What To Do If Your Doctor Gaslights You | Dr. Bayo

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2:00I had just delivered my second child via C-section. It had been 30 minutes, and I knew something wasn't right. So I pressed my call light, and my nurse kept saying, Oh, you're fine. Your vital signs look fine. You look fine. I pressed it four times, and she kept saying everything was fine. I had retained products. And so I was bleeding internally. Although I knew about that statistic and I know that Black women are likely to die, that almost happened to me. This is so important to me, to help people advocate for themselves.

2:37Doctor Mike: Have you ever been gaslit by a medical professional? An ex-boyfriend, maybe, but your own nurse? A doctor? That's someone you're supposed to be able to trust. Unfortunately, it turns out the quality of care you receive at the hospital might depend on the color of your skin. Dr. Bio is a board-certified family medicine physician who nearly lost her life as a patient when a nurse attempted to downplay her symptoms as if they were completely normal. She survived, but unfortunately, Dr. Bio's story is not an isolated incident. As she explains today, black women often experience worse childbirth outcomes because of longstanding inequities in access, quality of care, and how seriously their concerns are taken.

3:21Doctor Mike: Today, we break down what systemic problems still exist, how to deal with a problematic or dismissive doctor, and the website you need to use if you want to find a clinician who cares. Please join me in welcoming Dr. Bayo to the Checkup Podcast. You strike me as the creative type. So how does one with such creativity, with such an outgoing, happy personality, become a physician? So non-traditional journey, All credit, though, goes to my father. So my father was a triple war veteran. He was World War II Korean in Vietnam. And he passed away just a few years ago at the age of 99. And so I would go to the VA when he would have knee pain, stomach pain.

4:05And unfortunately, I would watch the dismissal that would happen where the health care professionals would say, You're fine, Bill. You're fine, Mr. Curry. It's not that bad. And in that moment, I knew I wanted to do something different for other people because watching my dad's face and he was a strong man. And for him to take the time to drive to the VA and say something's wrong with me. For a man, too. That's tough. For a man.

4:32Doctor Mike: A soldier. A man. And remember, World War II was segregated. So this man went through a segregated war. And so for him to say something's wrong and to watch that level of dismissal, that was the first touch point where I knew I wanted to go into health care and find a way to help advocate for people. So all credit goes to him. Yeah, he was a powerhouse. So in going through that journey, what was it like when you started college? Did you know right away med school was going to be on the agenda for you or what was the path? So I knew I wanted to go into medicine, but I wasn't sure. and I found myself studying psychology and I worked with autistic children and I love the behavioral analysis, the one-on-one.

5:16And in that time, so I met someone who was a PA and I was like, oh, this looks fascinating where I can still have some hands-on, do a little bit more science and in a new way. And so I applied to PA school and I remember my graduate professor who thought I was gonna go into psychology was like, what the hell is happening here? And I'm like, I don't know. But I feel like I need to do this. So I moved to Marietta College, went to PA school. And that was a culture shock because there really wasn't, there's not a lot of people that look like me in my own town. But in Marietta, Ohio, Appalachian, it was even less.

5:51And so I moved down there. Why specifically there?

5:55Doctor Mike: Like how did you? That's where I got in. So I've had, you know, I applied lots of places and did not get in. I had pretty decent grades, but just never got in. and I have some learning disabilities as well. So I have a little bit of extra TLC that I have too. That's what I like to call it. But Marietta College said yes. So I found myself there, did rotations, and then worked for three years as a PA. But I knew my last year as a PA that this was not where I was going to say, I wanted to be a doctor. I wanted to do more. I wanted to learn more. Not that the PA profession, it's rich in information.

6:33But for me, I really wanted to understand why does that happen? And I think a level of curiosity, which I've always had, has always been that common thread. And that led me to decide my third year in as a PA to leave my job and apply to medical school. And then I moved.

6:52Doctor Mike: Well, I mean, you tell that to your loved ones. Do they just look at you and go, what are you doing? You have a job. They thought it was crazy. They were like, I can't believe you're going to leave. and the day I got accepted to medical school, my husband actually got laid off at work. And so it was a terrible - Oh my God, talk about a culmination of events. And so people are like, are you gonna go? I'm like, absolutely. And so we've been together 25 years and he knows that I'm a woman on a mission and we've always had this level of uplifting and supporting. And so even though he had terrible news, when I told him that I got in, he didn't even tell me that he got laid off in that moment.

7:27We celebrated that night. We had salted caramel ice cream, which I love. And then, you know, the next day he's like, we're going to figure it out. It'll be fine. Wow. So I went.

7:36Doctor Mike: So what was going through your head in that moment? Did you think like, I messed up? I shouldn't have done this? Or you're like, no, no, no, this is the way. This is what I want to do. Wow. Steadfast. And at that point, were you just saying, I want to finish medical school? Or did you already have a specialty in mind? So I knew either family medicine or pediatrics based on my personality, where I should be. and so went through, got into Ross University, which I was so grateful. Had some challenges because, and people may be surprised because I often hear, well, you were a PA. I'm sure it was easy to go through medical school.

8:13Absolutely not.

8:14Doctor Mike: Oh, really? And yes, I had - You would think some of that background would translate. It did help, but there's a critical thinking that you and I know that it's different for medical school versus PA. And I had to change - Well, actually, I have no idea. I'm curious what the difference is. It's true. It's where in PA school, I understood how to identify things, but I didn't necessarily understand the path of physiology, all of the pieces behind it. Because when you look at PA school, it's normally two years of a program, but medical school, you've got four years and then you've got residency. So there's no way you can capture all that same information that you would get in a seven-year program with a two-year program.

8:50So I had to change the way I studied. And that was hard because I'm like, well, what's going on? Why am I not doing well? So I got challenges. So I had to start learning that I'm better auditorial processing. Yes. And so once I discovered that and I started recording or saying things out loud, it was a game changer. And I felt like, okay, I've got my groove. And that made a huge difference.

9:17Doctor Mike: You strike me as a person with a lot of energy. I love to listen to lectures at 2X speed. Was that something that worked well for you as well? you are my person this is true that's exactly what I do and I would just do it on loop that's exactly what I do like even with audibles like with the book I'm reading right now I'm literally reading a book right now I'm at a 2x speed I can't do 2x for some readers oh I can do 1.5 to 2 so it depends on the speaker a lot of med school professors I wish there was a 3x option so the mitochondria Andrea. I'm like, I just can't. I'm like, I need you to speed it up.

10:00We need to get it going. Exactly. And so when I discovered that it was.

10:04Doctor Mike: Does that make us bad people? No, no. That's okay. We're just different. We dance to our own beat. That's true. But I feel like, you know, they would say, Oh, kids don't read anymore. You're all listening to stuff. That's because your brain is not developed. And I always used to think it was a negative, a flaw within me. I don't know. Maybe it's okay. Maybe we're just different. People learn differently. I think we all learn differently. And I wish that it's getting better. The world is more accepting. But yes, if you can identify how a child learns early on, imagine what you can unlock and the ability.

10:37Because I felt like in medical school, there was a level that opened up that I was like, oh my gosh, this was missing my whole life.

10:46Doctor Mike: Oh, so you were craving the more information. But I couldn't necessarily always figure out how to get it all in or figure out. But once I learned that, I was able to take off as far as like with my studies. And then you mentioned earlier that you were diagnosed with a learning disability. How was that handled during medical school? So it was challenging because in PA school, I had some problems where they were like, well, we're not really sure how to help you. And so I was like, well, this is what I need. And in medical school, there were some challenges being able to get access to someone actually helping me have those materials to be able to listen to my lectures and know that I may not necessarily need to be in the classroom.

11:28I can listen to it. Like that's actually better because I get distracted in the classroom. So once I got everything, I advocated for myself and was able to get those things done. Yeah. And that's kind of what happened. But interesting, the other thing that I found that was important to me when I started PA school, I also was challenge with why am I having a hard time focusing? Well, they had the rule that you are not allowed to work or do anything, which I get because you have to concentrate on your studies. But for me, that wasn't right. I needed to do something. So I advocated to teach dance classes at the YMCA.

12:05And they're like, what do you mean you want to do this? I'm like, because I've taught dance my whole life. I've danced my whole life in Reno. I started this little program for kiddos in rural areas. So we had dance classes and then I got Walmart, different places to donate for the recitals. And I needed that in my life. And so I was able to teach dance classes in Marietta, Ohio, and it made my grades better.

12:30Doctor Mike: Wow. And I did that every place I went. I'm like, I need that. This is such a common story that I hear from patients, parents of patients of mine, where they say, my child's not doing well in school. And it's actually not the typical learning disability that the parent is thinking of that they're not capable of being cognitively sound. The reality is it's too simple for them or not enough is happening where actually you turn up the intensity and they're able to keep track better. I actually have a friend of mine who is part of my Ferrari Racing League and his doctor told him that he apparently would never do well in school because he can't pay attention.

13:12Doctor Mike: And when he gets into the car, it requires so much focus, so much quickness that they thought he would never be able to drive, get a driver's license, yet he's performing on a semi-professional level now. So it's interesting how sometimes you actually need to up the gas in order to have better control rather than slow things down for some students. Correct. I know there was a video where I think he was a medical student like studying in a club. Like you hear all this noise And he's like, that's kind of, what can I do to put that energy into something else, the right source? And then I'll soar.

