Fresh Take: Dr. Lucy McBride on Advocating for Yourself at the Doctor's Office

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0:32Hello, everyone, and welcome to Fresh Take from What Fresh Hell? Laughing in the face of motherhood. This is Margaret, and today I am talking to Dr. Lucy McBride. She is a primary care physician and co-founder of the Ackerley McBride Group in Washington, D.C., where she has been caring for patients for over 25 years. She writes the weekly newsletter, Are You OK?, and hosts the podcast, Beyond the Prescription. Her writing has appeared in The Atlantic, The Washington Post, and USA Today. And she has appeared on CNN, MSNBC, NPR, and PBS advocating for a data-driven, whole-person approach to health.

1:10Her book, Beyond the Prescription, A Doctor's Guide to Taking Charge of Your Health, which we will be discussing today, is in bookstores and everywhere you buy books now. Welcome, Dr. McBride. Margaret, I'm thrilled to be here. And please call me Lucy. All right, Lucy, let's go. I loved this book. Cannot wait to discuss it. The title, Beyond the Prescription, suggests that somehow medicine alone is not going to take care of everything that ails us. Why the title and why did you want to write this book? So I've been caring for patients, like you said, for over 25 years. And the same thing plays out over and over again.

1:51Patients come in, they've been dismissed, talked over by doctors, through no fault of doctors. Doctors don't have time. So they go to the wellness industry. That's what people do when you don't feel well. You go to ChatGPT, you go to Google, you go to the latest internet guru, and you leave feeling even more confused than when you left your doctor's office. Medicine has become overly prescriptive. Wellness has become protocolized. What most people need isn't a pill or a prescription. They need to understand their whole health ecosystem. Health is not just about your lab tests and someone else's prescriptive idea.

2:31It's about you, not me. And it's about understanding that you have more agency over your health than you may think. We have outsourced our intuition to these two dueling industries. When we house so much information about ourselves, our body, our mind, our relationships, our sleep, our stress, the things we're embarrassed to say out loud. This book is a way to mine your interiority, excavate all the data you house in your own self to then bring a more honest rendering of yourself to that 15-minute prescriptive appointment. I want to break that down. Lots of big words in there, and we're going to really break it down for people because people hear words like wellness, And it's like, wait, is wellness getting a massage?

3:16Is it getting a pedicure? Or is it like Goop and Gwyneth Paltrow? There's so much going on in that. But first, I want to start with the basic idea of the book, which was even an aha for me that I think I was raised with very traditional, like you go to the doctor, the doctor fixes it. And that's all you need to know. You show up, tell the doctor what's wrong. And raising kids and having my own health problems, I found much more that the reality is, you go to the doctor, they see one aspect of yourself or your child. They don't always know what the solution is, which kind of makes sense when you think about it.

3:55But why do we have this idea of the doctor fixes what's wrong with you? So the way healthcare in this country is built is that it's episodic, it's transactional, and it's impersonal. Transactions are part of what we do, right? You have strep throat, you take penicillin. You have an infected toe, you take this antibiotic. But health is about more than the absence of disease. Wellness is about a feeling. It's about a sense of agency. It's about the 364 days a year you're not in the doctor's office. Right. It's about access to information and guidance so that when you're making a decision, like whether to get a flu shot or not, whether to have that second glass of wine or not, whether to call your doctor to get an antibiotic or just, you know, take over the counter cold medicines.

4:48Those mundane decisions you make every day, you need to be armed with information and guidance to make those. You also need to be armed with the concept that health is not just about winning your doctor's appointment or having a perfect set of labs or getting your strep throat fixed. It's about body, mind, and spirit. It's about your lab tests and how you feel every day. It's no good for me to help someone live to their 100, which we can now try to do if they are depressed or anxious or socially isolated. And so health is much broader than what medicine is able to countenance right now. And so I think that's why wellness as an industry was born.

5:30Mm-hmm. The wellness industry recognizes that people don't feel well, whether it's a strapped throat and they can't get another doctor, or they are despairing over the state of the world, or they've experienced loss and grief, and they don't know who to go to. The wellness industry knows that. They know that people have been talked over and dismissed in the doctor's appointment. And so the wellness industry says, come hither, let me give you the illusion of control with these protocols and prescriptive pieces of advice. And if you just follow this person's advice, you'll be okay. And look, I believe in the mindfulness and yoga and wellness is part of what I do.

