How to Get What You Need From a 15-Minute Doctor's Appointment with Dr. Lucy McBride

24:03The challenge I see isn't so much that people don't know that, although there's plenty of people who don't know that. is that they don't know how to operationalize a plan around it. They have a barrier to entry on the recommendations. So they are feeling ashamed and less than because they can't get protein with every meal. They can't wear the weighted vest. I love the weighted vest. It's wonderful. But if I have a patient who has chronic shoulder pain and depression, my job is to help her fix those things first before we can actually get her in that weighted vest and on the treadmill.

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25:29Dr. Mary Claire Haver:And best of all, MIDI is covered by most major insurance plans, making expert, high-quality care accessible and affordable for every woman. All of which is why MIDI should be part of every woman's menopause toolkit. Book your virtual visit today at joinmidi.com. That's joinmidi.com. In business, there's no room for guesswork. Every shipment matters. Every deadline counts. When you're trying to keep operations running smoothly, the last thing you need is uncertainty. That's why reliability is at the core of USPS Ground Advantage. From the moment your package is first scanned in, it moves through a secure nationwide network, aiding in a timely and accurate delivery.

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26:59Dr. Mary Claire Haver:you write that when the healers are sicker than the patients they are supposed to treat the system is not just broken actively harmful to everyone it touches you know we see a lot about there's a difference between burnout and moral injury can you talk about the differences so i have been burned out in my life i'm guessing you have too totally i had my first child when i was an intern at Johns Hopkins Hospital. And I didn't know what burnout was until later, and that was it. Yeah. Where I was burning the candle at both ends, and I wasn't as good of a doctor because if I'm not caring for myself, it's very hard to take care of other people.

27:34So burnout is, you know, part of the problem in medicine. It's imperative that physicians apply the same level of self-awareness and self-care that we recommend to our patients. We are not good at that. as a general rule. Doctors are not generally very good at taking their own advice. At least, I have not been historically. Moral injury, I think of as the inability, because of a systems problem, to take care of patients in the way that you want to, that you need to for your core values. So take the pandemic, for example. We saw a lot of moral injury during the pandemic where people were not able to care for patients, say a patient who is at the end of their life and in the ICU and not able to see their loved ones at the end of their life.

28:24That's moral injury to a doctor who's empathetic. It's moral injury to the patient and their families as well. But take a more practical example of moral injury. A more practical example of moral injury is simply not having time to talk to patients. So if you don't have time and you have a patient who's crying in your office because of - Anything. Pain with intercourse or depression or they've been confused and been given conflicting advice about some medical problem. It is hard on the caregiver, like it is the patient, to not have the time to understand what's actually going on with that person.

29:02Yeah.

29:02Dr. Mary Claire Haver:I, you know, trained under what was a charity system at the time. And, you know, anyone who walked through the doors, we took care of. And the state would pay the check, you know. And then I went into private practice, then came back on as faculty, and the whole system had become more corporate, and they got rid of the charity system. And then now it was insurance-based, and a few counties would feed into our hospital that had kind of plans, but not all. And so we would get these patients who we could cure their cancer with a simple surgery or something very basic, but we had to turn them away because they couldn't pay.

29:40Dr. Mary Claire Haver:and I'll never get over that having to sit down and tell a patient you need a simple hysterectomy or you need a you know whatever and this would 100 % cure your cancer like stage one endometrial right but we can't do it because you can't pay and that was really really hard because I didn't that wasn't how it was in medical school that wasn't how it was in my training and then to turn around as like the boss in charge and have to look someone in the eye and say you're too poor for me to save your life was one of the hardest things I've ever had to do. It's excruciating. If you think about all the unmet needs out there in the community and all the people who do not have access to a medical guide who's evidence-based and centered on the patient's needs, it's really soul-crushing.

30:30This book is one attempt to help people make sense of this dizzying landscape where most people go to the ER for their primary care and then look on the internet for wellness advice. Now, again, we need doctors. We all want to be well. The solution is not to become your own doctor, it's to be a more empowered patient.

30:53Dr. Mary Claire Haver:Okay, we'll get into it. You describe patients as being stuck between two extremes, a healthcare system that reduces them to checklists and a wellness industry that can be full of false promises. You know, what does that look like in your exam room really for women in midlife? Because that's our audience, right? Well, you see this too. I see patients who come in who are like 30 years old and they're like, I have brain fog. I think I'm perimenopausal. And they may be, but they may also have brain fog because they're raising children, they're working full time, they don't have a supportive spouse, and they're not sleeping enough.

