Month: May 2019

What is tough to learn and EVERY doctor could do better?

What is something that is tough to learn and every doctor should know it better than they do?  Aside from Kreb’s Cycle.  Billing and coding! 

Dr. Charlotte Akor is a nationally recognized speaker and physician coach on billing and coding.  In this interview, we discuss the necessary history, physical and medical decision making in order to bill and code appropriately and then get into the weeds about proper coding of medical decision making.  She uses examples to help explain medical decision making with diagnoses of varying complexity.   We then get into the time-based codes and how to appropriately document for this.  We end with the common modifiers and some newer codes that are frequently missed in the primary care setting.

 Dr. Akor completed her undergraduate education at Yale, attended medical school at West Virginia University, and completed her ophthalmology residency at SUNY Buffalo.  She then completed TWO fellowships, one in ophthalmologic pathology at Emory and one in pediatric ophthalmology at Children’s Health Care of Atlanta Hospital.  She is the former head of the Pediatric Ophthalmology on the faculty of The University of Texas at Houston Health Sciences Center and is now in a hospital-based practice in Abilene, Texas.  She is the Amazon best-selling author of Medical Coding Decoded and can be found at CharlotteAkorMD.com.

 

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

What is tough to learn and EVERY doctor could do better?

What is something that is tough to learn and every doctor should know it better than they do?  Aside from Kreb’s Cycle.  Billing and coding!

Dr. Charlotte Akor is a nationally recognized speaker and physician coach on billing and coding.  In this interview, we discuss the necessary history, physical and medical decision making in order to bill and code appropriately and then get into the weeds about proper coding of medical decision making.  She uses examples to help explain medical decision making with diagnoses of varying complexity.   We then get into the time-based codes and how to appropriately document for this.  We end with the common modifiers and some newer codes that are frequently missed in the primary care setting.

Dr. Akor completed her undergraduate education at Yale, attended medical school at West Virginia University, and completed her ophthalmology residency at SUNY Buffalo.  She then completed TWO fellowships, one in ophthalmologic pathology at Emory and one in pediatric ophthalmology at Children’s Health Care of Atlanta Hospital.  She is the former head of the Pediatric Ophthalmology on the faculty of The University of Texas at Houston Health Sciences Center and is now in a hospital-based practice in Abilene, Texas.  She is the Amazon best-selling author of Medical Coding Decoded and can be found at CharlotteAkorMD.com.

 

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

 