13:46And that's what I needed. Because when I look back at my life, I've always done something else. I've never been one person to have one job. A movie, Cool Runnings, where you have five or six jobs. That's me. And that's my happy place.

13:59Doctor Mike: Yeah, it's kind of similar from a physiology standpoint of why white noise allows us to fall asleep. Because once you overload, the brain kind of relaxes. and it says, oh, well, there's a lot of noise happening. It's consistent. We don't need to constantly flash brainwave attention to this. And it allows you to chill out. So maybe our brains are just a little bit more wired for chaos, which is good for medicine, I think. I think so too. Right when you said 2X, you had me. I was like, oh. Did you ever have, maybe on the sad side, classmates, professors judge you for the approach that you took, the fact that you were working in healthcare, but now made this pivot?

14:37Yes. I would say the first kind of experience or example of judgment was when I moved to PA school in Ohio and I said I'm a dancer. And there was a whole nother concoction of what they thought that meant. But they also felt like that meant I didn't have the intelligence to be able to even be there in PA school. And then let's just lift the veil. I am a very happy, smiley person. And sometimes, you know, you can have those assumptions that if someone is outgoing, if someone is, you know, very warm, which I love, I love to embrace people. I love taking in. I get so excited. But then there's this.

15:16And so I've had to constantly fight to show, oh, no, I'm a very good doctor and I know what I'm doing. And I wish there wasn't such a separation of the two. You can be warm. You can be, I remember in family medicine residency, my first OB-GYN, Dr. Bethel, God love him. And he said this to me. He said, do not expect me to respond to your happiness. And I said, I don't because it has nothing to do with you. And the nurse is everything. And he's like, I bet you$100. Do they give you the snaps? And then they're like, oh my God. And then they said this. He's like, I bet you$100 that that happiness won't last through residency.

15:57And I was like, okay, let's bring it on. And, you know, I got my hundred dollars and I love Dr. Bethel to this day, but he realized, you know, this, this is who I am.

16:07Doctor Mike: You weren't putting on a show. No, this is me. And I do not have a thyroid problem. That's the other thing people ask. No way. They ask you about thyroid problems. Wow. Because I have a thyroid. I'm like, no, like other, you know, I'm like, this is how I've always been. And again, all credit goes to my dad because here's someone who experienced really bad things, but he would always tell me, bio, always think of what you can do. That's what he always said. He's like, you're going to face challenges every day, but the power in that is what can you do? And that's how I lived my life. So what is bio like when there's a crappy medical student who's being judgmental when it's been a bad day and there was a difficult patient encounter?

16:52Doctor Mike: Does the happiness go away? Do you have to encourage your happiness even higher? How do you balance that? So it stays. If anything for me, if you are, because I've been judged a lot. I had a medical student just last month. I'm like, oh, I think he thinks I'm tough, but that's okay. So instead I lean into curiosity and I share with this one student. I said, I'm curious, what are your thoughts on how this is going? And he was like, wow, I don't know. I guess it's okay. I think it's fine. I'm like, no, I don't think you do. And he just looked at me and I said, I would love to know. And he was like, well, I don't understand why you keep asking all these questions.

17:32So if you know me in the residency program, they're like, Dr. Bio will say, well, what about this? What about that? I'm the zebra person that's asking. And I said - You're playing the Dr.

17:41Doctor Mike: House role to the top degree. I love it. And I said, the reason why I do that is to build your catalog, all those pieces because if you ever have to pull from it, even if you didn't need it now, you're going to remember that this patient you saw, maybe they didn't have it, but you're going to connect the dots and you could see him like, oh wow. And then, you know, it changed. And so even when I do have a bad day or I know that I'm not getting the respect that I would love to have, I just lean into curiosity and some students may not get me and that's okay. Cause I know I'm not for everybody. and I think the biggest thing for me is knowing that's okay.

18:22Doctor Mike: Yeah, I struggle with that myself going in through third, fourth year of medical school when you're in your clinicals and you're going to new hospitals, so you're meeting a lot of different nurses, CMAs, doctors, residents and you would meet a nurse who's coming off really mean and you're like, wow, they're so mean to me. I'm just here to learn. I'm so excited and then you come to realize that they're the kindest, warmest person, but they're being defensive of their patients. And you're like, wow, my first assumption was that this is a grouch, but this is a person you want taking care of your health because they're being a grouch because the system sucks and they're protecting you from the bad system.

19:03Doctor Mike: And on the flip side, you have people who are like you, so easygoing, so happy, so passionate with so much energy, and you're also doing the right thing. And yet you're taking two drastic approaches. Correct. And both are great. They are. And I'm a bulldog. Like, do not, like if I need a referral, if I, whatever I need, when I get you on the phone, I'll get what I need. I am for, when it comes to my patients with a smile, you know, at 2am I'm like, hello. And they're like, what is it, Dr. Bio? Like, like now they just know that it's going to be this voice on the phone. Like, Hey. And even if you're grumpy pants to me, I'm not going to, my, the other thing my dad said, never let anyone take your character or who you are out of you.

19:46And so I think that has helped when people have been really mean to me. I check who I am. That's them. That's not me. So you can do you, but I'm not changing who I am.

19:59Doctor Mike: Right. That's so powerful. I'm sure people listening, watching might have trouble relating to you because they don't have a lot of positivity or feelings in their life. Do you ever get sad? I do. I get sad. What does that look like? So that looks like often reflecting on something personal that has happened or even a patient that I've lost. And I get very quiet. I tend to have to have some alone time. And I would say to anyone who is like, you know, first words, my happiness. For me, it's really looking at the little things that are positive. So I'm not looking at, oh, what did I achieve? I woke up, I opened my eyes.

20:45For me, I have lupus. I'm not in a flare today. Like those are the little things that I tend to focus on, which I think has been very helpful for me to be very present. But when I am down, if I have a lupus flare, that looks like I'm not going to be moving as much. I'll still smile because the smiling makes me, my heart feel better and it makes me mentally better.

21:09Doctor Mike: Wow. Is that true? you think what they say that even if you smile and you don't feel it neurochemically you start seeing some improvements i think i i definitely feel it i can feel when i smile and i am happy i can feel it from my head to my toes it's just an energy but i do i have those days when i've lost patience and i can as you can tell i feel everything that i say and and how i receive people i guess an empath i'm very much and that's been challenging because sometimes in medicine and we are told that we're supposed to be so stoic and that's not how I am. And so I tend to retreat to myself and I try my best to share with my family.

21:52I need five minutes. I need 10 minutes.

21:54Doctor Mike: So you set clear boundaries. I set clear boundaries. The other thing I do is I try every morning to spend five minutes with myself in my closet. So the rule is mommy's doing her thing. Like, so I have two little girls and if they really need something, they'll slip a note, like check yes or no. Um, under the closet door, but five minutes with myself. And when I've had a bad day, sometimes that five minutes is 10 minutes. Sometimes it's 20 minutes. And when I have missed it, I can feel it. So that, and what are you doing? Are you meditating? What's your, no, I don't have that. Like, you know, I bounce around, but just sitting there asking myself, how are you doing bio?

22:33What, what do you need? I have to physically ask myself those questions and I say it out loud sometimes because then I feel like there's a check like, well, I don't know. I think I'm okay. Maybe I'm not okay.

22:46Doctor Mike: Auditory journaling. It is. Yeah. So that's what I do. Um, five minutes with myself and no one can ask me where the shoes are. Where's lunchbox. Right. Yeah. Being an empath as a doctor, does that lead to higher burnout for you? I think it it probably does and I think if I didn't have a couple things in place one I work at different places so I'm always bouncing around I have the same job so it's the same hospital system but every day is different and I think that helps kind of counter if I was doing the same thing every single day I would not do well I would have a hard time taking in what I was seeing every day and possibly feel really down.

23:32But because I know today I did this, the next day I'm seeing kiddos, the next day I'm doing this or I'm traveling. I think that that has been very helpful.

23:42Doctor Mike: From athletic stuff, like a full court pickup game, swish to athletic stuff, like a half mile stroll. Get those steps in. Head to Sierra or Sierra.com for the brands you want at the prices that let you do it all. From athletic to athletic, ish. Sierra's got it. Your sausage McMuffin with egg didn't change. Your receipt did. The sausage McMuffin with egg extra value meal includes a hash brown and a small coffee for just$5. Only at McDonald's for a limited time. Price and participation may vary. Promotion pricing may be lower than meal pricing. Sam's Club is the club for every holiday club. Guess who's joining the club this season?

24:17Doctor Mike: Walmart Plus. Yep. Sam's Club Plus membership now comes with Walmart Plus at no extra cost. Two memberships, one great price. Just$120 a year can save you time and over$700. Want to get in on the membership duo of the century? Visit samsclub.com. Come join us. Sam's Club. Annual plan only, auto renews, TNC apply, estimate based on average combined. Walmart Plus and Sam's Club Plus savings among members of both for one plus year versus non-member or club member pricing slash fees. Excludes membership fees. See Walmart Plus terms and Sam's Club terms for more info. The holidays are busy enough. Getting your home ready shouldn't be.

