:56.400 --> 0:16:00.120 question to ask people at their annual checkup, like a 0:16:00.160 --> 0:16:03.120 well well person visit, it would be like, what are 0:16:03.160 --> 0:16:05.120 the things you're What's the thing you're most afraid to 0:16:05.200 --> 0:16:07.000 tell me out loud? Or what's the thing you're most 0:16:07.000 --> 0:16:11.840 embarrassed to say to yourself? Because the things that people 0:16:11.920 --> 0:16:14.200 don't say out loud are often the things that are 0:16:14.600 --> 0:16:19.160 sort of eating them up and that are causing them 0:16:19.200 --> 0:16:24.560 to have that gravitational pull towards alcohol or sugar or 0:16:25.440 --> 0:16:28.960 doom scrolling or just some other avoidance behavior, some behavior 0:16:29.000 --> 0:16:34.560 that's causing them to numb out or dissociate. And you know, 0:16:35.240 --> 0:16:38.520 our health is informed by our behaviors, right like behavioral 0:16:38.520 --> 0:16:41.080 health like the way we eat, the way we sleep, 0:16:41.120 --> 0:16:44.320 the way we exercise, the way we move, the way 0:16:44.360 --> 0:16:47.600 we relate to other people is inforigned by our thoughts 0:16:47.600 --> 0:16:50.160 and our feelings. So like, unless you elicit like what's 0:16:50.240 --> 0:16:53.440 actually going on inside, you're really kind of nibbling around 0:16:53.480 --> 0:16:57.160 the edges of understanding that person. Yeah, so it's a 0:16:57.200 --> 0:17:00.400 great moment when a patient can tell me, like, you 0:17:00.440 --> 0:17:05.200 know what I am feeling, like really, I'm perhassed by 0:17:05.200 --> 0:17:09.640 my boss, or I am worried that I haven't had 0:17:09.680 --> 0:17:14.399 sex with my partner in five years. And that opens 0:17:14.480 --> 0:17:17.160 up a whole conversation that is empowering to the patient 0:17:17.160 --> 0:17:18.920 because there are things you can actually do about that. 0:17:19.560 --> 0:17:21.439 There are things you can actually help people with. I 0:17:21.440 --> 0:17:25.919 mean there's you know, from relationship based counseling to vaginal 0:17:26.040 --> 0:17:30.399 estrogen and hormone therapy to just normalizing the experience of 0:17:30.480 --> 0:17:34.480 someone feeling vulnerable in their workplace. I mean we're all 0:17:34.520 --> 0:17:38.359 walking around like feeling vulnerable and scared, and you know, 0:17:38.520 --> 0:17:40.600 we self medicate in many different ways. 0:17:40.880 --> 0:17:44.879 Yeah, it's like that opens up what the what the 0:17:44.880 --> 0:17:47.040 real underlying problem is. Just trying to do some other 0:17:47.040 --> 0:17:48.760 stuff on the side is not going to fix I mean, 0:17:48.800 --> 0:17:51.320 you're just kind of like, you know, trying to add 0:17:51.359 --> 0:17:53.199 tire to the wheel that has a giant hole in it. 0:17:53.520 --> 0:17:57.280 That's right. So It's not that every disease process has 0:17:57.280 --> 0:18:01.399 some like psychological underpinning. It's that he human beings have 0:18:01.480 --> 0:18:04.080 thoughts and feelings and behaviors that have to be woven 0:18:04.080 --> 0:18:08.040 into the conversation about health. Even when you think about 0:18:08.040 --> 0:18:11.760 like compliance with medications, or you know, I can tell 0:18:11.760 --> 0:18:16.800 people all day long, eat less sugar, exercise more, lose 0:18:16.880 --> 0:18:19.960 ten pounds, see an next year, right, and that's a 0:18:19.960 --> 0:18:23.600 lot of doctor's appointments, right. Yeah, But unless someone's given 0:18:23.640 --> 0:18:27.840 a roadmap and sort of a pathway and also like 0:18:28.520 --> 0:18:32.639 interval check ins, it's really unrealistic to think someone's going 0:18:32.680 --> 0:18:34.720 to make a behavioral change. I mean, behavioral change is 0:18:34.800 --> 0:18:38.120 arguably the most difficult thing to do, like in ourselves. 0:18:38.600 --> 0:18:42.320 And when you're advising someone else, it sounds really good 0:18:42.359 --> 0:18:48.160 to say, look, take this prescription, lose ten pounds, get 0:18:48.160 --> 0:18:52.080 more cardio, get more strength, work sleep eight hours flows 0:18:52.080 --> 0:18:56.880 after every meal. But unless that person is a trusting 0:18:56.960 --> 0:18:59.560 of my advice, believes that this is actually going to 0:18:59.600 --> 0:19:03.760 help them, it has a realistic, sustainable plan laid out 0:19:03.760 --> 0:19:04.879 for them, it just doesn't happen. 0:19:05.440 --> 0:19:07.879 Yeah, totally. I mean that's one of those things where 0:19:08.080 --> 0:19:09.960 you know the government has been giving that advice for 0:19:10.000 --> 0:19:12.960 free since about nineteen fifty, and so just hearing it 0:19:13.240 --> 0:19:15.080 one more time probably is again to move dile. You 0:19:15.119 --> 0:19:17.160 need some sort of okay, well, how do I actually 0:19:17.240 --> 0:19:19.119 put it in my life. We'll take a break and 0:19:19.160 --> 0:19:22.280 then Lucy will explain the upsides and the downsides of 0:19:22.359 --> 0:19:33.600 the wellness movement. If I go online, say on Twitter, 0:19:33.840 --> 0:19:36.920 there's a lot of people in the wellness sphere who 0:19:36.960 --> 0:19:41.160 say that doctors just push medications today. What is your 0:19:41.280 --> 0:19:43.080 response to that. I feel like doctors are taking a 0:19:43.119 --> 0:19:43.840 lot of heat today. 