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

On today’s episode Dr. Charlotte a core and I discussed billing and coding. Dr. acorn completed her undergrad at Yale went to medical school at West Virginia University, and then did an ophthalmology residency at my alma mater of SUNY Buffalo. She then did two fellowships, one in pediatric ophthalmology at the Children’s Healthcare of Atlanta hospital, and an optimal logic pathology fellowship at Emory. She’s the former head of pediatric ophthalmology at the faculty of the University of Texas at Houston Health Sciences Center, and is now in a hospital based practice in Abilene, Texas. She lectures nationally and coaches on billing and coding and as the Amazon best selling author of medical coding decoded. So in this interview, we discuss the necessary history, physical and medical decision making that you need in order to build and code appropriately. And then we get into the weeds about proper coding specifically of medical decision making, because this is really the most Complicated aspect of those three. We go through some examples of medical decision making with diagnoses of varying complexity. And then we get into time based codes and how to appropriately document for this. We end with the common modifiers and some newer codes that are frequently missed in the primary care setting.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing kreb cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Doctor record. Thank you so much for being on the show today.
Thank you. How are you doing this evening?
I’m doing well. I’m doing well for the listeners. We were actually just having a very lively discussion. about different styles of figuring out how to get the billing and coding done. So, for us, it was a very interesting discussion. And I hope it is for the listeners as well, because today we’re going to talk about the topic that everybody wants to know. But nobody wants to learn. And that’s billing and coding. And so, so doctor a core, you started your book talking about medical decision making. So why did you that’s, you know, generally there’s the history, there’s the physical and then there’s medical decision making, but you went backwards to forwards. Why did you start with medical decision making?
Well, I started with medical decision making because as a physician, that is the part that I had the worst, the hardest problem billing and coding, you know, figuring out that schema and from the billion coding classes that I have been taking, the teachers were saying doctors under code and undervalue their work, understand Ending medical decision making will actually allow us to value our work. However, since I have been coaching other physicians on billing and coding for the last six months, I’ve just found out that different people have different deficiencies in their billing and coding. For example, some people don’t know how to take the appropriate level of history, comprehensive history. Some people don’t know exactly what, how many review of systems, you need to have a comprehensive history. Some people don’t know what the examination guidelines that are needed to have this comprehensive examination for the highest level of codes. And some people document very well, but they are unaware of the additional add on codes that they’re able to use, that they’re already doing and counseling their patients for those problems. They just don’t know, know how to code for those how to use modifiers to get paid for that work. So the reason why started my my book on medical decision making was the problem that I’ve had. But I found out there’s lots of different problems with medical billing and coding and learning the fundamentals and making a commitment to continue to learn and open your mind will make you a better biller encoder and hopefully prevent you from losing money in a medical audit.
Well, I think for history and physical, that that seems just a bit of rote memorization, right? Like you need a certain number of things. In the history to build a certain level, you need a certain number of parts to your physical exam to build a certain level. It seems like for our listeners, they can just look up the CMS guidelines for the minimum you need for each level and just make themselves a cheat sheet right like a little cheat sheet that they can keep next to their computer so that when they’re when they’re deciding what code, they can make sure that they listen to the heart and lungs. Or make sure that they look in the ear in the nose or make sure that they did those things, that that’s commensurate with the complexity of the medical decision making.
You think that but I think billing and coding training is somewhat lacking in residency, or I remember as a medical students, they tell you to go and interview a patient and write things down. But I don’t remember it being very explicit saying, well, when you ask a patient about their chief complaint, you need to make sure that you know when it started, you know when it started, are there any exacerbation factors duration onset? So I think as all as medical students, we all took a history and we probably had a lot of those elements written down, but in, in practice, you have your assistant do that. So if you are just reviewing what your assistant has said, you may not have that written down and like you said, not everybody has that cheat sheet. So yes, that’s something that Very easy to correct, but it’s not always taught. And the same thing with the physical examination because this because you can do the examination doesn’t mean that it’s pertinent to your, it’s pertinent to your problem. The the heart of billing and coding and when you get into the established codes is really that medical decision making?
Yeah, I think what you’re saying is, you can’t get blood from a stone, right? So if you’re someone with some very simple problem, if you do an extraordinarily extensive history and extraordinarily extensive physical exam, because you only need to add up three of those things to match up to get your code. And then the problem is, is very simple. You’re doing exactly that you’re getting the blood from from the stone. So you really need your medical decision making to the code.
I’ve seen it happen the other way around to people go to doctors and they’re sick for Example, I had an opportunity to work with maternal fetal medicine doctor, a high risk doctor, right people who go and see the high risk doctor, they referred to the high risk doctor because they are high risk. So the high risk doctor is doing examinations that have that moderate medical decision making, who knows even that high complexity medical decision making, it’s time for your baby to be delivered tomorrow, right? Here’s the ultrasound that I did in my office and also did your blood work and I checked your urine and it’s time for your baby to be delivered yesterday. But if their history isn’t of the complex variety, if their examination is not of the complex variety, you know, when those patients are sent to that doctor, and they’re not billed as consults, that physician is leaving money on the table. So, so there are a lot of doctors that undercoat you Do you think oh, well, there’s all these doctors who are over coding, like you saying, trying to make something that’s very simple complex. I don’t really think that’s the case. I think that doctors are taking care of complex medical problems. And all the elements need to align to be able to get paid maximally for their work. Oh, no, just
no misunderstand me, I think the majority of the time, people are probably under coding rather than over coding. I think that’s, I was just trying to interpret your statement of, you know, the medical decision making really needs to be kind of the captain of the ship, you can’t have a very simple problem and then and then inflate your code. But probably what most people are doing is they’re afraid of over coding. And so they’re, they’re assuming a less complicated code than then than they need to be. But I think history and physical well first for our listeners, and tell me if you if you agree or you disagree, if you’re billing at a certain level you need and it’s a new patient, you need the history, the physical and mental medical decision making to all match up. And if you have one that’s lower than the other two in terms of the code that you can build for, then you have to round down to that lower code. If it’s an established patient, now, you only need two out of three of those things. So between history, physical and medical decision making, only two of those things need to match up. So if you have a very complicated medical decision making very complicated history, the physical doesn’t matter. And and vice versa. And, you know, we said earlier, the history you can make yourself a cheat sheet for what you need for different levels, the physical, it also the physical depends on your specialty. So you know, what is considered a complex code for physical exam for an ophthalmologist is clearly going to be different from an otolaryngologist because they’re not asking you to do a mirror exam of the larynx and assess the hearing, right. So that’s, that’s something for one of our more complicated physical exam codes. So just have to memorize That, let’s get into the weeds a bit with the medical decision making, right? Because that’s really where the meat is, can you just give us an outline of how you arrive at a code for for medical decision making?
I usually like to choose the so there’s there’s three columns, I like to focus on the third column last, so the risk of complications or morbidity and mortality. I’m going to give you a couple examples. I’m an ophthalmologist. If I don’t treat a patient and they go blind, then I consider the loss of vision, a moderate morbid morbidity and mortality. So if someone is coming to me with a vision threatening condition, meaning amblyopia, loss of vision, because of their eyes are misaligned, that one eye sees differently than other than I’ve already got that that that risk of morbidity or mortality. I mean, blindness is a serious issue. serious medical problems. So I start there, you know, if somebody’s not going blind, then somewhere in the low to minimal, but most people are coming to the ophthalmologist, at least my subspecialty is pediatric ophthalmologist, they have some form of vision loss, which risk is that? And so for the listeners, I would recommend that you Google table of risk, because that’s going to get you to the table that we’re talking about right now. And I can link up an example of that in the show notes. So which which risk if you’re talking about loss of vision is that minimal, low, moderate or high? Well, I consider it moderate. So the patient’s parents do not comply with my therapy, then, you know, their their risk of vision loss is moderate. And so I the American Academy of ophthalmology does a really good job of training their physicians on billing and coding, and they just talked about how ophthalmologists really undervalue their work. So the difference between moderate and high, especially for ophthalmologist is a high risk is if somebody has a ruptured globe, or retinal detachment or really high intraocular pressure that really needs to be treated emergently the risk of morbidity and mortality, morbidity or mortality in the ophthalmologist cases blindness is very high, because it’s very acute in that moment, within 24 hours, the other blinding conditions like amblyopia or strabismus, we have time to fix those. So the risk of morbidity and mortality, I consider those moderate.
I also want to draw our listeners attention to the fact that on the same level as that, so there are three there are three columns, there’s presenting problems, diagnostic procedures and management options. On that same moderate risk is prescription drug management. So that’s also if you if you put the patient on prescription eyedrops, or you give them an antibiotic there, that that that also gets you to monitor risk and I think physicians are probably undervaluing the significance of the condition for something that they’re just giving a prescription drug for.
And I know and I definitely that’s what we’re, we’re we’re undervaluing our work, right? Because if we aren’t given glaucoma drops, that patients going to lose their vision. If we’re not giving antibiotics for a corneal ulcer, then that person is going to lose their vision. Now, if there’s a corneal ulcer in the center of their eye, and their cornea is going to melt and cause an open globe, that risk of morbidity and mortality will be high, but the corneal ulcer the glaucoma ophthalmologists are medical doctors and they’re dealing with a lot of blinding conditions, the moderate complexity does medical decision making schema should be able to be obtained. So first, I like to start with a column of the risk of complications and morbidity and mortality. And then the next column that I usually use Go to is the amount and or complexity of data to be reviewed. I’m an ophthalmologist, we have several we have several forms of testing in our office, a refraction, when we even figure out what a patient’s glasses prescription is considered a test, we take a picture of the back of the eye that’s considered a test. So we have testing that we perform, and that we review that that allows us to be in that column. And then the same as, you know, a primary care doctor who is is performing an EKG on a patient who’s getting bloodwork on a patient who is reviewing their patient’s chest X ray, who is, you know, going to order a stress test, that’s where you in that second column, the amount and or complexity of data to be reviewed, is where you would get that moderate
number or letter in that row together. go across with your medical decision making capacity so or medical decision making. So you need two or three. And then if you’re a person that loves to list different differential diagnosis or management options, then the moderate medical decision making you need to be able to list multiple diagnosis or multiple management options or for the high level, extensive diagnosis or extensive management options. So, back to medical school, I wasn’t very good at making a long list of differential diagnosis. So I usually shy away from that one, but I’m willing to help anybody go through that list with the main problems that that they see day in and day out. And one thing that we discussed before the show was that your pediatric ophthalmologist and so anytime you’re obtaining a history unless it’s an older teenager, you’re obtaining the history is from someone other than the patient, and you actually get two data points, and I’ll read this from CMS, it says review and summary of I don’t know why the grammar is right but review in summary of old records and or obtaining history from someone other than the patient, and or discuss discussion of case with another health care provider and documentation of relevant findings. But in that is obtaining history from someone other than the patient. So if you have a patient with confusion or dementia, and you’re obtaining the history from a caregiver, or if you have a child and you’re obtaining history from a patient, you already have two data points. So that brings you up to moderate already. So then you just need enough of a diagnosis or enough of a risk. And there and that’s a that’s a simple so I think one thing that you put in your book that I loved, was you recommend, come up with your 10 most common problems. So you challenge the readers to come up with their 10 most common diagnoses that they see and figure out what the medical decision making is so then you don’t need to think of it on the fly. And I think by sitting there for the Maybe 20 minutes that it takes to go through this and do your homework. Not only will they know the codes at the snap of their finger, but our colleagues are going to just understand the whole process a whole lot better. And we’re leaving a whole lot of money on the table, right? You This is what you say, right? You need you like educating your colleagues so that they can maximize the income that they deserve that they’ve earned because the medical is the complexity of the patient is there they just need to know the code. One of my
best buddies isn’t a neurologist. So she attended the online Facebook program that I had about, you know, one day I did history The next day I did physical and then the third day I did the medical decision making capacity. And she actually did that exercise on some of her epilepsy patients. You know, if you have an epilepsy patient, right, that’s not well controlled. You know, the risk of morbidity and mortality is high. You know what testing did? Have to do to learn more about that epileptic patient. And then you say if the epileptic patient has, you know, is is has some mental disabilities because they’ve had long standing epilepsy or if the patient has developmental delay or doesn’t speak, because the because they have epilepsy. She was saying, Wow, you’re billing all my patients as level fours. Maybe some of my really sick patients, I should be billing as level five. So I really do agree with you. I think it really helps to take your top 10 diagnosis because we do the same thing every day, right? You need to take your top 10 diagnosis and make sure that you can billing code comfortably for this chart. Ultimately, if you get audited, actually, it’s not if you get audited is when you get audited, that your documentation reflects your work and you get paid for your work. So I had another colleague who’s a neurologist, and he got audited and CMS said All the charts he gave us you under coated? Well, he they’re not going to go back and give him his money back. He still had to go through the audits. So you don’t protect yourself from an audit by undercoating, you just save the government money.
You might not know the answer to this, but does the government extrapolate? They do callbacks where they say, Well, we’ve reviewed 3% of your charts, and we found that you over coded in for X amount of money. So now we’re gonna extrapolate that to 100% of your charts and you owe us X amount of money.
I’m not sure if they extrapolate, but I know they can do cop. They do the clawbacks and they have those RAC audit, they pay those auditors to claw through your charts and take money back. So there are certain diagnosis in ophthalmology. So one thing I said well, you need to know the fundamentals and then you need to take your billion coding education to the next level. The American Academy of ophthalmology is Other subspecialty societies have their billing and coding update. So you need to physicians need to attend those or have somebody in their office attend those so they know what the auditors are looking for. So this year they were talking about, there’s a special test ophthalmologists can do that if you You’re only allowed to do it 12 times a year. So if you do it 13 times a year, you get a big ding and then they come and look at all your charts. Yes, the government can clawback things and so you have to make sure that you are billing and coding properly and that you’re also up to date on what areas that the government is looking for. To take the money back.
Can you walk us through how you would code medical decision making for a common outpatient problem like headache, headache, it has to be one of the most common reasons for a visit to the primary care physician er Urgent Care neurologist EMT, we see a lot of it. So can you just walk us through the medical decision making for something like a headache?
So the headache is something that bans all specialties. And it really depends on what really what your true differential diagnosis is. So, you know, I’m an ophthalmologist, I get a headache referrals from the neurologists to make sure that the optic nerve isn’t swollen, it really depends on the history of the headache. So, the history is very important. When did the headache start? How long had the headache been has been going on? And really, almost what studies have been done so let me talk about headache from the ophthalmologist standpoint. So an ophthalmologist of the mall just have a unique set of codes in the CPT book, we have eye codes, and we can actually use the evaluation and management codes, ophthalmology that evaluation and management code are a little bit more stringent for us to use. If there are really no abnormalities found, a lot of times patients are sent to the ophthalmologist for headache, and nothing is found. They don’t need glasses, their eye has the perfect structure. So an ophthalmologist would actually build that code. We’ll build that as the the AI code, where if they were going to build it in the evaluation management system, it would be low complexity, right? So there’s the risk of morbidity and mortality is very low for that headache, because there’s the ophthalmologist was asked to look at the eyes to see if there is anything linking the optic nerves or increase intracranial pressure to the headache and ophthalmologist don’t treat migraine So, you know, they’re not going to go through the number of management options, you know, pay go back to your neurologist, and usually when the ophthalmologist examines somebody with a headache and CAT scan or MRI may or may not have been done. So a headache for an ophthalmologist, you may be a low complexity for a level three new patient exam unless they see swelling of the optic nerve. And then that could be a serious condition, which would really would increase the medical decision making capacity to moderate because pseudo tumor cerebra is really serious condition where increased intracranial pressure shows up in the eyes and it’s a cause of headaches.
And I think that goes into that table of risk presenting problems, moderate risk, the way that they describe it is undiagnosed new problem with uncertain prognosis.
Yes. And a neurologist, you know, usually the neurologist is the last person to get the headache, right. So, you know, they would have had the MRI done, they would have gotten a bunch of data from the PCP obviously the headache is so bad that you You’re going to the neurologists, it’s causing a person to miss work debilitating. And when the person gets to the neurologist for headache management they’ve been on a lot of medications already you know the neurologist holds the toolkit for headache management they even have headache neurologist now so there are so many pharmacological methods to treat headache they’re doing Botox in the neck for headache now they’re doing other injections for headache. So, that headache when when the headache is being examined, you know, by the neurologist, then you know you’re going into moderate complexity, or it could even you know, be high complexity if if that that headache is a pseudo tumor, or if it’s chronic migraine where somebody failed tons of medication, that’s moderate complexity. You if a headache starts at the PCP, right, it’s all about the hip. Where your differential diagnosis is going so the headache could present to the primary care doctor as a manifestation of a brain tumor or pseudo tumor. So it’s it’s with billing and coding it’s actually really just documenting what our medical decision and thought processes but if you’re thinking your patient with headache isn’t just a you know stress or attention headache that can be solved with some some Tylenol then you know, that would be a low complexity headache, Hey, you got a headache is new, just go take some Tylenol, then you really need to be in that moderate decision making capacity area to get paid for your work because you’re working up this person’s headache. Does that answer your question?
Yes, yes, yes. Thank you for differentiating between moderate and high risk. You know, you mentioned specific to ophthalmology. One of the things that they that they have in high risk for presenting problems would be an abrupt change in neurological status. Yes, for Example seizure, Tia weakness, sensory loss. So if you have a patient with vision loss that gets you to high risk, yes. Just to reiterate, can I think that repetition is necessary? That’s only one column of medical decision make? Actually, I don’t think we even mentioned it. That’s only one column of medical decision making, you need two out of the three columns, correct medical decision making to be to be high enough. Otherwise, you need to round down if your risk is high enough for, say, a 99215. And your and your data is high enough for a 99215. It doesn’t matter what the first column is. So you need two out of three of those to match. But if you have high risk 99215, but the data is, you know, a nine to one, two, and the diagnosis is a 992 and two, then it’s still a nine, nine to one, two,
you’ve got to round down to that. But I think, yeah, you’d have to run round down But I think because you are, I think, because you are. So if the risk of morbidity and mortality is high, so we’re saying, like you said that change in mental status that that? What is the management options for that change in mental status? It’s not minimal. It’s not limited. It’s like it, you know, it’s probably multiple, too extensive. So almost, if you have an illness that is acute, and serious and needs treatment, then your management options or your number of diagnoses are almost going to be multiple, or extensive. So it’s almost like that.
Yeah. I mean, you’re not going to have someone basically if you’re not in two and five, this patient could be dying, right? There’s never going to be a circumstance where that patient is filled that a 992 No, no, I was just using it as an example to just clarify that you need two out of three of those of those columns to match. Yeah, I again, this is where doctors may be under valuing their service. Yeah, if you if you have a patient that that that is that sick, then inevitably you’ll have either enough diagnoses or enough data to match as long as you document that. And that’s, that’s the key to all this is that all of it needs to be documented because when the auditor comes, that’s all they’re looking at. They don’t know what was in your head at the time then just know it was on what’s on the paper.
Would I write an a note about amblyopia and I build a level four I don’t always say, well, without treatment, this child is going to go blind as a council, the parent that the child is going to go blind, but I don’t say that with every visit. But I think that is definitely implied in the chart note so as
I gnosis Yes, yeah, no, I mean, that’s and that’s the other thing is don’t think my documentation, if you compare it to some of my partners is probably excessive. That being said, I use a dictation, I use drag. I actually don’t have a scribe. I do all my own documentation. But I have a dictation dictation software. So I dictate Everything. So my, my explanation in my medical decision making is always probably a little more verbose than it needs to be.
And I wanted to mention one thing I have been following a bunch of Facebook groups and one person and why it’s so important that physicians know the rules about medical decision making these, you have to have two of the three columns. Somebody wrote in that she took a job that the the hospital or practice that she worked for said, you have to have all three columns, or we’re going to have that be the lowest. So her employer is causing her to Bill, under code and under Bill so you have to know what the billing coding rules so you’re not signing a contract that will will hold you to some
Yeah, some, some unrealistic names there. Yeah. I mean, listen, CMS is strict. Enough, there’s no reason for us to be harder on ourselves than CMS is just what you said no, your know your worth, know your worth. And it’s probably more than you think it is. And so I think for that, let’s segue into the time based codes. Because I personally have some questions about this, specifically, the documentation. So let’s say let’s say you’re billing based on on a time based code. And this is easy enough for our, our listeners to look up. You know, how much time you need to spend with a new patient versus how much time you need to spend with a follow up patient to code for each level. But how do you document for this? How do you say, I spent 45 minutes with this patient and then document 45 minutes worth of conversation?
So the example that I like to use is and you had chaired that you are going to be talking to some pediatricians soon. Is that the example that the American Academy of Pediatrics gave was a patient who came back for a return visit for their ADHD medication? Well, when the return visit happened, the mother came when she wasn’t at the first visit. So if you would just use the evaluation and management guidelines based on the history and or physical and medical decision making capacity because a child is doing so well, right? It would be a level three a low complexity, hey, you know, how’s he doing on his Ritalin? Oh, great. Okay, well, wonderful. Keep his riddle Ritalin. Right. That would be the level three, but the pediatrician had to go back. And, you know, re counsel the mother. Well, this is why your child is on Ritalin. You know, these are the things that you need to look out for. This is a Ritalin holiday. You know, this is what we’ll do in the summer. So basically, when a physician bills based on time. They have to put whatever history they did if they didn’t exam and talk about what they counseled on. So that pediatrician could say, I had to counsel the mother on why the child was on Ritalin. What side effects to look out for answered all her concerns and fears about the medication. Talked about a Redland holiday. And that visit took 45 minutes
is that time does that include the history and physical or that time is only for the counseling? Oh,
so when you build based on time, half of the time has to be spent counseling a level five. It established code has to be 45 minutes long. So half of that 45 minutes has to be spent on counseling. So you know, the doctor could be talking to the mother for 30 minutes about the Ritalin. She’s crying they consoled her. That is a 45 minute visit the doctor has to explain What took 45 minutes when that visit should have just been a quick established visit. But the doctor can justify that level five code based on time if half of that 45 minutes was spent on counseling, but he he just can’t say, Well, I just counseled the patient about their ADHD medicine. He they have he has he or she has to say what they talked about for the 25 minutes half of that time based visit of that medication management
broker. So you can see you can bill for a 45 minute long visit if half of that time was spent, if at least half half of that time was spent counseling because you’re effectively being paid in counseling. Correct. Okay, can we talk briefly about some of the modifiers that you have found that people get tripped up on? Do you have any favorite modifiers or Least favorite modifiers?
Well, I think well, the modifier that everybody talks about is modifier 25. It’s, you know, doing two different evaluation and management codes meaning a visit and a procedure in the case of primary care doctors doing a wellness visit, and a sick visit, all all at the same time, and the challenge of being paid for both of them. And modifier 33 is the almost equivalent to modifier 25. It’s the Modify you’re supposed to put with the wellness visit to get paid for the wellness visit, and the sick visit at the same time. But the key to modifier 25 is really separate and identifiable, separate and identifiable. So I’ve seen people say, Well, I’m I’m an old Do I and I’m doing an annual exam, the patient I have has high blood pressure, I told them that just go get their blood pressure managed by their PCP. And I’ve heard that people try to bill for their the woman’s annual wellness visit and an evaluation management code. Well, that’s not really separate and identifiable, right that that doctor isn’t managing the patient’s blood pressure now is that that patient goes for their annual exam, and they’re found to have an STD and obviously that now is an acute issue. Then when they bill for their annual wellness visit and two, they bill for the evaluation, management and treatment of the STD. So I think the key is separate and identifiable. And just because the evaluation or the CPT book says we can bill for it, the insurance companies are always looking at those codes, and sometimes these With a wellness visit and the sick visit, when you sign that contract with Blue Cross Blue Shield or united healthcare, they may specifically put in their plan language that you cannot build an annual visit, and a sick visit in the same day, we don’t care that there’s a code for it. You signed your contract with us. And that’s how it those are our rules, you signed up for it, and that’s how it’s gonna be. Yeah, we
we find that too, that just, you know, CMS has their rules. And by and large, the insurance company use those rules. But every so often they will have their own take on the rule. Like there are some times that they require us to use modifiers that CMS doesn’t, doesn’t necessarily use and it just seems there’s no rhyme or reason behind that. But that’s for whatever reason, what they’ve, they’ve decided to do so we like to think that the rules work for every insurance company, but they’re written by CMS and then modified by the insurance company as they see as they see fit.
Yeah. Ms makes the standards but the insurance company, they get to make their own rules and they are trying to keep their money. I mean, the one thing about CMS and Medicare they are, they’re usually very straightforward. They publish their rules you met, you know, Medicare is administered by regions. So you can go online and they’re very transparent about what documentation is that you need for a procedure. They’re very transparent about their CCI edits. They’re very, very transparent about what they expect, you know, what’s on their admission list. But the other insurances aren’t that transparent.
So I think we’re, we’re running out of time here. But to close, I’d like you to tell us just one or two other things that are common mistakes that you see patients make when either you’re giving a talk and answering questions or you’re coaching an individual physician or practice of physicians. What are some common coding mistakes that you see where people are leaving money on the table? Or maybe maybe coding more than they should be? Well, one,
I think everybody needs to start with some fundamentals. And I think one thing as especially new residents, and new residents that are doing primary care, pediatrics, internal medicine, Family Medicine, there were a lot of rule changes with the Affordable Care Act. So making sure that they are billing for smoking cessation counseling, knowing there those codes, knowing what documentation is required for those codes. primary care doctors, especially the ones who admit patients are the ones who don’t even admit patients, but get patients that were hospitalized, and then come to their office. CMS and Medicare have special chronic care codes, transition of care codes that if physicians aren’t Using these codes and putting these systems in place to get those patients, phone calls made and procedures in their practice, they’re losing money. So really, I don’t know in rent and residency where they are telling new physicians, hey, they’re all these additional codes in addition to the evaluation and management codes that you can be billing, billing for smoking cessation, depression evaluation, chronic care, quote, codes, extra time transition of care codes. It’s it’s like there’s there needs to be a workshop somewhere with the fundamentals and then they need to just grow on their knowledge every year to find out what the coding updates are. And when physicians figure out how they’re paid, and what they’re paid, then they ultimately I hope they become better advocates of talking being active. In their medical society, talking to their legislatures, legislators and say, Hey, this is the hard work I’m doing for your patient, my patient, let’s make sure that we are getting paid appropriately for our work. So in addition to making sure that we’re doing these things in the office, if we’re doing this in a vacuum and we’re not letting Washington or I’m from Texas, Austin and if you’re from New York, Albany know what we’re doing, then you know, it doesn’t matter what we biller code, they’re gonna, that you know, value all those codes at $5.
And that actually brings us to season one, Episode Two with Jennifer Tassler, where she taught taught us how to get involved in advocacy, what is the minimum involvement for the highest return on investment so you can get involved in your specialties as it advocate for your profession to make sure that we are being compensated appropriately so if so, After you finish this episode definitely circle back to that one so you can learn how to effectively advocate for our profession. Dr. accord this has really been very informative for myself and I’m sure for the listeners as well. Where can people find you online?
You can find me online. My website is www. Dr. Charlotte MD. com. I use the same handle on Facebook, Instagram, Twitter, Dr. Charlotte, MD. And you can get my book online at www medical coding, decoded 101 calm
and it is a quick read and very understandable book and for not that much time. It’ll probably help you boost your income quite a bit so that you can start coding more appropriately and getting Get what you’re owed. So once again, dark, dreary corner. Thank you so much for your time. It’s been very informative and a pleasure.
Oh, thank you for inviting me. I really appreciate it.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
Transcribed by https://otter.ai