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25:10Doctor Mike: Wayfair, every style, every home. Modafinil from Mod.com is changing the way high performers get energy. Modafinil is a prescription treatment that engages multiple pathways in your brain to achieve steady energy and alertness for 10 to 12 hours. And it's now available at MOD.com to qualifying patients. Visit MOD.com for a free consultation and get 10 % off your first order plus free shipping with promo code SPOTIFY. That's promo code SPOTIFY at MOD.com. Kind of adds to what we were saying earlier, how more things sometimes can create calmness. and more focus. Yes, yes. Why family medicine? Oh, I knew it was for me.

25:54I love the continuity. I love seeing every single age and being a part of the entire family. It is so special. And we are the anchor. And I loved my program, especially because the fact that we had to deliver, I don't know if you guys had like 15 where we took care of when mom was pregnant to the delivery and we had to take care of mom and baby. but I love being a part of people's lives. I tell my medical students, I, first of all, I think family medicine is the best specialty ever.

26:23Doctor Mike: Agreed. No bias. Yes, I know. And we should cherish the opportunity we have to be a part of people's lives. And not only am I part of your life when you're 10, but if I get to see you when you're 20, 30, 40, what a gift. Do you have any patients that you've delivered as part of that continuity that are still your patients? I do. Yeah. Isn't that awesome? It's so cool. And you are so proud to see the growth of like what they've become. And it's just amazing. There's nothing else like it. Yeah. Like one of the patients that I participated in the delivery process, because we also had an OBGYN resident there helping us out, her mom started posting her on Instagram recently.

27:12Doctor Mike: and she's like 10 or 12 probably now. And I'm like, I cannot believe that time has flown by so quickly that now you're drinking Starbucks. Where did the time go? Makes you feel quite old sometimes. I do, I was gonna say that that's my second answer. Sometimes I'm like, oh my, like I just remember being in the delivery, but it's wonderful to be. And I also love that we can talk about a lot of topics. Like I'm not pigeonholed. And it's interesting because when it comes to women's health, every once in a while, if I did a speaking engagement, someone will say, well, you're not an OB guy. And why can't, why are you speaking about that?

27:49I'm like, oh, I was trained in women's health. I feel very comfortable. And so I love that I can. And I think for burnout, it is also helpful because I'm moving up depression, women's health.

28:00Doctor Mike: You're not reading EKGs all day long. Because I can't even imagine if I had to just. No, it wouldn't work for me. Same. Yeah. Are there any patients over the last decade or so that stick out to you as patients that have made you proud to be a family medicine doctor? Yes. So there's one patient I remember. She was in her mid-70s, and she came in for back pain. And she was like, I didn't fall. I don't know why this is happening. Maybe it's just, you know, getting older. And so as I was examining her, I noticed kind of a smell. I was like, oh. And my attending was like, well, that's just, quote, unquote, old lady smell.

28:34And I was like, I don't know. it's just what is an old lady's phone because again i'm always like what i love that you're always challenging the status quo i challenge everything so good the running joke was i think i um annoyed but also intrigued my my residency program because i was always just like what about this what about that and so um i do an exam don't see any like step off any sort of weird but i was like let's get an x-ray and she was like i don't know if you don't see anything i'm like well i'm worried about it for a deep fracture you're older all the things and she's like i think i'll be okay comes back a month later and um for something else and i was like well how's your back doing and she's like oh it still hurts and i was like well i'd like to look at that again and um found out on the x-ray she agreed that there was metastatic lesions and i'm like okay how long has this been going on i'm thinking because i inherited her you know from residency and my attending's like well she just probably will have to send her to a specialist and they can figure it out.

29:34And I'm like, no, I just want to ask her a couple more questions. So be guardianly, he was like, okay, go ahead and go back in there. And so I was like, I'm just curious, you know, with this metastatic, we're trying to figure out the primary source. Do you, have you had anything with mammogram? No, I haven't. And I said, please don't take this the wrong way, but I am capturing a smell that I would love to know. Is this, do you smell it as well? That's what I said. And she was like yeah it's terrible and i was like so you smell it too and she's like yeah it's coming from this on her left breast she pulls it up she has a abscess a drainage so it was medicine it was invasive ductal from breast cancer so that she had a maxi pad on that area and it was draining and so that smell was from that area and so i remember her because that curiosity that level of feeling like, okay, I don't want to just have an assumption that she has old lady smell or that it's just this.

30:37And I love the fact that it wasn't a one-time visit. She was coming back for something and I could say, well, remember you had back pain. How is that? And so that sticks with me.

30:47Doctor Mike: Yeah. It's great that you're doing that. I see my residents struggle with this a lot because I also precept residents in our practice and I see them fall into two camps. Camp one is they want to do everything in one visit and they want to solve every problem and they think they're a superhero. And that's good in some ways, but can also create a lot of problems, not just for this individual patient because they're giving them so many things to do. It's so overwhelming. It can be so scary. It also pushes them behind so the people behind are also thrown off. That ruins their day. The residents feel a level of burnout.

31:25Doctor Mike: So no one wins in that scenario. And then on the flip side, they just want a box check and they want to say oh back pain i ruled out a fracture i'm done that i don't need to ask about the smell so how do you teach your residents to think about patients so that they're more holistic but not trying to solve every problem all at once so the first thing is i actually asked them to share what are your assumptions with this patient what kind of answers do you get for those yeah um well there's one story i'll have to tell you oh i think they're just here to seek drugs i just think they are just here to get a medication refill and that's important i'll explain why or i'm not really sure i don't have any assumptions but i don't really think they're that sick so it's been really wild to see some of the assumptions and so i had a medical student i'll never forget so the man was in his mid-30s unhoused had tattoos, came in with stomach pain.

32:24And I asked my medical student, okay, what do you think? After he came back, he's like, I don't know. I think he just wants narcotics and everything like that. And I said, well, on the belly pain, did you notice anything? Well, he had some, a little bit of pain, but it wasn't anything crazy. And I said, so what is your version of crazy? And he's like, well, what do you mean? I'm like, you said his pain wasn't any level of crazy. so that means you are assuming his pain is how did you how did you come up with that yeah and he was like well i guess and i'm like we always have to remember that this is the objective pain is not and that happens often where people feel like and so i go in there fast forward and send him for a ct had an appendicitis and so there were these assumptions that you know he was just there for narcotics and everything like that.

33:15So I lead with what are your assumptions at the door? And then when the patient starts talking, what made you rule in or rule out what, as we know those things, and was it based on assumptions or bias? And it takes a little time, but if you can start to, we live in algorithms, but create your own internal algorithm, even just the one, what what are my assumptions before I go in that door? It's amazing how much more that you can kind of start thinking about, okay, I assume this, my body language may give something to that patient because I'm assuming that they just want something from me or that they're really not that much in that much pain.

33:56So that's what I share. Just that one little piece. Right.

34:00Doctor Mike: And it may not be terrible to have some level of assumption or stereotyping prototyping because part of medicine is doing that, but it's being, trying to become aware of that and find evidence for and against both ways, because otherwise you'll end up just finding proof for whatever it is you want to find proof for. It's like that confirmation bias, but playing out in real time. So I see residents do that a lot. That's interesting that you pointed out. I ask them a similar question, but not with the idea of assumption. I might borrow that because I think that's very valuable. I'll ask them why they think the patient actually came in today, if it's a pain or a symptom that came up that's been ongoing for a long time.

34:47Doctor Mike: Or what do you think the patient's trying to achieve today? Are they looking for a diagnosis today? Do they want the pain or symptom gone right away? If you give them reassurance that this is no red flag symptoms for you that you're comfortable just watching it, would that be okay for them? So I basically try and put them into the shoes of the patient to better understand the patient. But the assumption actually forces them to think about themselves and what biases they're carrying into the room where it doesn't have to be about the person's identity, maybe, but it also could be about typical presentation of appendicitis.

35:24Doctor Mike: Well, it doesn't always have to be right lower quadrant pain. It can be around the embolicus and migrate at some point to the right lower quadrant. So those types of challenges are so valuable. But you told me you had an interesting case or student scenario that played out. Oh, that was the patient, the unhoused patient. But I agree with you putting, and I've shared that with my medical students too, putting yourself in the shoes, but that assumption, because if they are going in with certain assumptions and bias, it will play a role in how you speak to them. if you decide to sit down, if you feel like they're even worth your time or they're, they're wasting your time because all of us, I mean, and those are the conversations I like to have, which are uncomfortable.

36:08Be honest. Like what are your, what are your bias when you go in there? I'm sure you've experienced when a patient is not English speaking, there's a bias that I've seen happen where, Oh, this is going to take a little bit longer. And so when you feel like that going into the room, you may not go in with that openness that that patient deserves. Right. So recognizing it and then figuring out how you can, you know, help your patient.

36:32Doctor Mike: Yeah. And they're seeing one doctor. Right. You're seeing many patients. So you need to come in allowing them to see the best version of yourself because you're the only one they're going to see. And with the crap situation that our healthcare system is already, odds are you don't even have to meet a high bar these days. that is true it's like i'm like i came in i said like hey how's your day going and they're like no one's ever asked me about my day in health care i'm like well this is a really low bar we've set for people we have and you know the other thing that i um love to talk about is like the power dynamic so one thing i've done as an exercise in the past two years with some of my medical students and residents i say i want you to imagine that you're the patient and you check in you're walking through the door people are touching you getting your vital signs all the things but i want you to imagine that.