31:27Dr. Mary Claire Haver:Sometimes things are much more simple than... Right. Not everything is hormones, guys. That's it. But a lot of it is. I mean, I don't need to tell you, Mary Claire Haver, that women have been deprived for generations about basic information about their hormonal health and their brains and their hearts and their bones. but what I'm seeing out there is that people are being misled by voices that are very certain so if you hear someone talking on the internet and by the way I'm on the internet you're on the internet like and I'm trying to spread truth and facts but if you hear someone on the internet who's preaching certainty who's convinced that you will be better if you just do x y or z and do as I say, that's a red flag.

32:14I would say the same thing about a doctor. If you see a doctor who says, don't do this, do this, do as I say, that's also a red flag. So, you know, doctors don't speak in absolutes. We speak in ways like this. I wonder if you've thought about how this medication might affect you in this way versus this other alternative treatment. What do you want? That's how we speak. We speak in nuance. We speak in relative risk. But that's how we should be speaking.

32:45Dr. Mary Claire Haver:Yes. Okay. Right now, for women, what are you seeing as really dangerous wellness advice? So what is trending out there that you're like, whoa? So I think the biggest problem with some of the voices in the wellness space is suggesting that yoga and mindfulness and quinoa are necessary and sufficient for health. I think it's placing blame and shame on the patient. Absolutely. That she walks away from that message feeling like she did something fucking wrong. Yes. You know, that somehow she wasn't yoga-ing enough or, you know, she wasn't wellnessing her way out of whatever situation she's in. We preach the same lifestyle, right?

33:25Dr. Mary Claire Haver:Yes. Both sides of the fence, but not in absolutes, right? And I just hate when I see these messages and somehow the woman, especially the female patient, she's always doing something wrong. It's not enough. The problem I have with the wellness space, again, is similar to what you said. It's that it's implied that it's necessary and sufficient to lifestyle your way to health. Two, that it's not enough, that you're not doing enough and that you've got to always be doing better. And it plays a shame on the individual. And then third, I think it often leads people away from doctors. Now, doctors do a very good job of shaming patients as well.

34:07I mean, we are the chief shaming officers in many ways. Take my patients who have suffered from obesity their whole lives. I mean, they will tell you how shamed they have been by the medical establishment. It is a crying, crying shame. But I think what I'm trying to message in this book is the both and. You can try to be healthy with exercise and lifestyle and behaviors. You also need a doctor to partner with you, to shepherd you through sickness and health. Let's talk about supplements.

34:38Dr. Mary Claire Haver:Yeah. We, of course, in the medical history, ask about all supplements that patients are taking in our clinic, and I'm sure you do. What are you seeing in the supplement world? Like, that scares you. I think the reason the supplement industry scares me is because I think people often think of it as a substitute for medical care. So it drives people away from medicine. Now, again, as I just said, I'm a both and person. There's a role for supplements. There's also a limitation that supplements have. Same thing with pharmaceuticals. There's a role for Lipitor, but there's a limitation of Lipitor, right?

35:13Lipitor can lower your cholesterol, but it's not going to change your stress that's making you overeat. I think the problem I have with supplements is that there's this notion that there's a one-size-fits-all program for people. I love supplements. I take supplements myself, certain supplements. I prescribe and recommend supplements. But there are limitations to supplements. There are also limitations to pharmaceuticals. So the question isn't, do you maybe need a supplement or do you need a prescription medication? It's what is your goal and what are the limitations of these things you're taking for the health issues that you have?

35:51So let me give you an example. I have patients come in all the time, and they say that I'm taking ashwagandha for my sleep, I'm taking magnesium for my constipation, I'm taking fish oil for my heart, and they have a number of complaints that haven't actually been addressed. and they don't really know that their constipation is because they're not getting enough fiber,

36:16Dr. Mary Claire Haver:that their brain fog is actually menopausal, and their sleep is disrupted because they're drinking too much caffeine. So instead of supplements, I want them on the thing that would actually help them, hormone replacement therapy, fiber diet. Higher fiber diet. And, you know, understanding that alcohol plus menopause means you're going to sleep terribly. Terribly. So the supplement industry, I think, meets an unmet need, but we want to make sure we're solving the right problem. Right. Right. Let's talk about the bad boyfriend in the book. Oh, the bad boyfriend? Yeah. Trackers, wearables, shareables, nearables.