0:19:44.040 --> 0:19:45.720 Yeah, we're taking a lot of heat. And I think, 0:19:47.080 --> 0:19:49.560 you know, I understand that. I mean, people are really 0:19:49.600 --> 0:19:54.159 really feeling disenfranchised from the medical establishment. They're feeling disenfranchised 0:19:54.160 --> 0:19:57.080 from their own bodies. But again, I will say this 0:19:57.119 --> 0:19:59.879 from the hilltops, like it's not doctor's fault, right, This 0:20:00.040 --> 0:20:06.000 system is anti doctor, anti patient. Your question is about 0:20:06.000 --> 0:20:08.920 the wellness industry. By the way, I am pro wellness. 0:20:09.160 --> 0:20:13.600 I'm wellness adjacent, like I welcome wellness. In fact, that's 0:20:13.640 --> 0:20:16.760 what medicine needs to adopt is the concept of wellness, 0:20:16.760 --> 0:20:22.359 which includes helping people, meeting them where they are and 0:20:22.440 --> 0:20:25.119 understanding who they are, and then empowering them with tools 0:20:25.160 --> 0:20:29.840 and information that apply to their actual situation. But because 0:20:29.960 --> 0:20:34.159 medicine can't do that well, the wellness industry has taken 0:20:35.440 --> 0:20:40.160 its place in many ways. So your question was about 0:20:40.200 --> 0:20:44.120 when you see like a wellness influencer talking about doctors 0:20:44.160 --> 0:20:48.000 just prescribe medications. I think it's true that doctor's default 0:20:48.000 --> 0:20:52.040 to prescription writing you're crying in my office. Here's prozac 0:20:52.400 --> 0:20:56.080 high cholesterol, here's lebataire high blood pressure, here's a beta blocker. 0:20:56.920 --> 0:21:02.800 When what's empowering to patients is aunderstanding where lifestyle factors 0:21:03.359 --> 0:21:08.400 may play a role in lowering blood pressure, lowering cholesterol, 0:21:08.560 --> 0:21:12.960 improving mood, and then using medications as a tool, just 0:21:13.080 --> 0:21:18.760 like you know, exercises. I also think the wellness industry 0:21:18.760 --> 0:21:21.360 can be equally prescriptive. You know, it's like, got bloating, 0:21:21.760 --> 0:21:25.600 Take this supplement, got you know, brain fog. Try this 0:21:26.400 --> 0:21:29.639 when the bloating maybe because they're constipated and they need 0:21:29.680 --> 0:21:32.560 to have more dietary fiber, or their brain fog maybe 0:21:32.600 --> 0:21:35.199 because of metopause and they need hormone replacement therapy. So 0:21:36.080 --> 0:21:39.080 it's not an either or, it's a both. And the 0:21:39.160 --> 0:21:44.240 question isn't do people need prescriptions, and you know sometimes 0:21:44.240 --> 0:21:50.520 supplements they do, it's whether that advice matches the individual's 0:21:50.640 --> 0:21:51.399 actual problem. 0:21:51.720 --> 0:21:57.400 Yeah, where have you seen wellness help patients? Some might 0:21:57.400 --> 0:21:59.720 be obvious. I think you'd probably say, like exercise, eating, Well, 0:21:59.760 --> 0:22:01.399 where have you seen it actually harm them? Because you 0:22:01.440 --> 0:22:03.600 had some interesting anecdotes in the book about people who 0:22:03.720 --> 0:22:05.880 tried some wellness things that backfired. 0:22:06.480 --> 0:22:10.040 Well, first of all, nature doesn't always have our back, right, 0:22:10.080 --> 0:22:12.159 I love, I mean, nature is wonderful, right like, but 0:22:12.400 --> 0:22:17.159 but like, arsenic comes from nature. And I've seen patients 0:22:17.160 --> 0:22:20.000 have liver failure from green tea extract. I've seen people 0:22:21.000 --> 0:22:23.520 overdose on vitamin D. You know, if one is good, 0:22:23.600 --> 0:22:26.600 then five is better, and then they're vitamin D toxic. 0:22:28.359 --> 0:22:32.120 I've also seen people be so anti prescription that they 0:22:32.160 --> 0:22:37.920 think they can kind of like out exercise their genetic 0:22:38.200 --> 0:22:41.359 coronary arter or disease. So take my patient who's in 0:22:41.400 --> 0:22:46.120 his mid fifties, who is a lifelong athlete, and I 0:22:46.119 --> 0:22:47.960 think it's great that he comes in every year with 0:22:48.000 --> 0:22:50.440 like spreadsheets on his you know, he's got his CGM, 0:22:50.560 --> 0:22:53.760 he's got his step tracker, he's got his like you know, 0:22:54.520 --> 0:22:56.040 personal records for various. 0:22:56.720 --> 0:23:01.119 Time, whoop scores, mild time, exactly everything, and that's awesome. 0:23:01.119 --> 0:23:03.480 That floats his boat like that. For someone else would 0:23:03.520 --> 0:23:06.919 be like, you know, too much surveillance on the bodily system. 0:23:06.920 --> 0:23:09.560