37:20Then what is it like to sit in the sterile room? You're waiting for someone to knock on the door. You have no idea when they're going to knock on the door. You may have clothes on. You may not. You're going to be on this crinkly paper that is uncomfortable.

37:31Doctor Mike: No back support. No back support. And then you're waiting for someone to come in and say like, okay, this is the test I'm going to give you. This is what I'm going to prescribe. There is an imbalance there. And so if you can recognize what that person went through just to come in your door, that's a huge thing. Yeah. Yeah. We just had a, an encounter. Maybe this wasn't so recent. It was a few years ago with a resident where they were overworked. They were typical ICU rotation. Now they're in clinic seeing patients and they, before they walked in to see the next patient, they said, I have my next patient coming in.

38:08Doctor Mike: And I think they want an extension of their FMLA leave, like their family medical leave. And I said, like, you seem frustrated. Why? Well, they probably just want an extension because they don't want to work. And we had to address that. We had to talk about why they thought that because we didn't even know anything about the patient outside of the fact that the conversation is about FMLA. They went in, hopefully with a more open mind after our conversation. The patient wanted the FMLA to be over so that they could return back to work because they left the previous job. It was toxic for whatever reason.

38:41Doctor Mike: And they wanted to go to their new job that they got, but their FMLA paperwork was still active and they actually wanted it to be ceased and return back to work. And that was a great opportunity for that resident to see, wow, complete 180 from what I expected the scenario to be. And those types of situations where you're forced to vocalize your mess up before and after somehow teaches you so much better. It does because then you can, when you can label it and give it a name, then it becomes memorialized and it becomes part of those lessons that we learn. And those pieces are important. And I thought of a patient that I had last month, which was so, I try my best.

39:24I'm not always best at it, but I try to ask consent every single time before I touch my patient. And so I had a woman who was in her mid forties and she came in for shortness of breath. And I asked her, I said, I would love to listen to your chest. Do you mind if I lift up your shirt? And she stopped me and she's like, what? And I was like, do you mind? And she's like, no one has ever asked me that. People just, normally the doctor just puts, I'm gonna listen to you. And so those types of things that you can do can really help you think about your, that it's not just an interaction or transaction.

39:59These are beautiful relationships. Even if it's for 15 minutes, you are creating a relationship with someone who does not know you, who is going in trusting you, sharing your most intimate things. That's so powerful.

40:13Doctor Mike: Yeah, I mean, it's like one step away from like a religious scenario where they're sharing their most darkest secrets and such. So same level of confidentiality. In fact, maybe more because there's some legal protections here as well. Right. Yeah, I want more people to be practicing healthcare to the level that you discuss it. I'm trying to think of examples of... Oh, I was thinking about the flip side, showing how different patients are. I always try and lead with the same amount of disclosure of what I'm doing, describing the process so it never feels foreign, especially when I'm doing a procedure, let's say, on someone's back, right?

40:51Doctor Mike: Because they don't see, so I want them to feel comfortable. And I had a patient that I was examining an abscess that they had, and we were performing an IND. And I said, I'm going to explain all the steps, and I'm telling them that you're going to feel my hand. you're going to feel this, the injection. And he said, hey, stop telling me everything that you're doing. It actually is fueling my anxiety. And I had trouble because then I went back and had to fill the syringe or what have you. And I started explaining again. He goes, again, stop explaining what you're doing, where oversharing actually became a problem.

41:25Doctor Mike: So now I've kind of adjusted to it. I just drained an olecranon bursitis, I think two weeks ago. and I said, hey, do you want me to explain everything that I'm doing or do you want me to just go about my thing? She said, do your thing. And it made the process so much easier. It makes a huge difference, right? When you said it, I was going to say what I always do, and I actually did a video about this. There was a woman who went in because she had hemorrhoids and she was like, the doctor came in and said, drop your drawers and didn't even tell me what to expect. So I stitched the video and I said, what you can do is say, I would like you to explain this procedure.

41:58If you want to know about it, can you explain to me every single step of the way? And that allows you, if that's something that's important to you to know. But to your point, like having that conversation as a clinician, what would you like to know? And I think that part is missing so much because then that person feels like they have some control over what's going to happen.

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43:19Twas many nights before Christmas, and one woman knew she needed a Christmas tree, so to Wayfair she flew, finding just the right one, and for years it will last. Wayfair shipping was free and remarkably fast. What's this? Garland? A wreath? Essentials to host? Good thing she celebrates way longer than most. As her cart filled with magic and decor from the heart, Merry Christmas to all.

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43:51Doctor Mike: Brussels clean up nicely at Sweetgreen. Maple glazed, roasted, and edges perfectly caramelized. Sweetgreen's fall harvest is back on the menu, and the season's most overlooked little green vegetable is dressed to be devoured. You know what to do. Order on the Sweetgreen app. So this is stuff that we need to work on and improve. But for the patients that are listening and watching, they've had terrible experiences with health care is there a playbook for them what can they do there is like these are my people and you know i always like to start with where that love and passion comes from and i have a couple of stories but the one story that really fueled everything was um i just delivered my second child a vsc section it would have been 30 minutes and a lot of people are familiar with the statistic that black women are three times more likely to die than their white counterparts during childbirth or shortly thereafter and delivered my second child and I knew something wasn't right and I was having a hard time concentrating talking about energy level my energy was not there and so I pressed my call light and my nurse kept saying oh you're fine your vital signs look fine you look fine I pressed it four times and she kept saying everything was fine.

45:13And mind you, this is a hospital that I still work at, medical director, know the floor, have delivered babies there before, did residency part of it so everybody knows me. So I asked my husband to call my doctor because of course, doctor to doctor, I had his number in my phone. He calls Dr. Jack and comes back and he immediately knew that something wasn't right with me. And so he took me to the OR and I had retained products. And so I was bleeding internally and I got transfused. And so that was a very powerful moment because although I knew about that statistic, I know that black women are likely to die.

45:55That almost happened to me.

45:58Doctor Mike: Despite everything else. And so this is so important to me to help people advocate for themselves. yeah and it's terrible that we have to put this on people who are already sick going through it who are bleeding internally right and it just shows that you can have the most access in the world but you can still get dismissed and so I share my story even though it strips me from the inside out because if I can help somebody that's why I do what I do and so um this work is not work It is so important to me to help every single person that I can know that they can advocate for themselves.

46:52Doctor Mike: The shocking reality is there are so many ways people can advocate for themselves, find resources for themselves, find programs to help them. And yet I feel like in healthcare, we do such a bad job promoting these things, almost maybe purposefully at times, where people do feel powerless and then do experience terrible outcomes. And we do end up with these terrible statistics, even when you're a doctor in the place where you practice, even when you're a tennis superstar. Yes, it's wild, you know? And so having certain things in place, for example, being able to have someone with you if you can, calling someone on the phone if that's possible, if there's an advocacy program in the hospital you're at.

47:37And the other thing I love is sharing collaborative language to be able to advocate for yourself in the moment when you feel like you're being dismissed. And so for patients, my love and joy is putting the power back into the patient, but also honoring the restrictions and the pressures that we have as doctors. And I think for me, I love to be, or try to be that bridge where I'm pro-doctor, pro-patient. And how can I find a way to connect the dots? Because the healthcare system is broken. We know that. I personally feel that the healthcare system is a system that is built on speed and not listening.

48:19And that's what they want. They want us to just pump people through.

48:23Doctor Mike: And do you think that's a result of the fact that the system is broken and this is them trying to keep their heads above water? It's a little bit of heads above water, but also just pushing people through, like not taking the time. Like factory farming. Factory where it's just another person. No, it's a human life. It's a life. And so understanding that in order to have better outcomes, which people want the ROIs, all the things, and you need to also invest in where is the mistrust? Where is the gaps that have prevented that? And often, sometimes it's between the communication between the doctor and the patient.

48:59For me, if I can say, for example, if you go to the doctor and you are worried because you've got a couple of symptoms. So writing down what are the top two to three things that are concerning to you. Practicing how you can say it in the language you and I know in a very specific way. We're using this is I can't eat. I'm not able to get out of bed because that helps your clinician know, oh, my, this is a whole nother level. versus this is just something that is kind of not too bad. And so I think there's real opportunity to help people use that language, but also language that doesn't put your clinician on the defense.

49:39And that's what I pride myself. So collaborative. So instead of saying, why didn't you do this? I share online, help me understand. What were your thoughts behind that for a patient to say that? Or I see a lot of times people online are like, well, I was just told my labs were normal and I know something's wrong and I honor it. That's incredibly frustrating. So I share, use this language. I would like to know if my labs are normal or abnormal, what are our next steps? Because I'm still not feeling well. That gives the clinician the information, but also gives the patient information to have an ongoing conversation.

50:19and that's what I, that positivity piece, that's what I like to do.