36:53Are you a fan? So I think an empowered patient is a better patient, right? I understand why people want to track their sleeve, track their steps. I think these trackers are wonderful. It's sort of democratized, you know, medical data. But as we talked about earlier, Mary Claire, data without context isn't particularly helpful. So here's what I tell patients about data. When you want to bring that data to your doctor, bring the patterns, not just a single data point. It's more useful to me to know that your sleep was disrupted when you were laid off from your job than it is to know that you had a bad night's sleep, just one off.

37:32It's helpful for me to know that your headaches and your migraines got worse when you slept less than six hours than just handing me a spreadsheet. I think what's most interesting about the explosion of the wearables is that it shows us just how disconnected people often are from their own bodily cues. We live in a hustle culture. We live in a culture where we can have access to the Internet 24-7. And I think it's interesting that some people need a Oura Ring to understand that they're tired or they need a device to tell them they're hungry. And I think it says a lot about society and modern hustle culture that the devices are so popular.

38:15I also think they're wonderful in many ways.

38:18Dr. Mary Claire Haver:What about I'm seeing a lot of, you know, contention around the continuous glucose monitors. I've tried them. Yeah. And out of curiosity, I had insulin resistance. I've gotten it managed. And I was curious, right? And they offered me a free one. So I'm like, sure. I had more anxiety from, you know, I do wear an Oura ring and I've made peace with it. And I use it, I think, in a healthy way. Yeah. But that glucose monitor made me crazy. Well, that's the bad boyfriend I was talking about. So I recommended to one of my patients to take off her Oura ring because it was making her feel bad about herself.

38:53It was demanding more and more from her. It was like a bad boyfriend. And she took it off and she finally slept. She was having insomnia because she was so stressed about the lack of sleep she was getting. So the CGMs, the continuous glucose monitors, can be really useful. I recommend them all the time for patients who have, you know, diabetes, of course. That's a standard recommendation.

39:14Dr. Mary Claire Haver:But someone who's otherwise metabolically healthy. For someone who's metabolically healthy or who has an elevated hemoglobin A1c that's, you know, pre-diabetes, it can be really informative. because everyone's metabolism is a little bit different. And it can be useful to get a microscopic view of what in your daily life affects your blood sugar and why. So in the spirit of empowering patients with information, they can be very empowering, but they can also be an albatross and cause people to restrict and overthink eating. And then it's a net negative. You write in the book, and I see this all the time on social, you know, some of the darker side of wellness culture is you are ill because you didn't try hard enough.

39:59Dr. Mary Claire Haver:You got sick because you failed at wellness. Talk about that. The ease with which the medical establishment and the wellness culture we live in shames patients is pretty astonishing. I think people know that exercise is good for them. Like, I don't know if we need more studies to show that exercise helps with brain health, with heart health, metabolic health. We all know that. Everybody agrees. All sides of health and wellness agree. Yeah. We all know that broccoli is good for you and like eating sheet cake is not as good for you. Right. I would argue that sheet cake is good for you every now and then.

40:33Right. It's like part of joy. So what I want to tell patients, and this is part of what is in my book, is that health is very personal. It's not about a specific protocol. It's not about a specific diet. It's not about someone else's version of health. and we can reduce shame and feel like we're enough when we understand what our actual needs are first. So in the book, I talk about five elements for being healthy and being an empowered patient.

41:02Dr. Mary Claire Haver:Okay, what are those? One of them is understanding what health is to you. Not everyone wants to be exercising seven days a week and optimizing their macros and that's okay. Not everyone who has an extra 10 pounds on them or 50 pounds wants to lose that weight. That's okay. I mean, of course, being obese, having extra weight on you carries risk. But my first question to my patients isn't, what do I want? It's, what do you want? It's also to help them understand, okay, if you were to lose this 10 pounds, the sort of menopause weight gain, here's what that would require. and here's the risk of keeping it on you.

41:50And then helping them make decisions that work for their life.

41:53Dr. Mary Claire Haver:But all of society is telling them those 10 pounds are bad. Every magazine article, every picture of a celebrity who's over 50 now on the red carpet. And so when all of the messages are coming from, you know, we need to look like 14 year olds. Right. You know, how do you counsel your patients about that? I really want patients to give themselves permission to understand what health looks like for them. For some people, that's feeling comfortable in their own body. So for other people, it's not living in pain. For some people, it's not being depressed. For some people, it's being a certain body size, and that's okay too.

42:35do. But the biggest question you can ask yourself as a human being, in my opinion, is what does health look like to me? What is that defined by? Is it a certain cholesterol level? Is it a certain body mass index? Is it an appearance? Or is it a sense of agency, a sense of purpose, a sense of having access to guides when I run into problems. The healthiest people in my practice who are in their 80s and 90s are patients who don't necessarily have the perfect labs, but they're patients who have understood where they need to relinquish control and where they have agency. They've made peace with the parts of their health and their life they cannot change.