Cooking to Reinvigorate Your Health from TheChefDoc

Dr. Colin Zhu is a family medicine physician who practices primarily locums.  He also trained as a chef and a health coach at the Natural Gourmet Institute for Health & Culinary Arts and the Institute for Integrative Nutrition after medical school.   We discuss recommendations he has for his patients looking to eat healthier and physicians looking to do this same.  We talk about essential kitchen utensils and small appliances, his go-to ingredients, for simple, fast, healthy, and delicious meals.  We finish by discussing his book, Thrive Medicine.

Locum tenens has taken him to Nevada, where he worked with a Native American population at a tribal-run outpatient clinic, a Veterans Affairs system in Louisiana and a county medicine department in Santa Cruz, California that runs its own homeless shelter. A fourth position found him at a community health clinic in Seattle with a diverse refugee population. Currently, he works in Los Angeles. 

His traveling work has been featured in publications such as The DOMedPage Today, and Stat News. To share his unique blend of medical knowledge with a wider audience, Dr. Zhu launched TheChefDoc website, an online wellness and lifestyle education platform which has been featured in Jarry MagazineOWaves, and Brit + Co. Colin is also the author of “Thrive Medicine: How To Cultivate Your Desires and Elevate Your Life,” released in December 2017.  

Social Media Links:

Website: http://chefdoczhu.com/

Thrive Medicine the Book: https://www.amazon.com/Thrive-Medicine-Cultivate-Desires-Elevate/dp/0999646133/

Instagram: https://www.instagram.com/thechefdoc/?hl=en

LinkedIn: https://www.linkedin.com/in/colin-zhu-do-3905ba60/

Youtube: https://www.youtube.com/channel/UCeVW6o9F8V5BmCfkkLHUDTw

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

Cooking to Reinvigorate Your Health from TheChefDoc

Dr. Colin Zhu is a family medicine physician who practices primarily locums.  He also trained as a chef and a health coach at the Natural Gourmet Institute for Health & Culinary Arts and the Institute for Integrative Nutrition after medical school.   We discuss recommendations he has for his patients looking to eat healthier and physicians looking to do this same.  We talk about essential kitchen utensils and small appliances, his go-to ingredients, for simple, fast, healthy, and delicious meals.  We finish by discussing his book, Thrive Medicine.

Locum tenens has taken him to Nevada, where he worked with a Native American population at a tribal-run outpatient clinic, a Veterans Affairs system in Louisiana and a county medicine department in Santa Cruz, California that runs its own homeless shelter. A fourth position found him at a community health clinic in Seattle with a diverse refugee population. Currently, he works in Los Angeles.

His traveling work has been featured in publications such as The DOMedPage Today, and Stat News. To share his unique blend of medical knowledge with a wider audience, Dr. Zhu launched TheChefDoc website, an online wellness and lifestyle education platform which has been featured in Jarry MagazineOWaves, and Brit + Co. Colin is also the author of “Thrive Medicine: How To Cultivate Your Desires and Elevate Your Life,” released in December 2017.

Social Media Links:

Website: http://chefdoczhu.com/

Thrive Medicine the Book: https://www.amazon.com/Thrive-Medicine-Cultivate-Desires-Elevate/dp/0999646133/