50:26Doctor Mike: It's very powerful that you're doing that. I can just see though some patients being like, what the hell? I feel awful. I feel terrible. You're asking me to be positive here or they're going through depressive symptoms, anxiety, PTSD, what have you and we need them to be positive. We don't need them to be positive. We need them to be concise and direct in how their symptoms. So you don't have to have a smile or be positive. But if you can share, I'm feeling depressed for three days and it is affecting my quality of life. Having that language of sharing what's happening to you so you can say it in a timely manner because you've got 20 minutes, that sometimes can help you get more opportunities to talk to the doctor about what could be going on or what you need.

51:15Doctor Mike: Yeah, that's very powerful. And then you said that there are a lot of times patient advocacy groups within hospitals. So you're admitted into the hospital. You're labeled inpatient. You're in a bed. How do you find that? So the first thing is you can use your social worker, which I think are fantastic, and asking them if they have a patient advocacy program. If they don't, even online, there's so many different programs that you can actually reach out to even if your hospital doesn't have one. The other thing is I share if you are feeling dismissed, the important piece is to honor that because if you feel it and that's happening, that's going to impact the care that you have right then and there where you feel like you're not being heard.

51:57You feel like you're not being seen. So being able to utilize one of those resources when you're in the hospital, it's a win for the doctor and it's a win for you because then we can have that discussion.

52:08Doctor Mike: Did you feel that in the moment when you were going through your medical scenario? I felt like in that moment, like what is happening to me? I'll never forget because in my mind, as she's telling me, you look fine. Your vital signs are fine. I just kept thinking, am I, am I losing my mind? Like, am I, cause I don't feel like myself. And that would have been great to verbalize perhaps. I'm curious how she would have handled that. Yes. And when I spoke to her after. so and i remember in that moment saying i don't feel right i don't feel so you were oh i was saying like something is wrong something is wrong and she's like nope everything and i remember saying also you look you look what you're you're experiencing what you're supposed to be experiencing and that goes back to that full circle moment and i told you the medical student what is pain yeah so i think if we all can just take a moment sometimes to unlayer what we think pain looks like what we feel our person no listen to again object what is that person experiencing and we also need to give up this like gatekeeping mindset that we have that we are the ones that need to gatekeep how much health care is being used yes if you're saying it do the thing yes offer the thing it's not it's not yours you don't own it the purpose is to give it to someone who is feeling a certain type of way even if you give it and it wasn't necessary you still did the right thing you still and that in that moment she had the opportunity she may not have felt like i look like i was in pain right but getting another nurse calling my doctor doing exactly what i asked and listening yeah which is supposed to be the number one thing yeah and that didn't happen you know because on one side hearing uh a terrible outcome like that you say okay let's think about the nurse.

54:06Doctor Mike: She's managing many patients. She's checking vitals. She's trying to be thorough. She's seeing that the vitals are okay. A lot of women who are going through pregnancy or just delivered a baby may feel a certain type of emotion. So she's seen this play out. So she thinks she's doing the right thing, but it's a level of overconfidence that she's overriding how you're feeling. Correct. And that overconfidence sometimes, I mean, it's a double sword. We are supposed to be confident as clinicians, but it gets in the way when you feel that you know best and you're not listening to what that person is telling you.

54:42And from the outside looking in, I don't, what does pain look like to you? Because I obviously didn't fit that picture. So taking the time to kind of investigate that.

54:53Doctor Mike: So this statistic that you brought up, and we've talked about it a lot, even on this channel, that black women have higher mortality during pregnancy or during delivery. Where do you think that stems from? Do you think we're taking actionable steps to improve things there? What's sort of the progress in this regard? There's a lot of bias and assumptions. And let's just start with black women. There is a level of feeling that, oh, she's okay, she's fine. And that goes historically with black women being very resilient. That word is often thread when it's connected or connected to black women. And our face may not show what you feel pain should look like.

55:39We may not have the pallor or the changes in our skin color that you and I learn. So all of those things play a role in it. And I even think of Dr. Marion Sims, I mean, which we know the father of gynecology who used surgical tools on black women and didn't give black women pain medicine. But when he did it with white women, he did. And so there's that history. And there was a study in 2016 that showed medical students thought black patients felt less pain than white patients. So all of those pieces, now we are doing better, but they're with having resources, but we're not doing better with getting people to those resources.

56:21Because there's a lot of groups, Birth Fund, Elaine Wettemarth, who's doing amazing things, out there that are helping, but often it's hard to get to those resources.

56:32Doctor Mike: How much of the bias that occurs in these scenarios is part cultural, part socioeconomic, or is it largely appearance driven? What are your feelings on that? I think it's a mix of both. I feel, I mean, and I still like to always go back to the history, think of the VBAC scoring and how it was based, height, weight, and race. Why was race ever played a role in if you were allowed to have a VBAC? If your height, your weight, and your black, that makes it less likely for you to have a vaginal delivery. But we know a C-section is a higher risk, but that was the one race that was included. So those pieces have continued to spill over because people will share, well, that was a long time ago.

57:21And now the study was sunsetted in 2021. But there was a study from the National Institute of Health that showed it takes 17 years for new evidence to show up into standard clinical practice. Yeah, medical inertia is terrible. Yeah. But that, a great example for us, family medicine, that's from the time a baby you delivered turned 17 for that information to translate over. So it's cultural, it's how we look it's how we're perceived and all of that plays a role in unfortunately black women die i think of mercedes wells who i have now um connected with she was the woman in illinois who delivered her baby and her husband struck i don't know if you heard about that no tell me about that so mrs wells was getting ready to deliver her sixth child went into the hospital got triaged they said nope you're not in labor she's like oh i know i'm in labor i you know And they're like, no, you see her being rolled out at the hospital crying actively in labor and gets into her husband's truck and delivers her baby eight minutes later in the truck.

58:25He had to pull over on the side of the road. So what played a role in that moment? She said, you know, and still wasn't believed. And she was fully dead. They didn't even, no one ever checked her.

58:37Doctor Mike: So what happens in this? Maybe because I've worked in great institutions where we really try and go above and beyond. And we work at a community health center. So we have a charity care system. I've never seen this play out. So what happens in a scenario like that? How does a person saying I'm in labor and they're fully dilated and they just get sent out? She doesn't look like what you want to listen or believe. Bottom line. and that is why the statistic that's who i go back to it's getting better where people are actually working on resources but it's getting worse because our statistic continues to go up we're the only group that continues to go up that it is a risk as a black woman in a very industrious technology driven world in the united states we i am more likely to lose my life giving birth because of the color of my skin.

59:41Doctor Mike: How did your conversation with the nurse go afterwards? You mentioned you spoke to her. So again, I had to, oh, not again. I had to take some time with what did I want to get out of this conversation? Were you angry at her? Yes. Yeah. I was angry in the fact that I wasn't listened to. And I was angry because I could have lost my life and not had my babies to be their mom. and that's where that anger stemmed from but i was also curious to know why why didn't why did you feel that i did not look like that and her answer was like you just you i've never you did not look like what i felt like was someone in pain and i said so my follow-up question what does that look like and her answer was not you

1:00:38Doctor Mike: so there wasn't any reflection happening

1:00:44so although I wish that would have happened it didn't change my vigor and my drive to help I may not be able to change you but I know I can help other people

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1:02:48Doctor Mike: Sweet Green's Fall Harvest Menu is back. with seasonal favorites dressed to impress and made to be devoured. Warm roasted sweet potatoes, crisp apples, maple glazed Brussels, and crave-worthy flavors in the autumn harvest bowl, maple glazed salmon plate, and roasted bacon Brussels side. The season's most desirable menu has returned to Sweetgreen, featuring fall's best dressed. Make your move. Order on the Sweetgreen app. Yeah, so what do we do in those scenarios? When someone doesn't... is not interested in changing? So for me, because we can't change the world, but if I can help the people know what they can do and give resources.

1:03:30So if you do come across the same type of nurse that I had who wasn't interested, then you could at least identify it and maybe find someone else, ask for a charge nurse, ask whoever you need to call, even calling secure, whoever you need to do in that moment, doing it.

1:03:49Doctor Mike: Given how important this topic is and how near and dear it is to your life, obviously you being here, why do so many people in the healthcare system despise when their healthcare system starts creating education around systemic biases, racism, it's viewed with such disdain and discomfort? Do you feel, first of all, do you feel that? Because I've seen that play out across many a hospital system. So I'm curious if you A, see that and then B, why do you think that is? Yes, I see it. And I think with our political climate, it's getting even worse. There's this feeling that racism doesn't exist, that it's not even really present.

1:04:30And it's interesting because if you disrupt someone's world where they feel like everything's fine and you put in diversity culture, it shakes their world up because they don't feel like there's a problem. For example, my husband is white and he'll share, he has shared many times. He said, if I wasn't with you, I wouldn't have realized what you face or how you go through the world. It is so different than me as a white man. And so when you have these programs in the hospital, often if your world is where you feel like it doesn't exist, these are, it forces you to have to think about uncomfortable situations that you may not live in.

1:05:13And that feels uncomfortable. People don't like it. But that's uncomfort is how you grow. And that's how you learn from other people.

1:05:20Doctor Mike: Do you think these programs are largely successful in what they set out to achieve? I think if they are powered by the right person, if there's intent of versus just check a box. Who's the right person? The right person is someone. Besides you, because I think you're the right person, if I'm being honest. The right person is someone who understands that change is small, small little changes versus we're going to put a system in. You check the box. Everybody has completed a DEI or whatever. What do you see in your outcomes? Is there more trust with your patients? What are the scores of what people are sharing that they feel like they can trust this institution, that they trust the information?