43:23So it's a little bit like the serenity prayer of health is what I'm talking about. I think, you know, in our 20s and 30s and 40s and 50s, women in particular are told that health is about a certain number of steps per day, a certain weight.

43:39Dr. Mary Claire Haver:A certain amount of protein. A certain amount of protein. A certain supplement stack. A certain supplement stack. And that's not wrong. But there's more to health than a set of protocols or someone else's version of health. So if I had one message to patients at the end of reading this book that I've written, it's stop and ask yourself, what does health actually look like to you? You know, if you talk to enough people at the end of their life, you want patients who are not at the end of their life to have that kind of wisdom and self-reflection and ability to pull down the sort of defenses and the shoulds.

44:16And you want to apply that knowledge to you right now. That's what I try to do in my life now. I've had to define health. It's not just about a set of labs or a certain BMI. It's about a sense of agency and purpose and meaning. It's about relationships with other people, with food, with alcohol. It's also about knowing where you need help. So I don't think health is a one-person job. I think it takes a team. And you may need to assemble a team to help you be healthy that includes a yoga instructor, that includes a cardiologist, that includes a walking partner on the weekends. So one of the things I talk about in the book is how to build your team.

45:00It doesn't have to be expensive. It doesn't have to be fancy. But you want to make sure that you are solving the right problems and not solving someone else's problem for you.

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49:55Dr. Mary Claire Haver:Okay, let's talk about self-compassion. So you wrote, sometimes our bodies need fresh chemistry, new behaviors, and deeper self-awareness all at once. Yes. Two or more things can be true at the same time, but no prescription will work efficiently without a dose of self-compassion. I think you know this, but we all have an internal narrative in our minds, right? We have the critic. We have the governor. you have that voice in your head that says, you shouldn't have done that, or you really blew that, or wow, if only you were X, Y, Z, then you'd be better. That narrative, if it occupies too much brain space, too much real estate up there, it can inform your health more than any prescription will.

50:42So one of the things I talk to my patients about and one of the things people need to ask themselves about is what are the stories you're telling yourself? what are the voices in your mind the shoulds the what ifs the oh my god the catastrophization what are those voices telling you and how do those affect your everyday habits so if you have a narrative that says you're not thin enough you're not fit enough and then you skip lunch and then you overeat at night because you're hungry because you're human and then you You feel ashamed the next morning. And then the voice tells you, you ate too much last night and you keep doing the same pattern.

51:27Then you have a problem with your relationship with food. And maybe your weight's going up. You don't need Ozempic. You just need lunch. Maybe your negative inner critic is born from someone in your life who, you know, you need distance from. The point is, self-awareness is a superpower. And if you can understand what you're telling yourself, that can help you immensely show up as a more informed consumer of health care and a more powerful agent of change in your own life.

51:59Dr. Mary Claire Haver:You wrote about a patient in her 60s who came in asking for a Zempic, a stronger pain medication, and a sleep aid. And you realized after talking to her and getting to know her, what she actually needed was a dose of self-compassion. Walk me through what you saw in the room with this woman. So you see this patient. I see this all the time. People come in. They've looked up online what their complaints are. They come in with a list of things they want, pain medication, Ozempic, and something else. And those are things I prescribe. I think Ozempic is a wonderful medication in the right context. But before we start solutioning problems, I want to understand what we're actually solving.

52:41So this patient had been bullied and shamed by her dad since she was a kid. She was told she was fat and lazy since she was 10 years old. Those narratives die hard, right? When you are an adolescent and young adult, our brains are extremely plastic. And the narratives that we literally hear from our parents, the narratives we hear from society, those thought patterns can get laid down like concrete highways. And it takes a lot of self-awareness and sometimes therapy to help reroute those thought patterns. So when I took a minute to understand what was going on, that she was having pain because she had a hip problem and the hip problem resulted from her weight problem and her weight problem resulted from a shame problem.

53:34She didn't need Ozempic and pain meds. she needed a dose of self-compassion to understand that the narrative that she was telling herself, the story that she was telling herself of unworthiness was coming from her childhood. Did it work? Absolutely.