Instagram: https://www.instagram.com/thechefdoc/?hl=en

LinkedIn: https://www.linkedin.com/in/colin-zhu-do-3905ba60/

Youtube: https://www.youtube.com/channel/UCeVW6o9F8V5BmCfkkLHUDTw

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Count Zoo as a family medicine physician and culinary school graduate. We discuss recommendations he has for his patients looking to eat healthier, and physicians looking to do the same. We discussed the kitchen essentials with regards to utensils and small appliances, his go to ingredients for simple, fast, healthy and delicious meals. Then we finished by discussing his book thrive medicine.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
And now, here’s Dr. Bradley Block.
Welcome back to the physicians guide to doctoring. On today’s episode we have Dr. Collins zoo. Who is also known as the chef doc? So Dr. Zeus, thank you so much for being on the podcast
today. Hey, thank you doctor blog. I really appreciate it.
So first off, can you tell us a bit about your training where you went to med school and residency what your training is in, then include that bit about culinary school
desperately. I’m basically a Board Certified family physician. I’m also board certified in lifestyle medicine and I’ll get back to the lifestyle medicine in a bit. But I went to school in West Virginia, I did my osteopathic training there for those of you don’t know what op Pathak medicine is, is basically very, very similar to MD training, prescription of medications, we can do surgeries license in all 50 states. We just have extra training with manual manipulation in the school. Other than that, we look at things from a whole person approach And that was something that I, you know, really enjoyed about philosophies, because my mother is a Chinese medical doctor and she practices, you know, acupuncture and herbs and things like that out in New York. And so my upbringing was more focused on prevention, wellness education on just basically connecting with people. And so I after received my education in West Virginia, I taught in an extra year in automatic training and so kind of like a teaching assistant. And so I graduated after five years, and that produced the gap here. And so what I did was during that gap year, I just said to myself, What am I going to do? A lot of people said, you know, they would travel and, you know, such and such and I decided that I grew up with two parents who cooked in the kitchen. I was very fortunate. I’m trying some background and so I just also thought that there wasn’t enough nutrition in school. I don’t know about you Dr. Block, but for us, it was around like 10 credit hours, and it was mostly focused on biochemistry. I remember reading a recent survey back in 2010, pretty much 27% of all medical students across the board actually required a nutritional course. And so, you know, I felt that there was a paucity in it. And so I decided, you know, what we need to do because we fight a chronic disease burden. We have an obesity epidemic and a lot of things to lifestyle related. So I wanted to learn more about food and so I enrolled myself in the culinary school that was health supportive and plant based. I did that in Manhattan, after which I went to residency did my family practice training and then afterwards, I had used my college education to enhance my day to day. So what that means is I practice mostly on the outpatient side or mostly in clinics and in addition to one on one counseling with patients talking about diet and lifestyle tips, I also hold workshops and do demonstrations, food demonstrations, and I also speak at different national conferences, about food as medicine and or lifestyle medicine as well. And so that’s what I’ve been using the education for.
You mentioned plant based and I just wanted to clarify that the terminology for myself is plant based the same thing as plant only.
No it’s not plant only per se we’re not talking about vegan where you know you’re not having any type of animal foods or substances or clothing, things like that because sometimes, you know, you could have the definition can definitely over not laughing very plenties mainly talks about having a majority of plants. And we’re talking about you know, dark green leafy vegetables, nuts, seeds, beans, legumes, whole grains, you know, very, very, very, very little processed oils and animal foods, including me to eat fruits and things like that. So that’s what you know, mainly mean vegetarian. There’s a whole host of different definitions as such, but when we talk about plant base, we’re talking about Whole Foods in its entirety and retaining as much what Mother Nature has intended for.
Okay, good. I wasn’t clear on that term. But that certainly clarifies it. So it sounds like that’s really what a lot of us, dare I say most of us are recommending to our patients nowadays, right? Mostly plants, little processed food, lean meats, because if you use a term like vegan, you’re right that that also has a lot of other connotations. And I think an excellent example of a vegan Food is an Oreo. Oreo is vegan. So that’s not necessarily what we’re going for with our patients. But, but yeah, whole plants. And yeah, very little processed or minimizing processed foods and processed sugar. So to just start, I think it would be great if you could give us some information for our med student or resident colleagues who don’t have much time don’t have much income to work with, and may not have so much cooking experience. So if you could help our juniors out there, what are some recommendations that you would have? If they maybe come from a house not like yours, where there’s not much cooking going on? And they don’t have much experience? Where do where should they even begin? Like, what utensils or what equipment? Should they be purchasing to start with?
Yeah, definitely. It’s an excellent question and like other health care providers, including myself, and you, you know, we best gone through that phase of our life and knowing what it means to live off of a budget. And I think that it also relates to our some of our patients. For me, I do primary care. And we deal with all variety and across the spectrum in terms of social economic classes before I’m currently in LA right now, but before I was in Southern California, and I worked with an underserved Latino community, and before that, I was in Seattle, I was working with refugees in a community health center. And so doing primary care, you know, you get to look at different populations and you kind of meet them where they are. And so, you know, for your med students or residents, this definitely overlaps with also our patient population that are also looking for things on a budget. And we live in a time where you know, a head of broccoli is more expensive than a liter of coke and Bad is attributed to public policy and you know how certain things are subsidized but that’s an entirely different you know subject so I would say where to start would be number one looking at your market your supermarkets and also seeing you know what is nearby and believe it or not, there’s actually different kinds and different classes of supermarkets. You know, you have your whole foods and you know, I what I would call your upper tier supermarket, and then you would have something closer to the banner where like a convenience store or a bodega or something like that depending on what part of the country you’re at. And then you know, you have everything in between. So I would probably say in truth a plan, please shop for something local. Okay, if you can visit farmers markets, okay. You not only save in terms of costs, but also you get to meet the farmers and the people. That producing farm your food, right? You actually save in terms of food mileage. And what I mean by food mileage is if you ever look at a produce, and you look at the sticker, and you look at where it’s come, you have to understand and be mindful of how how many miles it has traveled until it actually reaches the shelves. And quite honestly, it doesn’t get picked and automatically teleport to your supermarket. They need to do a process, bring, you know, certain chemicals to preserve the freshness of it by the time it gets to your market, right. So that’s one thing to consider. So the closer in terms of food mileage it is to you, the better. Okay, another thing to think
about but, you know, when I was a resident, just the hours that we had to put in and I’m sure it was the same for you were so sometimes absurd that I getting to something like a farmers market would be would have been really challenging. So I really would have been stuck going to just a typical supermarket. So if you have your resident and he’s going to the supermarket or she’s going to the supermarket, they’ve never had any type of cooking experience before. And they’re just looking for something because you know what, they’ve been on their feet all day. They haven’t been eating anything except for graham crackers and ginger ale. But they want to, you know, do something healthy but really hard to screw up. So, right, what ingredients are we looking at specifically, where it’s hard to screw up, so it tastes good, but it’s, it’s, you know, however you wanted to find healthy, but you know, better for you.
Okay, so if you don’t have an opportunity to go to a farmers market, I would recommend if you have the cheapest plant food you can get is actually from ethnic foods or ethnic markets. So for example, if you have like an Asian market, a Mexican market and Indian markets You actually save a lot more in terms of produce and you actually save a lot more in terms of spices and herbs. But to answer your question, if you were to just go to your supermarket I would definitely say if you have little to no experience in the kitchen, what the what the supermarket does nowadays is that they actually combined certain ingredients together so you can immediately put it you know, on the in the oven on the pan or on the grill, okay, and we’re talking about things like something to start you know, making fajitas for example, you know, they would put different tricolour you know, bell peppers together, you know, you would just pick up whole wheat tortilla from the green aisle, and then you know, just make something quick like that. Or, you know, they have things to grow with, you know, they would have portobello mushrooms, they would have different grilling vegetables that You can do, they also have ingredients that they put together for example, carrots, onions, and celery. That is a base for most soups, a base to make stock with, you know,
okay, so sorry. So so far, a couple of things that you mentioned, just to recap so sliced bell peppers in a frying pan as a base for I think you said fajitas. And then what was that base for the soup, carrots, onions and celery,
correct. carrots, onions, celery, or it’s also called a mirror, mirror plot in French, that’s the combination for the base of the soup. Okay, any other of those simple combinations that that we might be able to help those residents or med students out with so they can make sure that what they’re eating isn’t so then just ramen again. Um, if you do not have time to prepare dry beans from scratch, you can get you know, canned beans or canned lentils and all So quick cook rice, specifically brown rice.
Kimani is very quick to make as well and then that could be added with your vegetables. You could stir fry, you know, something really quick, will be a couple more examples as well. Any go to batch cooking recipes. So for the listeners that don’t know what batch cooking is, basically it’s how my family we live our lives. We cook on the weekends, so my wife also cooks during the week, but sometimes either she or I or both of us will cook together on the weekends and we will make something that will last for a long time. You know, make a ton of it. Right? Right, have a couple of have a little bit of it fresh and then the rest of it goes into the freezer for use later on, which was right a resident or a med student or our patients right who are busy and don’t have much time for prep. It’s a very easy way you find a window of time you take advantage of it. You cook a huge amount Do it and then you have a lot of a lot to go with and it’s also a cheaper way to do it. Yeah. The economies of scale. So do you have any go to batch cooking either meals or recipes.
Um so this is something that I personally do myself during my busy days in practice is I would get most of my grocery shopping and cooking done on a Sunday and I would you know, cook for most my lunches and then you know, cook for some of the dinners to mix it up. I would actually cook every other day if I’m really busy or maybe cook you know, fewer or more times just depending on the week, but I would say your my, the quickest and most nutritious would be to make big pots of soup, stews or gumbo. Okay, and you could do that with any variety of soup recipes. I would highly recommend a slow cooker i know i know that we’re going to talk about kitchen utensils but a slow cooker is a great appliance. Also very cost effective to be able to, you know, put a lot of ingredients into it and then you you know, set it and forget it and then it does its own cooking while you can actually cook something else at the same time. So that way you know you’re not you’re not spending time cooking two different recipes. You already have an appliance that’s already doing it for you. Oh yeah,
I love I love this slow cooker. I it’s not really a plant based thing. But chuck roast is one of the cheapest cuts of meat out there because there’s so much gristle in it and it’s so tough, but you throw that in a slow cooker and you cook it for 12 hours on low and it just it’s just so good. So it’s cheap and then you get just a ton of meat and then you can mix that in your soups, your gumbo or Yeah, it’s very, very versatile. So yeah, I love that slow cooker.
Yeah, definitely. I mean I just made the other night a a spicy Like vegetarian gumbo on using the slow cooker so I had a separate batch of brown rice on the side and then I just chopped fresh parsley and you just you know, garnish it and there you go, that’s already three or four meals.
Yeah and the throws and throw the rest in the freezer. So what other so the slow cooker, what other are some essential utensils to have around the kitchen.
So essential utensils is you don’t have to have a lot of equipment you don’t have to have an expensive kitchen to cook well. You need to have a few items and you just know you just need to know how to use them properly. And I would definitely say you know spend money on high quality items. That is durable. Okay, we don’t want to my opinion you don’t want to really skimp out on that because not only does it you know affect you know the cooking and how well your food tastes at the end. But you also don’t want to spend more money Replacing the thing utensils. So for example, you know I would recommend getting either a smaller large soft pan, okay where you can make stock and different sauces or you can make you can also get a frying pan as well. I would say a eight inch diameter or 12 inch diameter two if you’re making for more than one, I would recommend you know stainless steel for the in terms of a knife I would recommend a chef or a French knife as it’s called and a sharpening steel and making sure that your knives are you know, kept sharp. The only other knife I would recommend that’s essential will be a paring knife in terms of foods and different small cutting as well. Getting a good quality chopping board and you know essential okay. In terms of other utensils would be a spatula, you’re my probably use a spatula, you know like a silicone base. A heat resistant and you can get that very cheaply and that is very versatile in terms of mixing, stirring and things like that. If you want to be fancy you can get in microplane to best you know different things to put on food. But the only other things in terms of appliances I would get is definitely get a slow cooker like we mentioned before. a blender quick, great things for blending would be making smoothies smoothies is a great idea in terms of mixing different ingredients together that’s also nutritionally packed. You can also store as well and it’s very versatile. You can also make sponsors out of that and you can also make you can even have good high quality blenders you make soups out of that. And also if you want to be fancy, you can make your own salad dressings out of that. The only other thing I would recommend would be getting a toaster oven so if you don’t have time to bake something, a toaster oven is really quick, depending on the efficient the heat efficiency of a toaster oven. Very quick to throw like, you know, a pizza in or any other things you want to, you know, throw in while you’re doing something else. Because I know that medical students and residents want to save time.
And I can imagine you can get something like that pretty, pretty cheaply. I think we had to get a microwave for one reason or another. And it was just remarkable to me how inexpensive a microwave like the cheapest microwave they had. I don’t remember what it was, but it was something like I was shocked to see how inexpensive a microwave was. So I’m sure a toaster would be relatively inexpensive as well. So how about ingredients? So you mentioned before, some simple ingredients that were hard to hard to screw up, but do you have any? What do you find the ingredients that you’re most commonly using? I know for myself, I put chia seeds on anything like if you ask my wife, I really put chia seeds on too many things. And when I do, it’s inevitably too many chia seeds and and therefore I’ve ruined it but any things that that you tend to put incorporated into a lot of your meals.
Yes. So when I am able to cook I always so when you guys do grocery shopping and the market has a bulk section and if it does then that’s great because you will save on costs if you get bulk items and what I would recommend getting bulk items for would be grains like brown rice or Kima. Any variety of beans, black beans, pinto beans, kidney beans, and lentils, green lentils, red lentils, and honestly Those are probably going to be your most nutritious most satiating high end fiber and you know most cost effective items to get right in terms of produce. What I typically get is always a bunch of kale. Okay kale is a very versatile and I know that we’ve been hearing kale and all over To place and you know, I do a lot with kale you know I can certify with kale I can sell a kale. I’m a big soup guy. So I always have carrots and onions and celery in you know, my fridge. And then usually I’ll just mix it up I’m a big fan of mushroom. Mushrooms is very versatile, MSG, which is a very common flavoring but it’s also synthetic and not healthy for us. It’s actually derived from mushrooms. So when people are saying that, you know, something common that I get from patients that you know mostly eat meat is that they don’t you know, they think that vegetarian cooking or plant based cooking is very bland and very, you know, just not flavorful. And if you know what ingredients to use, it’s actually the opposite and mushrooms is actually something that you know, it’s actually you know, very cheap and adds a lot of flavor you know to it. Other items I keep on stock would be garlic, fresh garlic and fresh ginger Growing up in an Asian household, we use ginger for everything. And garlic is honestly something that is very nutritious and also a great agent to be able to flavor a lot of different things as well. So
random question, how do you clean a garlic press because anytime I’ve ever used the garlic press I’ve never been able to get it clean. They’re always tiny little bits of garlic skin and old garlic stuck in it. Any tips? I know this has nothing to do with what we intended to talk about. This is completely
but what the high
was what I’ll be honest with you I have no idea what a garlic presses I actually chop and mince all the garlic myself using fresh garlic. What does it do it does they clamp down and give you a little How does it exactly
it’s got a bunch of holes in it and like no just like a press so you get squeezed Yeah, these tiny little holes, and then you’re stuck with some garlic remnant on the other side. Or to peel out Oh yeah,
Garlic Garlic is tricky because if your hands are wet or if the garlic is wet, then the actual appeal of it will be stuck to anything you know the board or you know any of the utensils. So, what I do is, you know, I just take a couple cloves of garlic, I use the flat surface of my knife and mash it, I remove the peel. And then I just hold the garlic and just basically just chop garlic and I just throw that to start any type of recipe that are any type of cooking I’m doing that night.
What about snacks because a lot of times what I tell my, when I tell my patients is try to have something relatively healthy, that’s just out all the time, so that if you’re walking by you’re more likely to snack on that. And then which then in turn makes you less likely to snack on something that might not be as healthy for you. So what about You’re either for yourself or what you recommend to your patients. What are your go to snacks to just keep out and keep available?
Well, I think the first thing that you touched upon is you know, whenever you walk into an office is a very common thing to have, you know, candy or chocolates right there. And I feel that if you remove, you know that item from your site, you’re not going to be wanting to try to, you know, reach for it. For me, I’m more of a firm believer of, you know, getting good, nutritious satiating meals two to three times a day that way that prevents snacking in between I believe that you know, if you snack you know more that you’re just going to be adding extra calories that you may not necessarily need So, but that the answer your question, I will, for me personally in my office right now, I go to a wholesale club, like Costco, for example, and I, you know, just get a jar of raw mixed nuts. We’re talking about the fast show with cashews, walnuts, you know, pecan, things like that. It’s easy to reach for things that are roasted and salted. And what you don’t want is the process oils and the extra sodium. So and I know very common thing to get would be like potato chips and things like that. But honestly, if I ever need to snack and I do too, I always reach for a jar of raw mixed nuts. Another thing you can do is, honestly, if you can prepare snacks ahead of time that you know that you’re going to be snacking, pack fruit with you fresh fruit with you pack, you know very simple stuff, celery and carrot and then bring a jar of peanut butter or almond butter or cashew butter with you. The combination of the two would actually satiate you. So it’s really about the preparation and that way you’re not going to have hunger pain, and then have the impulse to grab something. You know that where, you know, we alter is when we are not prepared? And then we’re like, oh my god, I’m so hungry I and then you, you know get hangry and and then you reach for something that is not nutritious because you’re trying to fill that, you know that immediate needs.
So it’s kind of like dig your dig your well before you’re thirsty.
dig your
Yeah, exactly. Whatever before you’re hungry. Yeah. So what about for patients? I think a lot of this stuff, if not all of this stuff that you’ve mentioned so far is are excellent recommendations for our patients who may be suffering from a metabolic disease. But is there anything else that you haven’t mentioned so far that you may be telling to your patients about improving their eating habits or if they haven’t had much experience in the kitchen or, or things that you would tell them about ways to prepare foods and certain foods to prepare, that you haven’t touched on yet?
I think what we touched upon is are very similar items that I touched on with them. What I use is a couple resources online. resource as well because we live in a world where pretty much everyone is quote unquote connected and virtually connected. And so I rely on that as well, for those that are, you know, tech savvy, whether they use computer or use their smartphones, so things so many metabolic diseases, you know, like chronic diseases like heart disease, you know, high blood pressure, high cholesterol people, you know, with stroke and things like that, you know, these are different things that we deal with on a day to day basis. So, what we do is that I actually counsel them and coach them on, you know, pretty much the same thing. And one of the resources that I would love to give you is looking up, Dr. McGregor’s daily doesn’t and he is the founder of nutritionfacts.org. And it is a free resource online and on a smart app, commercial free. Everything goes to charity from his web, website and all all the information there is better out all scientifically based evidence based on nutritional information and so he came up with a daily dozen that after so many years of you know looking at different nutritional scientific journals, he embedded out different food groups kind of similar like a like a food pyramid or food plate you know that we you know have and so I actually print that out and I actually you know, I can email this to you Dr. Blog later on, but actually print that out. And I give them that as a handout and I say hey, this is are the different food groups that I want you to you know, look at and these are including similar stuff that we’re talking about berries, whole grains, we’re talking about, you know, cruciferous vegetables like brussel sprouts, cauliflower, broccoli, flaxseed, fruits, bean, not things like that. It also includes recommendations for exercise and when I tell patients is 30 minutes at least have moderate intensity exercise that you enjoy. If it’s not enjoyable, you know it’s not sustainable. And moderate intensity is basically your huffing and puffing and huffing and puffing to the point where you cannot maintain a conversation. Okay, that’s moderate intensity beverages, we recommend at least 60 ounces of water. You can also do green tea, which is also packed with antioxidants and hibiscus tea, which is proven to actually lower blood pressure as well. So that’s what I give to them. A second resource that I would give to my patients is put out by the physicians Committee for Responsible Medicine, also a nonprofit organization, and they came up with a program called the 21 vegan kickstart. Now I don’t what I tell patients is that don’t let the word vegan, you know, mislead you. What it is, is that it’s a free online website and an app that you can just type in the Google cold 21 day vegan kickstart And what it is, is that it’s a plant based introduction. So this is also good for your medical students and residents. It helps with grocery shopping, it helps with meal prepping, and they have plant based recipes all for 21 day program all free. So what I do is that I print the two resources for my patients, and I give it to them. And I tell them a follow up, you know, in X amount of weeks or months, especially the ones with diabetes. And I tell them, hey, let’s go over this. You know, let’s get back to this because in my opinion, it’s not a one off where you see them for your physical and then you say hi, you know, goodbye, and I’ll see you in a year. For me. Things are more reinforced for behavior changes, if you see them more frequently.
Wow, those will definitely link those up in the show notes. So the Dirty Dozen and then the vegan introduction,
right. The Daily doesn’t. Dr. McGregor’s daily doesn’t.
Dr. McGregor’s daily, daily. Okay, thank you for clarifying.
And he had no problem.
So the other thing that we were going to talk about today was your book. Yeah. And I think you just released an edition in now it’s out in multiple languages. Right? You just released it.
In Spanish. Yeah. So I wrote a book called thrive medicine. And it’s basically a labor of love. It is kind of part memoir part, you know, self empowerment type of book. And it highlights my experiences as a traveling physician or locum. tenens is what it stands for in Latin. And what that means is to hold a plate. And what that means is that when a physician passes on, goes on vacation has maternity leave, or for whatever reason can’t work in a certain period of time. People like us are higher to be able to fill the spot. And so from this experience, I was able to practice in four different states practicing and preparing Different population patient populations. And so I use my experience from that. And I also travel the world as well. I’ve touched on every continent, and I’ve visited more than 30 countries so far. And what I’ve gotten out of that are really, really great connections with different travelers, different people from all walks of life. And what I really, really enjoy is the deep connections with people, even if it’s just for a few moments, or for a few months or years. And what I’ve noticed and observed is that people give me a lot of feedback about how Collin or Dr. Xu, you know, you’ve definitely inspired me to do X, Y, and Z. And so over time, I just thought to myself, wow, wouldn’t it be great if I could just put all these experiences onto paper and that’s what I did. You know, it took me a year and a half to publish the book in English. And now I just released it in Spanish and it’s also available in audiobook format. As well as Kindle.
Wow, really, really getting it out there? Was it you that that read the audiobook
version? Yes, I narrated the book myself. Wow.
So since the book is thrive, can you give us one simple habit for our physician listeners that they can, that we can do that can help us thrive and live more fulfilling lives? Something simple and easy to execute?
Yeah, so I definitely say in our current world were in our healthcare states and you know, we work hard as physicians, all from all specialties. Physician burnout is something that we hear about in the media, you know, live and I definitely, definitely want to emphasize self care. self care, is basically what it means literally, and that’s taking a moment, taking a day taking a few hours to reflect, rate, reset. Okay, and reinvigorate yourself. And basically remembering why, you know, you do the things you do, whether it’s personally or professionally. And personally, you know, I am a firm believer that I don’t want to preach something that I don’t do myself. And so I believe that every doctor is a role model and achieving the leader, and we need to be able to walk our talk. So all the different dietary and lifestyle changes, you know, that I emphasize, I do myself, and so self care is definitely something that I would want, you know, more of my physician colleagues and friends to do more of and, you know, and that, in turn lead to a more fulfilling, functioning and daily life and I just feel that you know, the better you take care of yourself, I honestly think the better you take care of your patients, because if you go down, then you know, you who’s going to take care of your patients. So you know, that would be the biggest thing that I would emphasize towards our future. listeners.
So people want to get the book and learn more about you. Where can they find you online?
They can find me online at mine website at www dot WEIU. calm. I have Facebook and Instagram that I’m mostly active on and also YouTube and you just type in the chef Doc, you know without spaces, she h E, CH e FB, OC, into those social media outlets and then you can also find my book on Amazon.
Great. This has been extremely informative for me. I’m anxious to now get back in the kitchen. And I hope our listeners feel the same. I’m sure they do. So thank you very much for taking the time to talk to us from the west coast. It’s been a pleasure.
Thank you so much. I’m excited. Awesome.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm or wherever you get your podcasts. If you have a question for a previous guest, or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
Transcribed by https://otter.ai