6:08It's what I want for my patients. It's what I want for myself. But health is about more than just doing yoga and exercising. It's also not about someone else's idea of what health is. It's not about someone else's goals. It's about what are your goals? What are your limitations on your life? For mere mortals, we can't track our steps and our grams of protein and our sleep hours and parents and care give. That just adds shame to the message that we have to be doing it all ourselves. Health is not just about optimizing body parts. It's about knowing who to trust, knowing what questions to ask, and honoring what your goals are for health, like today, next year, and in the future.

6:49It struck me as really revolutionary, this idea that really it's like balancing scales, kind of, that like everybody has a piece of your health and that you as the patient or the self kind of need to help everybody have the information to regulate that. You talk about living to 100. I was just with my dad last night, who's 92 years old, doing great, very healthy in a lot of ways. But talking to one doctor who thinks his job is to extend his life as long as possible by keeping his organs healthy. But the side effects of those medications are making his day to day life very unpleasant. And so he's now trying to push back against the doctor who's really kind of doing his job.

7:36He's a single organ doctor who's saying, I need to make this organ stronger. And it really reminded me of your book. And I was telling him about your book. Like, you have to be the person who is expressing, I would rather live one more year able to do the things I love than eight more years with my heart lung system functioning well, but I can't take four steps without being very tired. You said it. Health is about trade-offs. It's not just about solutions. It's about trade-offs. And the trade-offs you make are going to depend entirely on your pain points, your goals. So you may have a patient who has heart failure, for example, or who has a heart condition, who wants to be on the full court press plan to take every prescription medication, do every lifestyle intervention, never touch a sip of alcohol, never have a piece of birthday cake in order to squeeze the juice out of every minute of extra life they might have at the expense of side effects and sacrifices on that part.

8:43You may have other people who want to center quality of life more than anything else. They are willing to tolerate the risk of their blood pressure being slightly higher and not taking the pill to lower their blood pressure because it makes them feel terrible or use the bathroom five times a day or in the night. My point is that if you don't set your goals out there and communicate them to your physician, you run the risk, especially later in life, of being medicalized, right? Like there's a pill for every body part, a doctor for every symptom, and no one's talking to each other and the patient is, you know, it was called polypharmacy, over-medicalized.

9:16It's more important than ever to make your needs known and to bring up some mundane aspects of your life that are part of your health. Like if your dad, for example, is miserable from side effects from this medication, that is health too, right? Your quality of life matters just as much as quantity, arguably more. And there's abundant evidence to show that actually when we center quality of life, people actually do live longer because quality of life metrics improve our sense of well-being. It makes common sense. Yeah. Right. I mean, I remember when I was a resident of Johns Hopkins, new, fresh face to my 20s, and I was despondent when one of our patients who had ovarian cancer died in the ICU.

9:58She was young. And I learned afterwards that she had never been given the option to be at a hospice. Now, she may have decided, had she been given the option of hospice to be in center comfort and sent her quality of life, given that it was very limited how long she was going to live, she may have chosen anyway to die in ICU with tubes and monitors around her. But she wasn't given that option. And I remember being so upset and so angry that we chose the goals for her. That's not a fault of the physicians. It's a fault of our system. We tend to go, you know, default pathway of maximal medicalization.

10:32So this can happen in the outpatient setting, especially as we age, that you have a pill for every symptom, a doctor for every body part, and no one's talking to each other, and you're at home suffering from side effects, having not made your needs known. That's what this book is about. Identify your North Star, identify the real limitations of your life, identify the limitations on your brain space, your energy, and also, like, what do you want tomorrow, next week, next year? Because my goals, maybe one thing, but your goal is totally different, and it's about you, not me. I have another example, because I think what we're talking about can be hard to convey, And so I think the examples, I am dealing with a heart problem that's somewhat mysterious and changing, and I'm figuring it out, hopefully.

11:18But when I first went to a cardiologist, I was prescribed medication that was going to cost, let's say,$1 ,000 a month, a tremendous amount of money. and it was the kind of money that if I had had to come up with$12 ,000 a year for medication, it would have changed our lifestyle. It would have hurt us being able to save for our kids college. Like it would have lots of consequences, but it was feasible. But it was very hard for me to have a conversation. My doctor at the time was kind of like, well, you have to take it. you have a heart problem. This is the medication for that heart problem. And I was having a lot of trouble getting to, is this like GoFundMe level problem?

12:04Do I need to go out to people and ask them to help with this medication? Because it was just in that zone. If it had been$20 ,000 a month, I would have said, there's no way I can come up with this money. So we have to think about other things. It was just the borderline amount of money that I thought, I guess I could pay for this, but I need you to tell me on a scale of one to 10 how much I need to take this medication because it's a lot of money. Well, that's it. You're talking exactly about the problem we see all the time, that health is about trade-offs and doctors have a difficult time communicating relative risk to patients.