53:50Dr. Mary Claire Haver:How did you do that? Are you a therapist? Well, I kind of am. No, but I said, look, I asked the question. I said, you're getting emotional when you're talking about how frustrating it is that you can't lose weight and why you skip lunch and you do it all over again. and she started crying. And that's the moment where you say, pen down, laptop closed, what's going on? Well, she said, my dad shamed me for being lazy and fat since I was 10 years old. Okay, let's talk about that. First of all, I'm so sorry. And second of all, let's address that because that is probably informing a lot of your everyday choices in ways that you may not even be aware of.

54:32And I'm not going to do therapy with her, but I'm going to have her see someone who will help her untangle the relationship with food and the relationship with her dad. Right. So let me just say this too. It's a lot easier to prescribe Ozempic and pain pills than it is to have that conversation. And that's where medicine is falling down, not being able to understand the whole person.

54:50Dr. Mary Claire Haver:Right. I mean, I have patients coming in on polypharmacy, meaning multiple different prescriptions. When everyone's like siloing each symptom, okay, we're going to give you a sleeping, so we're going to give you a benzodiazepine for your sleeping habits. We're going to give you a beta blocker for your palpitations. We're going to get, you know, and so they end up on multiple meds, each individually treating problems where there's a common thread. There's a common thread. And no one's trying to untangle because we don't have time. We're not trying to do it, you know, and women are very complicated.

55:21Dr. Mary Claire Haver:And then we throw hormones on top of it, you know, and the whole system goes cattywampus. So let's go to the woman who's pushing through perimenopause symptoms. My patients, and I'm sure yours, are busy women. They have built these busy, busy, complicated lives. I mean, they could be CEOs, moms, stay at home, whatever. It runs the gamut, but they are busy, you know? But they had it. They managed it. They had it. They had it under control. The ebbs and flows, the ups and downs, they could manage and still be okay, right? And now they're not okay. They're running on fumes, cortisol is going crazy, hormonal chaos in the background.

56:03Dr. Mary Claire Haver:How do you counsel them? So first, I want people to understand that they are more normal than they think. That it's God's cruel joke that we put people through perimenopause. When you're raising children, you're caring for elderly patients, and you're at that career moment where you're, you know, maybe not the top, but you're almost there and you're hustling. So I want people to understand that they're not crazy, that they're human. And then secondly, I want people to understand that there is help for menopausal symptoms. You know, 10 years ago, we would prescribe antidepressants for the depression.

56:39Dr. Mary Claire Haver:I was 100 % guilty of polypharmacy. I just wanted to help the patients. And here are the tools I have. And so I'll give you six different things to treat each. and no one had taught me and I didn't understand the common thread of menopause. The root cause, right? There's almost nothing more satisfying than having the phone call I did last week with a patient who I put on an estrogen patch about a month ago. She's 45. She has an IUD for the progesterone element of hormone replacement therapy. I put her on an estrogen patch for all the symptoms of perimenopause that other doctors had told her was just stress.

57:16You know, her boss, who's a woman, said, You're just working too much. You need to, you know, take a day off. And she calls me and she's like, I can't believe how much better I feel. And I said, describe. And she said, the best way I can describe it is I feel like myself. And I said, that is what we want. We want you to be you. She was sleeping better. She was not having hot flashes. She wasn't having that irritability that comes from your hormones being yanked around. And in the old days, even 10 years ago, and I did this too, you would have prescribed, you know, an antidepressant, a sleep aid, and sort of patted people on the back and said, you know, use a fan at night and put your foot out of the cover so you don't get so hot.

57:57One leg. One leg. But we now know so much more. And so it's great to be able to empower people with basic information. So to the woman who says, I feel crazy during perimenopause, I would say, welcome to the club and you're more normal than anything.

58:11Dr. Mary Claire Haver:Yeah, you feeling crazy is a predictable biological consequence of being in perimenopause. Yes. But we can help you. The funniest story, you know, I was early in my menopause clinic, which, you know, I built like a field of dreams. I don't know if any whitey will come see me and I'm just going to try this and see what happens. And I had a patient young, very much perimenopausal. She came in, we started her on hormone therapy. She comes back for her follow-up and she's stomping down the hall furious. And I'm like, oh God, you know, throws herself in the chair, sits down and is like, I feel great.

58:46Dr. Mary Claire Haver:And I'm like, okay, you know, like good, right? Why are you so upset? She says, because I was allowed to suffer for so long. No one should feel this way. I'm like, what are we doing? And it took social media for me to learn so much about this. Oh yeah. You know, we weren't talking about this in clinic. We, in traditional practice, We were just hustling to get from one patient to the other and run to the OR and do all the other and then get to soccer practice and pick up my kid and make sure the nannies got food going and whatever. And it was social media and listening to thousands and thousands of voices to realize, one, how much women are being gaslit.