Is CBD TBD or NBT?

Dr. Rachna Patel is an emergency medicine physician who has a medical marijuana telemedicine practice, a book, and her own CBD oil.  Medical marijuana and CBD, specifically, seem to have become a panacea or snake oil with magical properties that can cure everything.  Like what we tell our patients about good nutrition and exercise. She helps to clear up fact from fiction during our wide ranging and comprehensive discussion, from the current state of dispensing, its legal status, biochemistry, risks, FDA approved and internationally approved derivatives, methods of ingestion and for what conditions she recommends it.

She has been interviewed on over 200 podcasts (but this has been her favorite), has taken the stage internationally to spread awareness, has been featured in articles for Lifehacker and MindBodyGreen and has appeared on major news networks such as NBC.  She recently published, The CBD Oil Solution: Treat Chronic Pain, Anxiety, Insomnia, and More- without the High, available on Amazon, and her own line of CBD oil.  

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

Is CBD TBD or NBT?

Dr. Rachna Patel is an emergency medicine physician who has a medical marijuana telemedicine practice, a book, and her own CBD oil.  Medical marijuana and CBD, specifically, seem to have become a panacea or snake oil with magical properties that can cure everything.  Like what we tell our patients about good nutrition and exercise. She helps to clear up fact from fiction during our wide ranging and comprehensive discussion, from the current state of dispensing, its legal status, biochemistry, risks, FDA approved and internationally approved derivatives, methods of ingestion and for what conditions she recommends it.

She has been interviewed on over 200 podcasts (but this has been her favorite), has taken the stage internationally to spread awareness, has been featured in articles for Lifehacker and MindBodyGreen and has appeared on major news networks such as NBC.  She recently published, The CBD Oil Solution: Treat Chronic Pain, Anxiety, Insomnia, and More- without the High, available on Amazon, and her own line of CBD oil.