1:06:07What are you doing to match your community? Do the clinicians you have match the community that you're serving? Those are the ways. And if you can have someone who understands that, that part is huge. And for me, something you and I talked about, health advocacy still ingrains health equity. But for me, I want to advocate for women, anyone who has been marginalized in the community. I think because we all have different identities and we all face dismissal. So if I can help people or help you in those moments, I think that's a win.

1:06:46Doctor Mike: I think it's also really powerful that you go about it without trying to both not victim blame, but also not blame the providers. And correct me if I'm wrong. My assumption in you doing this is not because you think that they're all innocent because there's certainly a lot of guilty ones. Right. but it's because you feel you're more effective in your approach by taking out the blaming of it all. If you can make it that two people are on the same page and you're not using labels for them as racists, as problematic providers, suddenly you're creating buy-in from people. They may be problematic, but you're creating buy-in and you're thereby improving the way that they take care of patients.

1:07:31Doctor Mike: Is that your approach? It is. the humanity of how can we foster a conversation with the patient and the doctor? Because in the end, you've got someone who doesn't feel well. You've got someone who spent their life achieving this degree that wants to help that person. So if we can strip those layers and find a way to connect the dots, it's a beautiful thing. I've said before, I think I wrote an op-ed somewhere that I don't think more doctors are suddenly gaslighting patients, but more patients feel gaslit. Why do you think that's happening? So I would say we don't know. We don't know that more doctors aren't gaslighting and we don't know on either side.

1:08:20What we do know is that there are more diseases out there that people have not been able to get diagnosed. We do know people, our population is getting sicker and they're asking for help. And we do know there's a level of mistrust that continues to grow. And so by recognizing that there is a group of people that feel very unheard and not believed, we have to recognize that they need access to care. And I'll give an example. Recently, I did a video where, or because someone reached out to me and they said, Dr. Bayou, can you respond to this Reddit thread? because there's a group of doctors who are complaining about how people are saying they have POTS or endless downloads because they just want to be trendy.

1:09:11And it was disheartening for that person to see it who has POTS because now they're like, oh my God, if I go to the doctor, could this doctor be the person on the Reddit group? So I think medical gaslighting has always existed. And when we have our proof of concept with women's health, not getting studied, that's gaslighting we haven't been studied we haven't been a part of clinical trials we have medications that still have not been studied in women that is a medical gaslight because when you attribute certain things to stress anxiety and you haven't looked into it hysteria so that's where i push back that medical gaslighting is bigger than we realize i just had

1:09:52Doctor Mike: a podcast guest here, a PhD in sports science, and he had a wild take about making all medications over the counter. And, oh, you could just put the five benefits and five risks on it and how long it's been studied. And that's enough information for most people to decide whether they should take it. And I said, hold on a second, five benefits for who? And he said, for the average person. I'm like, who's the average person? What about pregnant patients? Well, that's different. What about someone who's morbidly obese and their dose needs to be different? What about someone with kidney failure or worsening kidney status?

1:10:31Doctor Mike: Suddenly, oh, wow, yeah, so it's can just write five and five. But people don't think about it that way. They think there exists this like prototypical average person or average presentation of a condition that's going to be right out of a textbook and just so far from reality well again if that's your world and you don't know anything else different that's what you're gonna think i think that's literally what i said i said this is in your world yeah this is your reality this is not reality it's not a match reality and so for women when we see the studies that show women wait longer are 50 longer for seeking care in the er we are more likely to be told that we have anxiety stress or something else medical gaslighting it's just been happening forever, but it's, the voices are getting louder.

1:11:15There's more opportunity to connect the dots. Oh, I've had these symptoms for five years and no one has been able to diagnose me. But now that I have social media, I did a video and now you know, but 20 years ago, we would not have known.

1:11:28Doctor Mike: So, so how do we have this conversation? You brought up this Reddit thread. I'm curious your thoughts on it because there are certain conditions that I hate saying socially contagious because I don't feel like they are. But in some ways, I forgot who it was. A famous celebrity came out and said they had a condition. And literally my residents kept coming in, in one precepting session, one full day, asking about this condition. And I was like, what is going on that everyone's coming in about the same condition? And it turned out that, I forgot if it was Taylor Swift or Kardashian, someone came out and talked about it.

1:12:07Doctor Mike: So how do doctors discuss people thinking they have a condition or self-diagnosing a condition off of the trendiness that is social media and celebrity culture respectfully without hurting people who truly do have the condition and seeking care? I think the first thing is asking the patient, why do you think, or tell me more of why you think you have this condition or disease and putting it back into the patient to explain why they think because sometimes they may say well I saw this I'm thinking it might be and then you have the opportunity to go well do you have this symptom do you have this symptom no I don't so I think if you can go in there without a prejudgment and ask you know tell me more I'm curious about why you think you have it right now on the flip side I'll share with you I received an interesting text message I from somebody that I work with in Reno and the message was you I'll let you interpret the message and she said she was like I so I did a video about IUDs I do them quite a bit how women are offered pain management options we're just told it'll pinch a little bit just take ibuprofen and Tylenol and it's not acceptable and she shared well I want to tell you my experience.

1:13:25This person is an OB-GYN. And she did a great job as far as the way she wrote the text. And she said, I find that my patients are more anxious because of what they saw online. And that is why they are feeling like that. But once they get into my exam room, I reassure them and I tell them they're going to be fine. And I thought to myself before I sent the reply, because again, I like to kind of check myself. You assume that it's from social media that that's why they're anxious. No, there's a real level of anxiety. And you also have now done the power dynamic where, oh, you're gonna be okay. It's fine.

1:14:05That person isn't going to feel comfortable telling you this hurts. I want pain meds. And so I think we have to take ourselves into the level of our patient and really remind ourselves every single step of the way, whether it's something trendy, like I think I know what condition you're talking about or whatever, let's ask the patient, what do you need? But yeah, she felt like it was social media. So what did you tell her? So I said, I would love for you to look at the comments on my video. You're gonna see women sharing. They've been screaming on the table. They've been yelling. They said it was the worst pain ever.

1:14:44They weren't offered any pain meds. and they were told by their clinician, it's not going to hurt that bad. So I invite you to look at that. She responded and she was like, wow, I didn't realize it was like that. That was really, and she said, that's really good or that's something I need to look more into, but I haven't heard back from her.

1:15:03Doctor Mike: Well, that's good. Yeah. But I, you know, with the curiosity. Yeah. Yeah. I think it's tough, especially when we get ingrained with a certain level of education by someone we admire, we trust, you know, a role model that's like, this is how you do it. You think, oh, my role model said this. How could I ever challenge this notion? But it's always good to challenge us. Like you're going in and asking why, why are we doing it this way? Right. And then for that person you that came in that was like, oh, I might have this. Who knows? They might have had these symptoms forever. And finally, when they saw that celebrity, the dots were connected.

1:15:37And so you have that opportunity to embrace it.

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1:18:19For example, you care about if there is an additive flavor for a soda. I care about my patient's food insecurity where they're just trying to have enough to eat. So what are we doing to help those social services have the fruits, the grains, so they can have it versus worrying about if there's an added dye to a soda? I think there is a disconnect there. why do you think that exists because in your ecosystem if your world is oh diet soda or going to whole foods or different places that's not the world that my patient lives in where they're just trying to have 20 to feed their family right and so there's a different level of understanding when it comes to nutrition i have three dollars to make a meal tonight I can't buy the organic leafy vegetable that is now what you are pitching on the pyramid.

1:19:24Doctor Mike: Right. I run into this problem a lot. Whenever private equity starts entering the healthcare conversation, for a couple of reasons. One, I don't think Uberization of healthcare really works. I think as you mentioned that it's such a beautiful space in that it's very human focused and ROI isn't always so clear because human life really should be valueless, even though some insurance companies and life insurance companies will put a value on it. So I think, A, as a model, I don't like it. I also don't like it for the same reason that if you raise the cost of this chair, ultimately people will stop buying it so they'll know how much they can charge.

1:20:05Doctor Mike: You can't do that for insulin when it's keeping people alive. That's not ethical. So that's another reason why private equity I don't like. But then whenever I go into the private equity rooms, because I get invited a lot given the social media presence, they will pitch a really cool solution for a problem that impacts the top 5%. So they'll say, oh, we created a middle ground between an ER and an urgent care that people can buy as a subscription where they don't even need insurance. and we just charge them this flat fee and they can come in for as many visits as they want and we'll scan them and we'll do this and blood work.

1:20:46Doctor Mike: I'm like, this isn't going to solve anything. You might make a few people's lives better who are wealthy already and they're already getting great care. Now they can get more care, which isn't even better for them in many cases. And you're not fixing the healthcare system and you'll probably make a buck. So as a business thing, maybe this is good, but not actually helping solve anything. In fact, I just met with the CEO of a major hospital system who told me that these things coming in are actually destroying health systems because, especially in an area like New York City, you have a very unique patient population.