59:24Dr. Mary Claire Haver:Absolutely. By a system. Yep. Why do you think that's happening? Because doctors don't have time and because we weren't trained. I was at Harvard Medical School in the 90s and early 2000s, and I learned very little about menopause. In fact, I don't think I learned anything. I was at LSU, very much a state school, super proud of it. We learned the same thing. We didn't learn anything about it. We didn't learn much about nutrition. We didn't learn about mental health. I mean, my mental health education was going to a psych hospital where people were talking to the walls. Schizophrenia. Right. When, guess what?

59:56We all have mental health as part of the human experience. It's ground zero for health. So the point is that we weren't taught these things. and like you, I had to learn about menopause from people like you, from my friends Rachel Rubin and Sharon Malone and reading and studying and understanding the nuances and continuing my education on it because things change, things evolve. And I think the best thing a doctor can do is to say, I have new information and my opinions and views and guidance have changed over time. To have the humility to acknowledge that we have been part of the problem.

1:00:31Dr. Mary Claire Haver:How do you guide someone back who was dismissed, was gaslit, turned to alternative sources, was not served there? Yeah. You know, how do you bring her back to evidence-based without making her feel bad or shame that she just was looking for help? To that person who's been gaslit or dismissed by the medical system, I say, I am so sorry. I understand that. and we have been complicit in shaming and blaming the patient. The system wasn't built for the whole person in mind. So to anyone who feels misunderstood or not heard, that's not a you problem, that's a problem. It wasn't actually built for the female body.

1:01:12Dr. Mary Claire Haver:It wasn't actually built for you. So I think, you know, the first step towards gaining trust is being humble about what we don't know, what we didn't know, and acknowledging people's pain. And then you can try to help someone when they trust you and when you feel like they understand where you're coming from and vice versa. Okay. Why would someone buy this book? What are they going to get out of this book? They're going to get a practical roadmap to getting what they need from their doctor's appointments and watching out for the landmines in the wellness industry. The solution, as I said earlier, is not to be your own doctor.

1:01:52It's also to recognize we all want to be well, but it gives you vocabulary to bring to your doctor's office. It gives you an understanding of a way to frame your whole health ecosystem. It gives you a visual representation of the health ecosystem. Health is not just about your lab tests or a normal mammogram. Health is about your biographics, your story. Were you raised by an alcoholic mother? Were you raised in poverty? It's about not just what you eat, but what's your relationship with food. Are you a stress eater? Are you a restrictive eater? Are you an emotional eater? It's about understanding where you are mental health-wise.

1:02:33We all have mental health. It's about anxiety and where do you live on the continuum of anxiety. It's a roadmap to help people ask better questions of themselves and then of their doctors.

1:02:45Dr. Mary Claire Haver:What are the first steps that a woman can take to reclaim agency in her medical encounter even when she's only got seven minutes. So what are your top tips? My top tip is to stop and ask yourself, what do you actually need? How do you feel? What are the actual pain points in your life? Is it stress? Is it insomnia? Is it your weight? Is it lack of access to a doctor who can answer your question when you're up in the night and on Dr. Google? What are the things you actually want? I think we're given so many messages about what health is out there when health actually starts in here. So the first step is self-awareness.

1:03:28Dr. Mary Claire Haver:Okay. What do you say to the woman who can't afford, you know, insurance is her only option. Will these guidelines work for her as well? This book is my attempt to reach people who don't have access to a doctor who has time, which is most people. Right. Again, And not through doctor's fault, the system is not designed to take time with people. So it is designed to help you sketch out, map your health ecosystem, your nutrition, your body mechanics, your mental health, your medical data. It's a guide to ask smarter and better questions based on your problems and your needs and your unmet issues.

1:04:09And it's a way to help you prioritize yourself and not someone else's version of health.

1:04:15Dr. Mary Claire Haver:you want every patient to become CEO of their own health. I love that. What does that look like practically day to day for a woman in her 40s or 50 who is managing her symptoms, her family, and a 12-minute appointment once a year? Right. Let me first say that not everyone does want to be the CEO of their health. If you look at one of the chapters that I put in the book, it's about the patient personality. So one of the ways to have agency of your health is to identify what kind of patient you are. So in the spirit of self-awareness, understand, are you the person who brings reams and reams of printouts from Google to your doctor's appointment?