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

EPISODE TRANSCRIPT

Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Dr. Richard Patel is an emergency medicine physician who has a medical marijuana telemedicine practice a book and her own CBD oil. Now medical marijuana and CBD specifically seem to become as panacea or snake oil with magical properties that can cure everything. Kind of like what we tell our patients about good nutrition and exercise. She helps to clear up fact from fiction during our wide ranging and comprehensive discussion from the current state of dispensing its legal status, biochemistry risks, FDA approved and internationally approved derivatives, methods of ingestion and for what conditions she recommends CBD and medical marijuana.
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. On this podcast accept no liability for the outcomes of medical decisions based on this information. As the radiologists like to say, clinical correlation is required. This is not medical advice. And this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention. And now here’s Dr. Bradley Block.
Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Rashmi Patel, who specializes in medical marijuana. So that’s going to be the topic today. So Dr. Patel, thank you so much for being on the show today.
Thank you for having me. So first,
let’s talk about your origin stories. Which is pretty interesting story. First, start off with your training and then how you got into medical marijuana.
Yes, so during training my backgrounds actually in emergency medicine. I found myself basically what do you do as an ER doctor? you rule out emergent cause right? And if emergent cause has been rolled out, typically you send the patient on their way With a script for prescription medications, typically opioids because most patients come into the emergency room complaining of pain, and a recommendation to follow up with their primary care doctor. Now, given the way that our our healthcare system is set up, a lot of these patients would end up coming back to the emergency room, I see the same patient. And they’re complaining that the medications didn’t work, or that they were getting side effects of medication. Or I was in the unfortunate position of having to resuscitate patients that had overdosed on these medications. And then things really hit home for me on my toxicology rotation, where the only thing I saw were overdosing on prescription and over the counter medication. So, you know, there I was, as a physician, I became a doctor bright eyed thinking that I will actually help people I will actually help them to solve problems in their life. And I instead what I felt like I was I was creating problems. And, you know, during residency isn’t working gosh was over 100 hours, sometimes a week. And so you experienced a ton of insomnia, there comes a point where you’ve been awake for so long, you just can’t sleep. And, and that’s what I was experiencing. So during those times where I was too wired to fall asleep, but too tired to really do anything else productive, I would surf the internet. And I happened on an ad on Craigslist, that said, medical marijuana doctor needed me to reply to the ad right away. I spent a good year digging into the research. I just hung out on pubmed.gov looked at research, study upon research study, what you know what little information there was available on medical marijuana at the time. And about a year later, is when I found another ad, because they were as a bound on Craigslist. And I responded to that ad and so I have now been a medical major Wanna doctor since 2012, essentially a veteran in the field?
So you didn’t find your job after residency by looking on LinkedIn? I mean, I don’t know if any doctor does go into hospital websites. Talking to previous graduates, you found your job on Craigslist.
Yeah. by responding to an ad on Craigslist. I mean, I’m going inside. I made a whole career just because I responded to an ad on Craigslist.
Alright, well, what was the second coolest thing that you’ve ever found on Craigslist?
roommates that have turned into lifelong friends you know, back when Craigslist wasn’t shady Okay, this is
a time when Craigslist wasn’t shady.
Yeah, like early millennial. You know, when I when Craigslist first came out when I was back in like college, that’s where everybody went. To find places to live, and to find roommates, and it wasn’t shady recently, I tried to like buy furniture on Craigslist. And like, there’s people asking me for a cashier’s check, before even seeing the piece of furniture and it’s like, Okay, this is what happens. This is not the Craigslist that I remember.
We’re trying to rent apartments in New York City, and then you go to see the apartment, and it clearly looks nothing like the picture. They’ll switch. Right. So there’s actually a lot a lot to unpack in what you said about how you first got into medical marijuana. First, it relates to burnout, which is something that we talk about a lot on the show. And one of the sources of burnout is is that we’re not able to stem the tide of this systemic problems that are leading to the health issues that lead us lead people into the office, right. So you’re dealing with a systemic issue that leads To opioid addiction, the lack of safety nets and the lack of the ability for these patients to get follow up care. So there’s that. And then crisis. So your response to the opioid crisis is, is there something else out there? And so that’s how you ended up in medical marijuana. So I think those are two tremendous issues that you really addressed in your career.
Yeah. And I think it just came from like, a gut feeling where I was like, Okay, I can’t spend my life not actually, you know, just clocking in and clocking out, just to be a slave to my wages, like there has to be meaning and purpose to what I do.
So tell us about your practice now, or how it started, and then how it evolved.
Sure. So I started off to learn the ropes by working at a medical marijuana clinic in California, and I did that for a period of about two years. And then in 2014 I started my own practice. Now the reason being a lot of these clinics that popped up in California specifically, because there’s loopholes in the law, they were essentially mill, where doctors were just handing out medical marijuana cards, like candy. The consultation would be maybe all of like, I don’t know, five minutes in the clinic, that I was that there is definitely a lot of pressure to turn over patients, right? No different than in regular medicine, where there’s a lot of pressure to, you know, to see as many patients in as little time as possible. I remember there were times in that clinic where I saw in a matter of seven hours, probably 60 patients. And if I took more than like five to 10 minutes and probably a lot of this is illegal. But if I took more than five to 10 minutes, you know, the receptionist would wouldn’t even knock on the door. They just come barging into the office saying that your next patient is ready. And I actually remember going to the osteopathic medical board of California about this saying that hey, I’m because I didn’t have any other you know, I work for a, a small clinic. I don’t have anybody else to go to so I went to the osteopathic border of California situation. And their response was, well, you don’t have to work there. And I was like, Okay, well, great. Well, this is definitely helping the cause. Oh, and the other thing that happened was that a lot of these patients were coming to me and medical marijuana is illegal in California since 1996. And this is back in 2012. It would have been illegal for quite a while before I started and so these were patients that had you know, been using medical marijuana for a while but they you know, complained to me that hey, you know, I use medical marijuana but sometimes it works. Sometimes it doesn’t. When I go to the dispensary, I don’t know what to pick, you know and so they wanted answers to questions like that. And you need as a physician, you know, a lot of this you can figure out if you know basic pharmacology and then you study the chemical kinetics. of adenoids, you can put two and two together and figure it out, especially when you’re getting clinical feedback as well. Right? So that’s essentially how I figured out it. Basically, I now have protocol by medical conditions on how to use medical cannabis for these specific conditions. So, and you need time for that you need to really sit down, spend time with the patient, and be like, Okay, give me a story. Tell me what’s going on? What medications are you taking? What have you taken in the past, and then based off that, I can give them you know, best practices for their medical condition. So, at that point, you know, I had earned enough capital to start a very lean medical practice. And I did it differently. You know, I was definitely charging a premium and seeing fewer patients, but I was able to spend more time with them. And, you know, and I gained a lot of trust. In that way of the patients that I received from they weren’t, there were hardly any doctors that were doing it the way that I was doing it.
So Let me just get this straight because it sounds like at least in the state of California, you would give the patient a prescription for medical marijuana, but it really wouldn’t. Well, what would that prescription say on? Would it just say? Not not yours, but the standard medical marijuana prescription? Did it say anything about the dosing or the regimen? Or does it just say you were approved for medical marijuana?
So the basic language is, is that based on my professional medical opinion and evaluation, I believe that this patient benefits from the use of medical marijuana for his or her condition. So it’s not even a prescription. It’s called what’s called a recommendation.
Right? Then they go to a dispensary where someone who was hired at the dispensary, maybe getting after having been fired as a barista from Starbucks, maybe not the works there and then they make their recommendation for what the patient needs. Kind of like Going to a bartender and asking the bartender, what drink do you recommend for my back pain or my anxiety? Or my post chemotherapy? nausea? Right? You’re not getting that sounds like you’re not getting that information from the doctor. You’re getting it from someone with no professional training or expertise.
Yeah, no experience, other than the fact that they’re probably heavy users of marijuana themselves. That is their only experience. That’s amazing. Okay, so so that’s essentially Yeah, you got it. That’s essentially what’s happening now. You know, California was the beta, right, based on the mistakes that California made. Other states are doing it differently, right. One of the ways that they’re doing it differently is that number one, you can’t go straight from the doctor’s office with your your recommendation or what’s called a certification to the dispensary there’s an in between, and that in between is that you need to register with the state that you want. That’s right. So you have to show things like proof of residency. You have to provide medical records to backup your diagnosing someone also double check that, okay, based on the medical records based on the physicians evaluation, that this patient would actually benefit from the use of medical marijuana. So this book take the state of Pennsylvania, for instance, in terms of numbers, now, they legalized early 2018 that will be legalized prior to that, but the medical marijuana program went into place in 2018 January. Since then, to this point, they’ve now registered 100,000 patients, but only 70% of those patients have actually received their state ID card to then actually get medical marijuana from the dispensary.
Is that because bureaucracy is slow, or because those patients have been denied?
Probably they’ve been denied.
Cuz it sounds like it sounds like a laborious process to to go through all that right?
Right? Yeah, not in California right now it’s legal for recreational use and just if you’re over the age of 21, you can just walk into the sensory. But prior to 2018 the way it worked was that you could just go to your doctor and then go straight to the dispensary. But all the other states did it differently. I don’t know of any other state that did it the same as California. And the other thing was California was that there wasn’t a restricted list of medical conditions. Somebody’s knocking the phrase after the list of medical conditions and any other illness. But basically, it was up to the discretion of the physician to determine whether or not the patient would benefit from medical marijuana. Right, which is typically how medicine works. But when you’re dealing with marijuana, and you know when there’s financial incentives to just hand out cards at any venue At that point, you know, your your ethics are go out the window and you’re then just approving any medical condition and just handing out the cart. So that’s another thing that I think other states learned from California, they have a restricted list of medical conditions that beyond this list of conditions, met, you know, the use of medical marijuana cannot be approved.
So how do you think that liberalisation of recreational marijuana is going to impact medical marijuana?
Well, there’s data to back this up as well. Right. I believe I forget if it was Oregon or Washington, or meeting with Colorado, one of the states. I think it was Colorado, they have data to show that as soon as marijuana gets legalized for recreational use, the number of medical marijuana patients dropped significantly. And you know, is there an economics behind it? There certainly could be right because you’re now not having to pay a physician for Evaluation which often times can be a hefty fee, right? It can run anywhere from 200 to $250, sometimes even more, and then you’re having to spend money on the medication itself. So a lot of people would just bypass the physician altogether and DIY it at the dispensary. How many successful have? I don’t know,
right? Especially if you’re getting your dosing recommendations from the dispensary to begin with right then if the doctor is just giving you the permission, and now the state has given you permission, well then you don’t need the doctor at all. You just need the dispensary in order to get it which is again where you come in right with your recommendations for frequency and dosing and then you know differentiating between THC and CBD which we’re going to get to later so you know your you are your niche, even in places where there is recreational marijuana available.
right because even if Those areas, there’s going to be people who are going to who are like, Okay, well, I think I’d rather just go to a doctor make sure I do it right. Because I don’t want to get high off of marijuana. I you know, I am taking prescription medications, you know, what if their side effects, I’ve even had patients, you know, who had heart attack? And they’re like, okay, should I take using marijuana? Should I not be using it? So there’s questions like that that definitely come up and are relevant, medically speaking.
It’s a while while we’re on the topic of the legal issues, I just want to mention that it is still classified by the FDA as a class one drug. And what that means is there is no therapeutic value, according to the FDA. So here we are talking about the therapeutic value of medical marijuana, which certainly quite a bit is still up in the air and so we’re going to be getting to that later. But what the FDA is saying is, there is no therapeutic value, which is why it remains a class one drug yet there is states where it’s legal. And so how do you how is it illegal federally, but legal in the state and how does that work? And that means federal funds. And I think this came through under Obama that federal funds can’t be used to prosecute in states where it’s legal. So that’s why, if you can have a dispensary even though at the federal level, you’re doing something illegal,
right. So federal law, Trumps state law, but the federal government also has to enforce the federal law as well. Right. And so way back when Yeah, the federal government was enforcing state law by rating dispensary’s. That’s typically what they went after, are the people who were actually selling marijuana, not physicians, not patients, but the people who were selling and the people who are growing marijuana. But yeah, as it stands, THC specifically is considered a class one substance Per federal law, but you have things that have now 10 states plus the District of Columbia that have now legalized marijuana for recreational use. And we have 33 states that has a medical marijuana program in place. So more than half, a lot more than half. And so essentially, that’s what it comes down to is the federal government making a decision to actually enforce federal laws, which has been less and less, as I’ve seen it, you know, back in 2012.
So yeah, I think this has developed a momentum and it’s only going to spread spread further and further, but one of the things that that’s confusing to me is that you can now buy substances that contain CBD. So we’re going to talk in a little bit about the difference between THC and CBD. But since we’re talking about the legal issues, right, how is it that you can just buy CBD in a skin cream?
Right. So you CBD is classified a little differently. So it’s interesting because the hemp plant itself was on a national level deemed legal to grow. Before you go any further, what’s the difference between hemp and marijuana? Okay, the basic difference. They’re like cousins, okay marijuana and hemp are like cousins are from the same family main difference is a legal distinction in terms of the amount of THC, that’s me, okay. So by law, hemp should not have hemp or any hemp derived products should not have more than point 3% THC. And then by default, marijuana products have more than point 3% THC. That’s essentially what it comes down to. And point 3% is arbitrary. If there’s nothing scientific about it. There was a guy named Ernest small way back when, who decided it’s going to be point 3% and so in Stuck since then. And so that’s that you know, here we are today. And then Okay, so back to what was the question that I was originally answering?
I think it dovetails into the CBD. So how can we have CBD in all these other substances?
product? Yeah, so you had Farm Bill 2014 which allowed certain institutions to grow hemp for for research purposes. And then fast forward to 2018 where the cultivation of hemp has now been legalized. Okay, now, CBD is tricky isn’t a great area. Even when you read the law, different departments say different things. So the DEA is saying one thing the FDA is saying one thing, there’s no united front when it comes to CBD, so it’s really murky. So let me tell you what each of them are saying her and a lot of this change because of it. prescription medication called epic deal. Okay, this is basically an FDA approved version of CBD. It’s just like the CBD that comes from hemp and the CBD that comes from marijuana, the molecule is the same. It’s just that it’s the formulation that has been has been approved by the FDA. Okay, so this all happened in the summer of 2018. What happened was this company called GW Pharma, I believe they partnered up with bear came up with this medication. They did clinical trials. It was approved for specific subsets of epilepsy, pediatric epilepsy. And basically the FDA went Hey, look, we’ve approved this drug, it’s gone through you know, phase three clinical trials. And then they went to the DEA and they said you need to request by CBD. It was pretty much that that easy, and they said you have 90 days to do it. But what the DEA decided was okay CBD in that’s an FDA approved drug is going to be considered class five CBD that’s in any other form is going to be considered class one which as a physician It makes no sense because it’s the same damn chemical doing the same damn thing right? where it comes from doesn’t really matter I mean yeah, you know the end product will be more standardized when it comes from pharmaceutical company health as opposed to it being extracted by grower or manufacturer out in Colorado. So that’s essentially where we stand. The FDA also says that a lot of what was going on with that CBD was being sold as a supplement a dietary supplement. So they’ve made the statement that CBD cannot be sold as a dietary supplement. But it still is right and CBD is being sold rampantly and the FDA doesn’t have any enforcement jurisdiction as far as I know. And the DEA, I believe it is There was something somewhere that said that they’re not going to spend funding on enforcing the THC and the CBD products, not the THC products, sorry, but the CBD products being sold. So that’s kind of where we stand. And it’s basically an unregulated industry. 70% of CBD products are mislabeled. So people are out there, buying, you know, a one ounce bottle of pretty much olive oil, and paying like, a lot of money for it, in hopes that it will help things like their pain or their anxiety or their insomnia, but 70% of the time, it doesn’t help them because the products are labeled.
Well, that’s the supplement industry to begin with, right? It’s because it’s not regulated by the FDA. They’re not subject to any type of screening to make sure that they’re selling what they actually say that they’re selling. And actually, that happens in restaurants too. That happens restaurants where they tell you that you’re getting one fish and you’re really eating another buy there was an article in The New York Times a couple of years ago about the frequency of Miss labeling food, particularly fish on the menu, but you think you’re eating one type of fish and really you’re you’re eating type of another so so as much as people like to trash the FDA, at least by and large, we are getting what we think we’re getting. So, but yeah, it sounds like CBD is in the wild west of the of the supplement industry.
Right, exactly.
So you you mentioned what was that product? That’s you that’s a CBD is it? Is it CBD is just CBD derivative that’s used to treat epilepsy. pediatric epilepsy.
Yeah, so is CBD derived from cannabis? Not hemp. And it’s called epi, epi di o le. And quite pricey.
Why wouldn’t it be?
Right?
So are there any other either any other marijuana derived medical patients that have been approved by the FDA. So what I want to get to is I want to start off talking about really the, the stuff that’s backed by as much evidence as possible. And then we’ll kind of loosen it up a bit.