1:21:24Doctor Mike: You have ultra wealthy clientele that are paying huge amounts of money for private rooms and this and that. And they offer that because they also want to make money. And then they also lose money on patients that are unhoused, that are struggling to make ends meet, that can't afford their bills, perhaps immigrants that are here legally and illegally. And they lose money. but because they balance this world in the area in which they live, they're able to make the business still work and they still function as a healthcare system that helps everyone. But now as people on the wealthier side are leaving to these very unique, profitable companies that offer them maybe a little bit more VIP service, they've lost that revenue and now they continue to have their losses and the losses are just continuing to pile up.

1:22:14So these hospital systems are now thinking about closing and are not going to be available when rich person A needs more advanced care than the CT scan that they need in that moment.

1:22:26Doctor Mike: And they go, where's this hospital system? Well, private equity broken. People don't realize that. And it's like all of the that's why when I say access doesn't necessarily mean it's real access for everybody else and it's equitable. And I think of like the casino workers that I see, they make just right in the middle where not enough to be on Medicaid or services and not enough to be able to pay for their insurance. Or they're working with a system that will only give them part-time hours. So they don't have to give them insurance. And so you've got people, those are the patients I see that are stuck in this system.

1:23:00And then you have these hospitals and they close their doors and then there's nothing. And then the rent has escalated because you had all these people move into that area. and now no one can afford to live there. And then my patient's driving an hour outside just to get to their job, but then you've got gas,$6. So in the end, it's cumulative and you have people who are struggling and can barely make it. So back to your maha mom, it's like, where's the investment in that?

1:23:31Doctor Mike: Yeah, because if you think about why we're not healthy, it's because of that. Yes. It's not because of the dye in some fruit loop or something. Telling someone you need to eat fresh fruits and vegetables. That's why you're overweight. That's why you're this. I have$3. I have a patient who has$3 a day to make a meal for her family. Yeah. And organic doesn't need to be a part of that conversation. It actually doesn't need to be a part of conversation for most anybody. That should be just like a pure entertainment play, honestly, at this point. And the other thing, you know, I have a conversation with my girls often.

1:24:03I tell them, I say, you know, mommy and daddy work really hard, but it's important to know how the, we work hard, but so do other people. So just because we have certain things doesn't mean how hard we work is different than someone else who's working at another place. And I think that is an important lesson because you hear often they need to get off their bed. They need to work harder. No, people are working hard.

1:24:30Doctor Mike: The bootstrapping thing doesn't play out as neatly as people play it out in their minds. So like, yeah, for some that are healthy, that largely have things going their way, yeah, it can work. Even in some people who don't have it going their way, they can push through. But what happens when your health gives out? What happens when you have to be a caretaker to three, four, five people? So like this loss of putting ourselves in different scenarios starts impacting us when it happens at scale. And I feel like on a macro level, people have lost that where, yeah, we should encourage people to work hard and have the fruits of their labor when they do work hard.

1:25:10Doctor Mike: But at the same time, we need to think a little bit more equitably. We need to think about how your great new prescription med is going to be great for everyone, not just for the people who can afford to pay for it. Correct. And you're going to get a kick out of this because I think that there's new companies that are coming in that are weaponizing the appetite for equity. Get this, GLP-1's very important for patients who are diabetic, overweight, maybe sleep apnea, heart disease, etc. Valuable medication for many people, especially in America as we find ourselves in our current metabolic state.

1:25:53Doctor Mike: There are companies now coming out in certain Asian countries that are being manufactured as not the true GLP-1, but as a regular peptide that acts as a GLP-1 orally, that they don't want to be regulated as medication. They want it to be a supplement. I asked why. Well, we don't want to put the cost on the patient because if we run the trials to prove this works and this is safe at the scale that the FDA requires us. It's going to be so expensive for patients. And we don't want patients to face that expense. So now in trying to weaponize that, oh, we're being equitable, they're trying to sell unproven BS peptides with the slogan being we're being equitable and fair to people.

1:26:53Doctor Mike: Isn't that wild? It is so wild. And again, misuse of being able to use wet equity, all of those things. Yeah, what things are valuable for. Then you have the person, oh, I'm part of an equitable process or campaign. No, that's not how medicine should be delivered or used. Have you seen any systems do this well? I have. God, it's so terrible that you're not finding it. I'm not. God, we're doing so bad. I know. And the one thing I keep going back to, right now people are so against the pharmaceutical companies and I always say the wellness industry is a multi-billion dollar industry and they don't understand.

1:27:34They're like anti-pharma, but there's so many things that they have to go through to get versus I can slap a label on in an hour and say, take this. And it's just backwards and I do get worried about where we're moving. I'm still hopeful that we can somehow get that pendulum back in a way that is better. But it is, I haven't really seen a system that, because, you know, I've talked to women around the world who have given birth or seek the health care in different countries. And sometimes they are limited to who they can see. And then when you're limited to who you can see, if you're being gaslit, if you're being dismissed, if you're not able to get the care that you need, it's universal in so many different areas.

1:28:21Yes.

1:28:22Doctor Mike: I'm curious if you've ever felt this because I had this thought pop into my head the other day. So I feel that the current administration has gotten really comfortable with blaming doctors, nurses, frontline health care workers for problems of society. and here's why i noticed it secretary kennedy head of hhs it's pretty obvious that he's anti-vaccine right like he i mean i i think it's been he's proven it himself yes and he's very anti the business of health care he's not anti the business of him making money off health care but you know for health care he doesn't like it i've heard him over the last year bad mouth doctors as profit mongers, bad mouth, any doctor that pumps babies full of vaccines, countless examples of him saying doctors are problematic.

1:29:23Doctor Mike: Have you heard him name one pharmaceutical company? Not one. Not one. Interesting. The man who is anti the business of healthcare, constantly bad mouth doctors, constantly says we're the problem, has never said Pfizer, you're a problem, has never said Moderna, you're the problem. Why? Follow the money, follow the trail. And just some of the things that he has blatantly mentioned has been so harmful. I mean, I just think of black people, he said something, process medication differently. Like these are really harmful things that are affecting people and you are in charge of our health. I mean, I think he literally said Chinese people and Jews are immune to COVID or something wild.

1:30:11Like it's just, this is the person in charge of healthcare.

1:30:15Doctor Mike: And by the way, I'm not saying to people listening at home that Moderna or Pfizer somehow are to blame, but it's just interesting how he says the business of healthcare is the problem, but he never really is the one attacking it. So I'm trying to highlight his hypocrisy that does he actually believe what he's saying If he's constantly blaming the frontline workers who are trying to do the best with the evidence that we have, and so far it's been working great actually and is not the problem of why we're not healthy as a nation. And there's no changes being made. Only negative changes. We know how that shows up.

1:30:52that shows up in the 62 year old woman that I see on an urgent care shift that has chest pain and worried about taking any medicine because she's not sure what's going to be in it because of what she has heard. And then ultimately it was like, I go, would you like me to explain everything? No, I just want to make sure I'm fine. And I give it. And so that's real life, you know, of how those implications show up where there's this hesitancy from someone who does not have the medical training that shows up when a patient is trying to, when a patient is in a critical point in their life where they're facing a health crisis.

1:31:28Yeah.

1:31:30Doctor Mike: It's really sad that we're at this point that we're having to defend healthcare. And yet there are true problems where it's been our fault for so long for making these mistakes, gaslighting our patients, not doing enough research on certain groups. So I really hope we get better. And well, it's interesting because blaming us and looking at all of the amazing research and all the things that we have been able to accomplish, the amount of medications that have now been able to treat cancers, help people live longer. Where is the celebration with all of that? Where people we've identified, there's been research in certain things for like 10 years, 15 years.

1:32:09But then again, we are all, you know, gaslighting. And I think that needs to be uncoupled. When we talk about medical gaslighting, we're talking about groups that have been dismissed and not been able to get fair access. That should not be conflated with a political movement and saying that all doctors are bad. And what you've now done is brought along a group that needs to have access and put it part of your political agenda. And by doing that, you are hurting people. You're impacting lives.

1:32:41Doctor Mike: I get really angry when I see senators and legislators ask Secretary Kennedy questions when he comes up for these hearings. Do you? I do. I don't think they ask good questions. They don't. Why don't they ask us frontline workers what to ask? Well, you know what? Isn't this normal for our, like, think of the hospital. Nobody asks us. Yeah, nobody asks. Nobody's asking us. No. Which we should be a part of that process. the people who are a part of the system, the infrastructure. A long time ago, someone said without doctors, without healthcare professional, nothing happens. So why aren't we at the table?

1:33:19Yeah.

1:33:19Doctor Mike: Are your patients using AI incredibly more now? How do you feel about that? I love it. Yeah? I love that. But I share the best practices. Of course, not putting any of your personal data. And then also realizing nothing can replace my personal opinion from hands-on, touching, talking to your doctor. Because AI still has those inequities that it's going to perpetuate moving forward. Because it's a system that has information that's been put in by people who have biases. So you can't forget that. It's good information, but it's about making sure that you landed in the right place so you can talk to your doctor.

1:34:03Doctor Mike: For sure. Even when I'm using one of the apps, and you know how they have different levels of search of how quickly it does it? You ask at level one and then high level, the answers are drastically different. And some people can't afford to pay for the pro model, so they don't get the pro answer. so we have to remember that like there's now information inequality happening because if you're only doing the instant search you might not be getting the best information so super super messy and i worry about the maha not so much the community because i feel like the maha community is made of people who want something that health care system perhaps hasn't delivered to them but more so like the the advocacy people in the top who have weaponized the maha movement infiltrating AI to give bad answers.