12:38What I want patients to ask their doctors is what are the alternatives to this medication? When you say this is going to reduce my risk of X, do you mean it's going to reduce my risk from 2 % to 1 %? Or do you mean it's going to reduce my risk from 80 % to 40 %? Like what are the absolute risk reduction numbers we're talking without having a crystal ball? Of course, there are many, many medications out there that are expensive designer medications that may be the new thing on the market, but that doesn't mean that there aren't alternatives like for blood pressure or for heart failure or for depression.

13:14Like there are many, many tried and true medications. And just because there's something new and sexy on the market and the drug rep may have come around and sold the doctors the idea that this is the new thing and the only thing, doesn't mean that it is the only thing. Again, health is about trade-offs. You have to be honest about your limitations financially, time-wise, brain space, and what your goals are and get the actual data that suits your life and the recommendations that you're going to adhere to, not that your doctor has to have you do for whatever their reasons are. I'm going to tell you, I wish I had read this before going in for those appointments.

13:48The book is Beyond the Prescription by Dr. Lucy McBride, and we're going to come back and talk about some practical ways to approach your doctor. Hey me, I'm soaking in it. You know I hate packing to go places, which is why I'm so grateful that Quince's mix and match pieces make throwing together a vacation wardrobe so much easier. Quince specializes in high quality essential pieces that will become the basic building blocks of your wardrobe, like the 100 % organic cotton poplin pin tuck maxi skirt I just got. You can wear it to the pool. You can wear it out to dinner, wear it everywhere because it goes with everything else that's already in my closet.

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17:28That's Nutrafol.com spelled N-U-T-R-A-F-O-L dot com promo code laughing. So I learned a new term from this book and I had to Google it to realize it was not a term just for your book. It's an actual term. Informatics. Tell me what those are. Informatics is what doctors love to think about. Measurable data, things you can measure in a test tube, on a scan, an x-ray, MRI. Informatics is basically an arsenal of data, right? Patients are walking around with data on their wrists. They have trackers to track their sleep, their steps, and trackers to track their step trackers. Informatics, however, important, is only one piece of your health puzzle.

18:13Medicine likes to index on this part of your health ecosystem. And doctors and patients alike like to conceptualize health as like a normal set of labs, a normal cholesterol, a clean mammogram. But health is much more than just your informatics. Data without context is just data. Right. So, for example, for people trying to put a point on it, you could be missing a hand, but your labs are normal. And if you're only looking at the data, right, like you have to see a bigger picture than just what the kind of computer is spitting out or your labs are spitting out. For example, you can be in perimenopause or menopause and have normal labs and feel miserable.

18:58Right. Two patients with the same cholesterol level, the exact same reading, one person's cholesterol level means that it's way too high and is putting them at risk for cardiovascular disease. Another person's cholesterol, the same level, it's completely normal for them. So in the era of ordering your own labs and conceptualizing health as no red marks on your lab test printout, we have to be cautious and recognize that data without context is not meaningful. Therefore, you need a doctor to trust to contextualize your health and also to recognize that sometimes the most important elements of your health are not measurable in a lab test.

19:40But then on the flip side of that, we kind of get into like mind-body connection and whole person health, which starts to sound like weirdos on the internet giving you information. Like as soon as I start to hear sometimes like mind-body flow, I'm like, okay, now we're in Gwyneth Paltrow territory. Like, I want real medicine. And so how do we kind of get those two things to function together? So it's not alternative. It's not outside the box to understand that we all have mental health. We all have thoughts. We all have feelings. And thoughts and feelings drive our behaviors. And behaviors inform health.

20:19So just as important as how many drinks do you have per week is what's your relationship with alcohol. For someone who use alcohol to self-medicate social anxiety, which by the way, isn't measuring a lab test, three glasses a week is three glasses too many. They need to work on their social anxiety instead of avoiding it by numbing, uncomfortable feelings. The same person who has three drinks a week and is pairing it with food and has it for enjoyment and doesn't have any negative consequences, that's probably fine. The patient who comes in who's 80 grieving the loss of her husband and asks me if she has dementia, needs to understand that grief, insomnia, and blues inform cognitive health just as much as other measurable factors.