1:04:51Or are you someone who just wants a prescription and you don't want to understand the why? That's self-awareness. That's self-empowerment. And not everyone wants to be the CEO of their health. Some people just want, tell me what to do and tell me where to go get it. And other people are skeptical. They've got the one eyebrow raised and they're like, hmm, I know you recommend that medication or habit, but why? So not everyone wants to be the CEO for health. I think like some people do. But I think the point is to be able to be an empowered advocate for the needs that you have, which sometimes means asking where to get help.

1:05:28Okay.

1:05:29Dr. Mary Claire Haver:You've got your appointment. You want to show up at your doctor's office prepared. Yes. What do you recommend? First thing is know what questions you want answered. Like what drop dead things do you need to know before you leave? And communicate to the doctor that. Say, here are the three things I don't want to leave without having answered. Number two is make sure that you've mapped out your health ecosystem. Kind of prepackage yourself before you show up to the - How do I map that out? So that's what the book is about. Okay. The book is basically a guide to map your health ecosystem to help you understand the different components of your health.

1:06:04It's not just your labs. It's your story. It's your body mechanics. It's about pain, past injuries. Do you hand this to a doctor? No, you do this before you go to the doctor. So this book is basically prepping you to be a patient. So if you go on my website, beyondthepescription.com, you can get the downloadable map of your health ecosystem and you can write out, based on the instructions in the book, the different elements of your health. What's powerful is the downloading of information that you have inside you already. And then seeing how you can connect the dots between your childhood trauma and your relationship with food and your cholesterol.

1:06:45The interesting thing about the health ecosystem isn't just the components. It's about the relationship between your anxiety and your sleep and your protein and your blood pressure. So if you can do the homework and you're a prepackaged patient by mapping your health ecosystem, you are then going to squeeze more juice out of that 15-minute appointment with your doctor.

1:07:09Dr. Mary Claire Haver:What do you think about patients ordering their own labs? I think it's a terrible idea. I mean, we're not In-N-Out Burger. It's not that I'm saying I'm better than In-N-Out Burger. I'm not morally superior to In-N-Out Burger. I'm just saying that, like, I do have some training. You've had some training. You know a few things about how to apply medical knowledge to the data in front of you and the person in front of you. So I think that if you look at the landscape out there, basically we're moving to a place where we're asking people to be their own doctor. Download your labs into this chatbot, operationalize a plan, and here's the protocol.

1:07:44Print it out, put it on your fridge, and do that. and what that does it deprives people of agency because it doesn't help them connect the dots between their everyday experience the limitations in their lives their fears their vulnerabilities their problems they're embarrassed to say out loud it just assumes a certain risk and risk tolerance it assumes a certain set of goals and there's no human element there which is really essential for providing care and for receiving it. Do you think we'll ever get there, that they'll train the algorithm? So this is actually my fantasy. This book is not an ego project.

1:08:24This book is actually my calling card to be part of the health reform movement.

1:08:29Dr. Mary Claire Haver:What is the health reform movement? What would perfect health care look like? I've lived overseas. I've seen the positives and negatives of socialized medicine. Yes. Right. Like in the UK, clinicians, physicians mostly, practice in a very narrow set of protocols. Right. And if they step outside of the protocol, as that was put together by a very small group of people sitting in government type agencies, they could lose their license to practice. So like. So I'm not recommending socialized medicine. This is the United States of America. I don't think that's ever happening. OK. Even if it were a good idea, I don't think it's happening.

1:09:10What I think needs to happen is that we need to scale primary care and dispense it to communities all around the country. Let me say this. If you look at total health care spending in this country, 95 % of health care dollars go to damage control hospitalizations, ER visits, and damage control medicine. 5 % to prevention. There's no shortage of evidence in the medical economics world to show that when you dispense primary care into communities, people live longer and they live better. And we save money. So that is not up for debate. Like, it's already been decided that deploying—

1:09:56Dr. Mary Claire Haver:Then why isn't it happening? Because the insurance companies have a hold on the medical system. They have a hold on doctors. Should we get rid of the insurance companies? I don't think you want to get rid of insurance companies. Because the number one cause of bankruptcy in the U.S. is medical debt. Exactly. So. But there's an easy solution to it. All right. I'm not saying it's going to be simple to execute. Simple is different than easy. But easy. I mean, this has been shown again and again. Just like we don't need more studies to show that exercise is good for you, we don't need more studies to show that primary care, when deployed nationally and when scaled, saves money, saves lives.