1:34:46I agree. I think, you know, when you think of the Maha movement, there's pieces of nutrition, wanting to have better access to food resources, all of those things, but they've been now embedded into bad practices, into things that are not equitable.

1:35:02Doctor Mike: Yeah. I can't name a good thing that Secretary Kennedy has done. No. I mean, he's done like this milk commercial with Kid Rock. Who in our nation was struggling with not enough milk? Was Ricketts a big problem all of a sudden? We're having epidemics. We're facing an issue of a pandemic that just passed. We have outbreaks of all sorts of infectious diseases happening because we're such a globalized community now. And yet that's what he's putting his focus on. Well, again, his world is not the world. It's like, come and see what community workers are doing. Put yourself in the people's shoes. But no, you're putting these practices into play that really have no real impact on everyday, on what people need.

1:35:48Doctor Mike: Yeah. Shame. I agree. Can you leave us with some good news? What's happening that's good? There's good movement as far as people being able to come together in a sense of danger. Even have a conversation like this? Yeah. Like having this shared connection and being able to put the information out there is such a powerful thing. And although sometimes we may feel powerless, our voices, as my dad would always say, there is power in that because there's one conversation, there's something that will land that might spearhead or advocate or help someone feel like, okay, I never thought about it like that.

1:36:29Or that's a good point. Maybe I should kind of go a little bit further. Yeah.

1:36:33Doctor Mike: And I have to give you a huge congrats because somebody just hit 100 ,000 subscribers on YouTube. So you're making that conversation happen. I am. When I think of my journey into social media and how wild it has been, I am so grateful for the community that I'm a part of and just going online, doing videos and trying to help people do something at least when you feel dismissed, when you feel gaslit. And I guess another good news I want to share that I'm really, really proud of. One story. So I created a free resource called CliniciansWhoCare.com. And this was created out of a story. I was a third year medical student in Chicago and I started losing my hair.

1:37:17But the first thing that I noticed was, let me back up. I noticed that when I would put my shoes on, my shoes were a little tight. And I was like, God, that's a little strange. and then when I was back and they were still writing it was hard my hands were swollen and then as time went on my joints were really like I was I felt like I was no I don't want to say any ageism but I'm like am I like 60 or 70 it was something strange and then I started losing patches of hair I go to the doctor finally on my one day off a week and I was told that it was just stress because of medical school and I remember in that moment like I thought to myself oh, maybe I can't, maybe I'm not able to cut it, especially with all the challenges that I have as learning disability.

1:38:03And so I go to more doctors. I'm told again, well, it's just stress. We don't see anything wrong. It wasn't until the seventh doctor, because a doctor in Reno was like, bio, I want you to see this one doctor when you come into town for Christmas break. And I'm like, okay, I'll do it. And I found out that I have lupus and I have antiphospholipid syndrome. And I almost quit medical school because I felt like, oh my gosh, I can't do it because I was exhausted. I was tired. I wasn't keeping up. And so although I share a lot online, I shared that recently, like nine months ago, and I wasn't prepared for what happened next.

1:38:36So, of course, we talked about gaslighting, people sharing. Well, in my video, because I love positivity, I said how the one clinician made a difference in my life. And people started sharing the names of clinicians who made a difference in their life. So I was like, oh my gosh, I know what I'm going to do. So my little team, which I shared, my husband, we, we created something. And I said, you know what, why not create a free resource list that could help people find compassionate doctors. And I was really intentional wanting it to be positive. So then I said, okay, we're going to do city, state, and country.

1:39:13And that came a little it later, but I'll explain. And then every type of clinician, MD, DO, PA, MP, therapist, dentist, midwives, doulas. And then I thought, oh, let's have every specialty, family medicine, cardiology, OB, surgery, everything. And so he created the list for me and we put it online and it was beautiful. Someone from Canada was like, I have the name of a doctor in Canada. Can you make the list worldwide? I was like, yes, I can. And so we have in free text, you write in how this clinician made you feel because think about it we're all different flavors not everybody is a great fit but if i'm sure people have called you do you know the name of a doctor that you recommend well this list serves as that trusted recommendation and they're only positive comments and so we have over 5 000 names worldwide we are in china we're in australia we are in germany all 50 states and it is growing so quickly and the best part about it is the testimonials so one story to share.

1:40:12I had a woman who reached out to me and DMed me and thanked me for getting a diagnosis of cancer. And I was like, why is she doing that? She said, I have gone to multiple doctors and I have been having symptoms for years. And I found a doctor on your list in Florida and I got diagnosed with ovarian cancer. You and I know how hard that can be. And she was thanking me because she finally had an answer, even though it wasn't, you know, ideal. And then And I just had last week a woman who has triple X syndrome. She saw my video and she did a snarky comment. She'll tell you. She was like, okay, this is fine.

1:40:45But what are you doing for this Dr. Bio? And someone responded and said, she has a free resource. She checked it out. She went and saw a doctor in Greensboro, North Carolina. I won't say the name of the doctor. And she said, this was the best visit I've ever had. Because she's in her quote, I had to pull back my happy tears because I felt seen, I felt heard. And then she had a follow-up appointment and it was beautiful. And so this list serves two people. One, if you're looking for a doctor, there might be a clinician. Every day new names are added. And second, if you know the name of a clinician that has made a difference in your life, add them.

1:41:25Because every name added could be a lifeline for someone who is looking for a clinician. And there's nothing else like it. There's no star reviews, there's nothing. It's just people sharing their stories. and it's been beautiful.

1:41:38Doctor Mike: Yeah, wow. All I'm worried about is someone corrupting this beautiful project. I've got an update for you. So after we spoke, because we are on a full social listening tour and so this community only lives because of the community that's a part of it. And you and I had a discussion and you were talking about it. So we did some work and as of two days ago, yes, you know, I'm like, let's do this. And so we built, it's a brand new web-based form. It's no longer on a Google sheet. You can now search by symptom. You can search by tags, LGBTQ friendly. You can search by different things and it will pop up.

1:42:14We have an AI verification now to make sure you're a person, that you're not a bot, email, like multi-layer application. And we launched it yesterday. We worked so hard. I'm really excited. And so, yeah, it's been featured in Forbes and People Magazine and it's growing and it's helping people.

1:42:34Doctor Mike: So people can visit that? I wish I had when I was going. What's the website? Clinicianswhocare.com. And so, yes, you can go on there, check out a name or add a name. Every name added could be a lifeline. And the other thing I often hear is like, do you celebrate these doctors? I do not. This is a community of people just sharing stories. So it is all a lot of people don't even know they're on there. Yeah. But yeah, it's been a beautiful thing. And the list serves if you are someone who has been dismissed or looking for a doctor and struggled in a system that hasn't believed you, this list might help you.

1:43:14Doctor Mike: Wow, that's so powerful. Where can people learn more about your journey? Where can they follow along to become a member of this compassionate team? I welcome every person. So I'm on Instagram, TikTok, YouTube, and then, of course, clinicianswhocare.com. And is your handle the same across all of them? Yeah, doctor.bio. And I would be remiss if I didn't mention I do have a book coming out. I'm so excited, Dr. Mike. When is the release date? May 2027. Okay. And it's titled How to Talk to Your Doctor. And it is an advocacy book that provides collaborative language to help you advocate for yourself.

1:43:50Doctor Mike: So we have plenty of time when that book is starting to do its release. You'll come do your book tour with us. I would love that. Yes. All smiles. Yeah. Smiles and interesting stories because you have a lot of them. I do. Thank you so much for leading the way in a really crappy time for our healthcare system with so much positivity, with so much forethought about what everyone is going through, not just one part of the equation, but trying to be as balanced as you can. I know when you want to be a firm advocate, sometimes people lose that opportunity to be able to realize that there's humans usually on both ends of an equation.

1:44:26Doctor Mike: So I very much applaud you for that. Thank you for that. And thank you for making me a better doctor by hearing all these stories. Well, thank you for just having me. And I'll leave with a quote. My dad said, he would always say, think of one thing you can do to make the world better each day. And it can be a minor thing. One thing you can do, whether it's saying hello to someone, whether it's just making eye contact with someone. So although the world is a little crappy, if you can find joy in one little moment, that can sometimes carry us through, even through these terrible moments in life.

1:44:59and so it also can help propel you.

1:45:01Doctor Mike: Yeah, I think you're our moment of joy. And I say that for all the listeners and viewers and myself included. So thank you for that. Thank you, thanks again for having me. It has been such a pleasure. Awesome. Make sure you head to clinicianswhocare.com to nominate a doctor you know and love or search for a healthcare provider that you might need to see. It's such an awesome new resource. And speaking of great doctors, I need to give a shout out to Dr. Fagenbaum who actually discovered a cure for his own disease. His story is incredible, well worth scrolling back on and listening to that one. And if you enjoyed this episode, don't hesitate to give us a five-star review, leave a comment down below, or share this episode with a friend or family member that might enjoy it as well.

1:45:42Doctor Mike: And as always, stay happy and healthy.