Yeah. So there is another marijuana or a derived medication not approved in the United States, but approved in other countries called Sativex that is also a cannabis, derivative of both THC and CBD. And then finally, we have molecules that mimic THC, right. So you have drew national, which goes by the trade name, marijuana oil, and then you have mamelodi and forgot the trade name for that. But those are basically synthetically derived or synthetic synthetically produced, twin of tsp.
And what are those do?
They have been approved They were approved back in the around the 1980s for the use of nausea, vomiting and lack of appetite in patients who are undergoing chemotherapy and in HIV AIDS patients.
Okay, so so far we have some specific types of pediatric epilepsy that are treated with marijuana derivatives. We have nausea, vomiting, wasting syndromes that are treated with marijuana derivatives, are there or synthetic versions thereof? Are there any other currently FDA approved medications either derived or that mimic any other aspect of marijuana?
Those are the main ones. There’s bad effects. Like I said side effect was not approved in the United States. But it’s been approved in other countries like the United Kingdom or Israel and one of them Australia. or multiple sclerosis facticity associated with multiple sclerosis.
Do you know if they’re used for spasticity in any other condition? Or is it that specific that it’s just in multiple sclerosis?
Just multiple sclerosis, okay? Because that’s what they, they they ran the set the clinical trials one.
So let’s take a step back and just talk about some of the biochemistry, just some basic biochemistry, right? Because the tagline for the podcast is everything that we should have been learning while we were memorizing Krebs cycle. So we don’t want to get into the minutiae of human race. And I can’t remember any of the steps of the citric acid cycle, but you get what I’m saying. So just some basics of the biochemistry of THC and CBD. How do they work? What do they bind to? Where Where are those receptors?
Sure. So you have in terms of receptors, the most prevalent receptors, that the cannabinoids interact with our CB, one cannabinoid, one receptor. CBG cannabinoid two receptor, okay, maybe one is very prevalent in the central nervous system, whereas CB two is more prevalent in the immune system. In terms of like in right the ligature, chemicals that interact with these receptors we have endo cannabinoid, right so cannabinoids that our body produces, the two of which have been most studied include a Nanda mind, which is similar in structure to THC, and to ag. Okay, so those are endocannabinoids. Then you have Phyto cannabinoids. So you have a cannabinoids that are derived from either marijuana or from hemp. And they those that are made and most prevalent by these plants are CBD and THC. And then you have the synthetic cannabinoids, which I talked about, such as Marinol and now below as well.
So what about side effects? What are the types of side effects that you see with? Let’s start with THC?
Sure. So with THC if any of your listeners have ever gotten high back in high school or college, what you experienced were the side effects of THC, right? So the side effects occur at based on dose if you overdo it, you’re going to experience side effects, which is typical of basically any medication. And so with THC. The most common side effects include palpitations, right so your heart’s gonna feel like it’s racing, anxiety or in worst case scenario, paranoia, dry mouth, and dizziness. Those are the most common side effects of THC. Now, that’s if you somewhat overdo it, if you really overdo it. In all likelihood, you’ll you know, you’ll probably be like curled up in a fetal position somewhere and you’ll feel really nauseous. You’ll you may start vomiting and you may hold and with CBD, the worst case scenario if you take too much most common side effects that have been reported include tiredness and diarrhea, and changes in appetite and weight.
The side effects of THC somehow remind me of, you know, how does a hair dry as a bone? marrow doesn’t matter? Whatever that medical pneumonic, what about the potential for overdose,
overdose so we don’t have cannabinoid receptors in our brain stuff, right? And that’s the area that controls the breathing. And so though you may feel really crappy by overdosing on these chemicals, it’s not there. It’s not lethal dose. It’s not a Wiesel substance.
And you mentioned that if you’ve ever gotten high then you’ve experienced the side effect of THC. You know, keep in mind that that’s, I mean, our listeners Keep in mind, I know you keep that in mind that that’s all a matter of perspective, right? Like Benadryl, Benadryl, when used as an ad histamine for its or diphenhydramine when used to anti histamine. One of the side effects is drowsiness now Yep. If you’re taking NyQuil or taking Tylenol PM, well the active drowsiness inducing medication is diphenhydramine. So you’re using the side effect as the desired effect and so potent is are effective is NyQuil that they branded z coil, which is just diphenhydramine. Some brilliant marketing, I think, in some ways that maybe went to the wrong profession should have gone into more. So, okay, so no overdose potential for those because there’s no binding in the brainstem, so there’s no potential for respiratory depression. What about any drug interactions that you see?
Um, yeah, there can be drug interactions with CBD specifically, what they found when they were studying at the DLS was that when taken in conjunction with valproic acid, which is a commonly prescribed anti seizure medication, they saw the participants, liver enzymes, and liver enzyme levels go up. Okay. So In general, they just said in that in that study that any medication that has the capacity to cause hepatocellular injury should be used with caution when use with PPG. Right. So you really want to have your liver enzyme, enzyme levels monitor, we’re taking something that could potentially cause injury to liver and you’re taking CBD along with it. Okay. With THC, it’s a little bit more gray because there isn’t as much definitive data on it. There was a case study where a patient who was on THC took warfarin and impacted their INR levels. But clinically, I’ve treated patient upon patient with who were on warfarin. And you know, from year to year, we track their INR levels, and it stayed the same, you know, they didn’t have to adjust the warfarin level, the INR levels were not impacted. So, you know, I don’t know One case report that you know, who knows what could have happened there. So and I haven’t really seen any other major drug interaction, but THC off the top of my head. If you go to
a few episodes ago with Dr. A fib, where he was talking about the use of warfarin for a fib, it looks like it was when I was a resident that was the anticoagulant of choice. But now with eliquis, and some other medications, looks like most of those patients that were previous on warfarin are getting off of it. So that other potential interaction that the case report is not gonna be as relevant as maybe it once was.
Yeah. And I’m actually going to have Dr. molars on my YouTube channel to discuss this very thing he said, and medications that are used, and potential for interaction. DMT is free. So tune into that YouTube channel. Yeah, I look forward to seeing that.
Yeah. So we’ve talked about side effects. We talked about overdose. We’ve talked about interactions, what about addiction
addiction. Okay, so this is really interesting. There’s there’s this whole sort of notion that marijuana is the gateway drug. Right. And I looked into the research on this as well, around back in 2010, there was an international study done to me, where, you know, they actually studied whether or not marijuana is a gateway drug. And so the hypothesis was, was that when you have a population that has access to marijuana, in all likelihood, there’s going to be greater use of other illicit drugs. And when and if there’s a we see a lot of use of illicit drugs and in all likelihood, these these, this population is probably also using a lot of marijuana. Okay, so they looked at Japan, Japan, the data showed that by the age of 29 89.2% of the population had to use some form of an illicit drug other than marijuana. However, Only one point like 6% of the population had used marijuana. So it blew one of the theories out of the water. Now, the other thing that they did was they compared this was back in 2010. Number This is when in the United States, marijuana was only available for medical use, not for recreational use. Okay, so they compared the United States to Amsterdam, right, which is known as the marijuana capital of the world, or was at least, and so that population had a lot of access to marijuana, the US at the time, did not. And so they assumed that there’s been a lot of illicit drug use in Amsterdam compared to United States, not the case. There was more illicit drug use in the United States, then in Amsterdam. So this entire study, International Studies sort of, you know, blew the whole theory that marijuana is the gateway drug out of the water. And that is the data speaks for itself. In that case, there is potential prediction, I’m not going to say there is is a potential for addiction. Okay, it all depends on how you use it. When you do moderation, there’s little to no potential for addiction. But if you abuse it like a drug, yeah, there is potential for addiction. Again, like a lot of other medication.
What would you experience any type of withdrawal symptom after stopping chronic use? Are there any reports of that?
Nothing, nothing like with alcohol or opioids. The reason is, is that that the cannabinoids are fat soluble, okay? So even if somebody stops that cold turkey, you have stories of it in your body that can help you essentially wean off of it. Worst case scenario, you have withdrawal symptoms for a period of maybe four to six weeks, where you have changes in mood, appetite, sleep patterns, that’s probably about it.
Well, you just mentioned the fat solubility. So let’s use that to dovetail into the different methods of of ingestion, right? The difference between smoking and eating and topical application. So what is it? What is important to know about the different methods of ingestion?
Okay, so let’s back up a little bit talk about what are the different methods of administration or delivery methods, right for marijuana products and for CBD oil products. So, common methods include topicals. Okay, we do have receptors for cannabinoids in our skin. And that’s one formulation. Then you have edible right most commonly with found are things like gummies and chocolate. Then you have what are called tinctures which is basically a sublingual formulation of either CBD oil or marijuana product. Then you have inhalation right now. Yeah, there’s smoking but typically I don’t recommend that to my patients, but rather, what I recommend is vaporisation. And essentially that’s, that’s eating These products up to the point where you know, they’re not combusting. So you’re not creating hydrocarbons. And then Believe it or not, there’s also rectal and vaginal formulation of these cannabinoids as well. And best delivery methods depend on the patient’s current medical history, and also what other medical conditions they have. So as an example, I’ve had patients who’ve undergone gastric bypass surgery, and what I know from treating patients is that these patients do not have edible Wow, and instead need to use inhalation or sublingual formulation to be you know, to get a better effect from the cannabinoids directly. Yeah, that’s another way to use it as well.
I’m always gonna recommend that not just because it’s available. Right and not being serious.
Okay, I thought you were I was like it was a possibility.
This is the time that having a podcast interview people that don’t know me so well anyone who’s listening to the podcast knows that. They would just assume that I’m going to say that anyway. But my recommendation, anytime you’re administering a THC or CBD is going to be rectally. It doesn’t matter what your condition is. In the touch.
Well, also a doctor talking to doctor it’s like, okay, yeah, sure, you know, as opposed to somebody else. Okay, sorry to interrupt. Yeah. So basically, those are the various different delivery methods. And you know, it varies by condition like anxiety, for instance, obviously, topicals are not going to be effective. migraine topicals typically not effective, you have to take it internally. So it’s really going to depend on the patient’s history, the patient’s medical condition that they’re looking to treat. So
what do we have to know about like, say, the bioavailability for those different methods of ingestion? So if you’re, if you’re making a recommendation to a patient, right, because certainly the bioavailability is going to be different for oral sublingually transcutaneous Li, or inhaled or directly?
Yeah, so we don’t have a lot of information about availability, we do have information on in terms of pharmacodynamics. Our peak effects and average duration of effect, right? Not what percentage is available for your body to consume, like with inhalation may have an idea like inhalation versus vaporization, what amount is actually getting into your body. But we don’t we don’t have it down to exact numbers yet when it comes to comparing with different methods, but what I can tell you is that with inhalation, the peak of fact is anywhere from two to four hours. With ingestion, it’s six to eight. With sublinguals. It’s about four to six hours. Now duration is a little bit different because again, it’s a fat soluble substance. So for some patients, you know, the effect can last for a while. I mean, it just depends on on, on, you know, your metabolism of your fat cell.
And I would imagine, in patients that have obesity, they’re the half life is going to be a whole lot longer, right? Because it’s like salt in the fat. And then then it’s going to say more slowly, just like a patient with obesity when they’re getting an inhaled anesthetic, right, that’s going to be fat soluble, and it’s going to take a lot longer for them to breathe it off then for someone with less adipose tissue,
right, so there’s the half life in the adipose tissue, but then there’s also the plasma half life as well, right? The plasma halfway from what we know is anywhere from a can range anywhere from nine to up to 30 hours.
That’s quite a range. Yeah, it is. Alright, so we’ve we’ve spoken about the marijuana derivatives and what they’re FDA approved for or approved for and in other countries. What is the most ridiculous thing that someone has hoped that they could use? Use it for but actually can’t use it for like, will it help me to regrow my hair or help me break a nine minute mile or something? Have you heard any say preposterous use for medical marijuana or derivative thereof that you think is not true?
Well, okay, so this is this is a tough situation to be in. But I’ve had patients come in wanting to cure their cancer with marijuana or CBD oil. And you know, they may they most Usually what happens is that they read something on the internet, that BAM Dr. Google, and you know, people are telling stories that Yeah, you know, a cured my cancer, and then I have to sit down with them and explain to them that I cannot say with certainty that it will cure your cancer. First of all, the concept of curing a cancer is not even used by physicians, right will say that they can Cancer is in remission, we won’t say it’s cured or treated. And yes, there’s research in animal models, and in petri dishes to show that these companies compound could have could have anti cancer properties. But we barely have any research in humans. And so you know, it can’t be fast. But then I’ve had, like, family members of people who’ve had patients and call my receptionist up and you know, very adamant and say, What is Dr. Patel mean that it doesn’t cure cancer? I need to talk to her. She’s a doctor in this field, how could she not know this? And so you know, I’m in the position that a lot of other positions are where you’re fighting medical misinformation on the internet. And it’s unfortunate because these patients, especially the patients with cancer, they’re doing it at the width of their life. Right, they could potentially what they might be doing before going conventional treatment, which for certain cancers is Nowadays very successful, have they found ways to do it, you know, have very targeted their treatments that minimize side effects. And yet, they’re like, No, I don’t want to do that, you know, the chemo is going to kill me. I just want to treat, you know, cure my cancer with marijuana or with CBD oil. And so I’ve had to send patients back out, I wouldn’t issue them the recommendation, because it felt like okay, this is they’re endangering themselves. They’re endangering their life by doing this.
Yeah. And that’s some of the danger of complementary and alternative medicine is, I mean, people make the argument that some of them well, it doesn’t have any negative effects. So if we’re taking advantage of the placebo effect, what harm Could it be doing? Well, some of the harm is situations like this where people then take that and run with it and use it, not in addition to allopathic medicine, but instead of allopathic medicine,
right. And the thing is, is that it’s being touted As a journal, but as a doctor, I always have to remind people look, it works great for certain medical conditions better than pharmaceutical meds, but not for all conditions. Right? So even for instance, like blood pressure, I’ve had patients come in wanting to treat their blood pressure with with medical marijuana with CBD oil. And clinically I, I’ve never seen anything that you know, these medic medications haven’t made blood pressure worse but they haven’t made it better. You know, a lot of my patients who started off on antihypertensive a year later after being treated with medical marijuana CBD oil had to continue to stay on antihypertensive. So there you know, I think that’s the other thing so one of the other things that I do on my YouTube channel is not do I not only do I talk about what these substances, you know, CBD oil and marijuana help, but also what did they not help as well? Because I think that’s that’s important and you know, Thing is, is that a lot of these claims are driven by money, right people making claims on the internet to sell their products or their services. But they don’t realize the harm that can be done in, you know, nonchalantly saying. Yeah, marijuana cures cancer, you know, it could be at,
I think CBD has gone the way of Frank’s Red Hot, right, the commercial for Frank’s Red Hot. I put that on everything. I think that’s what CBD has has become. So let’s actually go into what else what you do use it for. So what are the conditions you use to treat that you use medical marijuana to treat if you use medical marijuana, or you use specifically CBD, please, you know, differentiate between the two.
Yeah, so let’s start with CBD. What if I found CBT effective for most common conditions, migraines and headaches. nerve pain and we’re talking about mild to moderate nerve pain, not severe nerve pain, muscular pain, anxiety and mild to moderate insomnia, with THC. In some cases, it’s just high amounts of THC that are effective in some cases. In addition to the THC, you do need some amount of CBD for to be effective. But overall within this category, you have autoimmune conditions, right such as psoriasis, Crohn’s disease, rheumatoid arthritis, you have nausea, vomiting, lack of appetite, severe nerve pain, and severe insomnia. So those are that covers, I would say, the most common like 80% of conditions that medical marijuana and CBD oil are affected for. And then you also have conditions such as autism, and other conditions that fall within the other 20% of categories.
Well, is there anything else that you want? To discuss today because I think this was pretty, pretty comprehensive.
Um, no, I hope that, you know, whoever your audience’s walks away, well informed with the information that I had to share.
They definitely will be. So you mentioned that you’re going to have Dr. Morales, Dr. A save on your YouTube channel. So where can people find this YouTube channel?
Yeah, so just do a Google search for the medical marijuana expert plus YouTube or the CBD oil expert plus YouTube, either one of those two, the channel will show up on the first page of Google search results at the very top. I also have a book that’s coming out tomorrow, which releasing tomorrow, March 5, and it’s on CBD oil. It’s titled the CBD oil solution. You can find that on Amazon or wherever books are sold, including Barnes and Noble. And then finally, I have a Facebook group that’s dedicated to just answering questions about CBD and CBD oil. We can get to that by going to facebook.com backslash groups backslash ask the CBD expert in there one other product. Yes. So I do I have CBD oil. And I also do consultations online as well. So, so that’s that’s the full range. You got it all.
Fantastic, fantastic. And one more question and if you don’t want to answer this, I completely understand where do you were in the house? Do you keep your stash? Is it in the medicine cabinet? Is it with the grains? Is it with the next to the oregano? Where do you keep it?
Okay, so I’m very scientific about this. I keep it in the refrigerator. And that is because the chemical breakdown when exposed to heat and light. So to prevent the chemical breakdown, I stick it in the fridge. Excellent. Yeah.
If you come to my house, open up my frigerator that’s my sash. That’s okay.
All right. Well, it has been extremely informative, and comprehensive. And I really appreciate you taking the time, especially the day before a book launch. So, best of luck with the book launch. And we’ll definitely have links to all of that in the show notes. And, again, appreciate you taking the time.
Yeah, yeah. Thank you so much.
That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests, or have an idea for a future episode, send a comment on the web page. Also, please be sure to leave a five star review on your preferred podcast platform. We’ll see you next time on the physicians guide to doctoring.
Transcribed by https://otter.ai