21:03Social isolation has measurable effects on cardiovascular health. So this is not woo-woo. This is just medicine practiced in a way that recognizes that so many elements of the human experience can't be quantified in a blood test. You also talk in this, you talk about the four quadrants of which informatics is one, the data, right? Second is inputs, which again, abuts some of the woo woo, like this kombucha antioxidant can cure all that ails you. You don't need a prescription. So talk about the role of inputs on your body. Doctors love to tell people, you know, eat less sugar, eat more protein, ditch the alcohol, right?

21:47Like nutrition advice that's often very prescriptive. And sugar, alcohol, protein, all those things matter. But the reason I have a whole section of the book about inputs is because inputs are also all the things you put in your body, alcohol, recreational drugs, supplements, and those things that you put in your body affect your medical data in ways you may not realize. Green tea extract, which is touted as, I don't know, I think it's something for metabolic health. I had a patient come in with green tea extract related liver toxicity. I had a patient who was taking vitamin D because her wellness provider or someone on the internet told her that vitamin D was important for bone health.

22:26It is. She thought if one tablet is good, then five is better. She has a vitamin D toxic. So my point isn't to tell people, to lecture people, you know, eat better, get rid of sugar, get rid of alcohol, although that may be appropriate for the right person. is to take an honest inventory on your own time of everything you put in your body, everything you inhale, everything you ingest, because guess what? It has everything to do with the things you can measure in your blood test. And it's time to start connecting the dots between informatics and inputs, and then render advice to yourself or through your doctor's help on how to tailor your inputs to your particular medical issues.

23:06Because there's no one-size-fits-all prescription for nutrition. Then we come to infrastructure, which is all about, well, you tell me, I won't tell you since you wrote the book. So infrastructure is the container, like the vehicle that drives you through life. It turns out that most people take care of their vehicles, their cars, better than they take care of their skeletons. And we need these vehicles to function because movement, exercise, as you know, is important for everything from preventing diabetes to dementia to depression. So instead of doctors just telling you exercise more, do better, see you next year, and you're sitting in your car after the appointment thinking, gosh, I got to be better tomorrow.

23:45Think about your actual infrastructure. Think about the three things you need to take care of your skeleton. Cardiovascular exercise, strength exercise, and stretching. And then think about the limitations to getting those things. Maybe it's time because you're working two jobs and caregiving for a loved one. Maybe it's money because you don't want to go to the gym, maybe it's body shame that keeps you from going to the gym or exercising in public. Think about what the limitations are for you keeping your skeleton healthy and analyze, take a skeletal survey of what hurts, what's tight, what pain points do you have in your body that are keeping you from moving the way you should, that are keeping your informatics on the fritz or just making you feel lousy.

24:26And then let's talk about insight and the mental health aspect of bringing all of these pieces together. Yeah, so insight is where you think about your attitudes towards health, your relationships with yourself, with your work, the way you manage stress, because it turns out the way you manage stress has everything to do with how much you drink, how do you take care of yourself, and it informs your blood pressure. I remember during COVID, during the panicked days of COVID in the spring, I had people coming in complaining of earaches. They're like, I have an ear infection. It turns out it was stress living in a jaw and the jaw causing ear pain and head pain.

25:03I had people coming in during the summer of Black Lives Matter with high blood pressure saying, I've never had a high blood pressure in my life. What's going on? Well, they were under enormous stress, right? So insight is about pulling up a mirror to yourself and understanding where you live on the continuum of anxiety. We all have it. Where do you live at baseline? How much brain space does worry, hypervigilance, occupy in your brain? And then what do you have to cope? What tools do you have to cope to manage anxiety? Tell me about your relationship with food, your relationship with alcohol, your relationship with your spouse.

25:35Those things matter because those things inform how we behave and our behaviors inform our health. And this information, which I want to try to get at in case people are not picking it up from our conversation, it lives really best with yourself as the patient because you see so many different practitioners or doctors and that you kind of have to be able to see these four quadrants for yourself so that you can paint the correct picture to your provider. Is that correct? That's right. Until you kind of bring the human elements of who you are, what's happened to you and understand the connections between your past and your present, your labs, and what's going on in your life, then you aren't really painting a full picture of your whole health.

26:29That's homework you can do on your own. Those are questions you can be asking yourself. And that's really what this book is about. It's about asking yourself better questions, being radically honest with yourself so you can then bring a sort of more authentic version of yourself to your doctors and have figured out some of these puzzle pieces on your own. I am talking to Dr. Lucy McBride. She is the author of Beyond the Prescription. And we're going to come back and really dial in on owning your role in your own health care. Well, Amy, I'm about to head off for vacation. And even with those hotel hair dryers, I know my hair will be, as you like to say, bouncing and behaving thanks to Nutrafol.

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