1:10:31When you have a doctor who knows your name and not just your diagnosis codes, who can connect the dots between your sleep, your stress, your grief, your cholesterol, your blood pressure, and then help you make a plan that works for your life, that is medical care. So there's no mystery as to how we solve the healthcare crisis in this country. It's by scaling primary care and deploying it nationally, not just for people who can afford it, but for every American. Every American needs unfettered access to a primary care medical home. And the primary care medical home needs to be a hub for problem solving, not just a gatekeeping apparatus and a prescription mill.

1:11:09That's what medicine should be. That's what I thought I was doing when I went into primary care as a field. AI has a role in the healthcare transformation space. But if we use AI to replace the patient-doctor relationship, we're no better off. What we need to use AI and technology to do is to elevate the patient-doctor relationship and for AI and technology to do all the crap work that is required to do the back end of, you know, running a primary care practice and all the grunt work that doctors do that could be done better by AI or some technology. That is going to happen if we have doctors shepherding technology in the appropriate way.

1:11:55But if we let AI and AI alone reinvent the healthcare system, then healthcare is going to be this. It's going to be a chatbot and, you know, a physician extender for their license to just prescribe medications.

1:12:07Dr. Mary Claire Haver:Well, that's the way corporations will make the most money. So what needs to happen? You need a populist movement. You need a movement of empowered patients one at a time to demand what they don't even know is possible. I don't think people know what is possible in health care when you have a relationship with a doctor who understands you and not just your medication list. People don't know to ask for it because they don't know that exists. But more and more doctors are leaving the system and voting with their feet and saying, look, this is not a health care system we have in this country. We have a health insurance system, but we don't actually have a health care system.

1:12:43Dr. Mary Claire Haver:Right. We need Congress to pass more legislation to allow doctors to practice medicine and build practices that honor the patient, not just their diagnosis codes. We need to incentivize medical students coming out of medical school to go into primary care fields. Why would you decide to choose a primary care field when you're graduating from medical school if you look out there and you're getting paid minimum wage to be a primary care doctor and see, you know. They're terrified AI is going to take their job away. Well, and they also see the burnout and the moral injury in primary care fields and the low pay.

1:13:19So we need to incentivize financially medical school graduates to go into primary care fields. and we need to empower patients one at a time to demand the kind of care that is not just about a pill for every body part and a doctor for every complaint. You need a medical home. You need a primary care provider who knows you. Having a relationship with a patient is why any of us went into medicine. I mean, maybe not if you're a surgeon or an anesthesiologist, you wanted them anesthetized and, you know, like under, right? But most of us went into medicine because we want to help people, not just write prescriptions.

1:13:58Dr. Mary Claire Haver:Right. So you wrote a piece on aging gracefully. Yes. That I keep coming back to. So you had a patient in her 80s told you she only needed four things. Yes. A doctor she could trust, a friend that she could lean on, a sense of humor, and a good hairdresser. Right. What did that teach you about what actually matters? I'm assuming this girl was thriving. This woman is thriving. And that's what I meant earlier when I said that my healthiest patients aren't the people who are necessarily optimizing in every way they can all the time, or they don't necessarily have the perfect set of labs. They are people who know themselves.

1:14:34They know where to let go, and they know where to lean in. So this patient has a sense of humor and a sense of acceptance over the things she can't control. She's not trying to fix every wrinkle. She's not trying to optimize everything in her body. She's understanding that, you know, health is not guaranteed. And she's going to center pleasure and joy and levity. And she's going to take care of herself by getting her hair done. I love it.

1:15:00Dr. Mary Claire Haver:What are the top three things that you want people to take away from the book? The three things I want people to come away with from this book are, number one, feeling less alone and feeling less shame from the medical system. It's not a you problem. It's a systems problem. if you've ever felt dismissed or unseen by doctors. Number two, I want people to have a practical vocabulary to bring to their doctor's appointments, to know what questions to ask, and to make sure they're centering their actual problems, not someone else's problem. And then third, I want people to be able to stop and pause and ask themselves what they need to be well.

1:15:38I want people to have permission to stop chasing someone else's version of health. And that would be a job well done if people could come away with those three things.

1:15:46Dr. Mary Claire Haver:Well, Dr. McBride, so great having you on Unpause. Thank you so much. Mary Claire, thank you so much for having me. Dr. McBride's new book, Beyond the Prescription, is out August 11th and is available anywhere books are sold. You can visit drlucymcbride.com to find out more, subscribe to her newsletter, Are You OK?, or listen to her podcast, Beyond the Prescription. And you can follow her on Instagram at drlucymcbride. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawslife.com.

1:16:26Dr. Mary Claire Haver:My new book, The New Perimenopause, is available now everywhere and anywhere you buy books and through our website. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People.