Teen Depression and Suicidality

Dr. Uchenna Umeh is a pediatrician who has lost people to suicide.  She saw this as a growing issue among her patient population, so she left the stability of her medical practice to affect a wider audience by reaching out to larger groups.  She is now a public speaker on childhood, teen and young adult depression and suicide. We discuss her recommendations for recognizing characteristics of depression and suicidality, how to start the discussion about such a sensitive issue if we suspect it, and why we should start that discussion even if we don’t suspect it.

She also goes by Dr. Lulu and the Momatrician. She completed medical school in Nigeria and relocated to the US for her pediatric residency program at Howard University Hospital.

She currently resides in San Antonio Texas where she practices telemedicine and freelance writing. Her brand-new bestseller, How to Raise Well-Rounded Children, is available on Amazon here and on her website, teenalive.com. She hosts a weekly Facebook live, Ask Doctor Lulu, on Sundays at 2 pm CST. She was recently invited to testify at the Texas state-house on behalf of the House Bill 10, in support of funding for mental illness. 

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

 

Teen Depression and Suicidality

Dr. Uchenna Umeh is a pediatrician who has lost people to suicide.  She saw this as a growing issue among her patient population, so she left the stability of her medical practice to affect a wider audience by reaching out to larger groups.  She is now a public speaker on childhood, teen and young adult depression and suicide. We discuss her recommendations for recognizing characteristics of depression and suicidality, how to start the discussion about such a sensitive issue if we suspect it, and why we should start that discussion even if we don’t suspect it.

She also goes by Dr. Lulu and the Momatrician. She completed medical school in Nigeria and relocated to the US for her pediatric residency program at Howard University Hospital.

She currently resides in San Antonio Texas where she practices telemedicine and freelance writing. Her brand-new bestseller, How to Raise Well-Rounded Children, is available on Amazon here and on her website, teenalive.com. She hosts a weekly Facebook live, Ask Doctor Lulu, on Sundays at 2 pm CST. She was recently invited to testify at the Texas state-house on behalf of the House Bill 10, in support of funding for mental illness. 

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

 

Challenges Faced by International Medical Graduates

Dr. Jasmine Marcelin is an infectious disease doctor at the University of Nebraska Medical Center.  How did a doctor from Antigua end up in Nebraska?  Through Canada, of course!  It is an interesting story that she uses to educate us about some of the challenges and stigmas that international medical graduates face in order to practice medicine in the US. 

Dr. Marcelin is an Assistant Professor of Medicine, Co-Director of Digital Innovation & Social Media Strategy and Associate Medical Director of Antimicrobial Stewardship and Infection Prevention & Control at University of Nebraska Medical Center & Nebraska Medicine. Her Antimicrobial Stewardship interests include diagnostic stewardship and ambulatory stewardship. She is a member of the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA). Dr. Marcelin is a member of several national medical society committees including the IDSA Medical Student Scholarship Committee, the Inclusion, Diversity, Access & Equity Taskforce, SHEA Awards committee and SHEA Journal Club Committee. She is a passionate advocate for gender and racial/ethnic diversity, inclusion and equity in medicine and contributes to Faculty Development efforts related to diversity & inclusion and social media for healthcare professionals. Dr. Marcelin received her medical degree from American University of Antigua College of Medicine and completed her Internal Medicine Residency & Infectious Diseases Fellowship at Mayo Clinic in Rochester, MN.  You can follow her work on twitter @DrJRMarcelin and on LinkedIn.

 

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!

Challenges Faced by International Medical Graduates

Dr. Jasmine Marcelin is an infectious disease doctor at the University of Nebraska Medical Center.  How did a doctor from Antigua end up in Nebraska?  Through Canada, of course!  It is an interesting story that she uses to educate us about some of the challenges and stigmas that international medical graduates face in order to practice medicine in the US. 

Dr. Marcelin is an Assistant Professor of Medicine, Co-Director of Digital Innovation & Social Media Strategy and Associate Medical Director of Antimicrobial Stewardship and Infection Prevention & Control at University of Nebraska Medical Center & Nebraska Medicine. Her Antimicrobial Stewardship interests include diagnostic stewardship and ambulatory stewardship. She is a member of the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA). Dr. Marcelin is a member of several national medical society committees including the IDSA Medical Student Scholarship Committee, the Inclusion, Diversity, Access & Equity Taskforce, SHEA Awards committee and SHEA Journal Club Committee. She is a passionate advocate for gender and racial/ethnic diversity, inclusion and equity in medicine and contributes to Faculty Development efforts related to diversity & inclusion and social media for healthcare professionals. Dr. Marcelin received her medical degree from American University of Antigua College of Medicine and completed her Internal Medicine Residency & Infectious Diseases Fellowship at Mayo Clinic in Rochester, MN.  You can follow her work on twitter @DrJRMarcelin and on LinkedIn.

 

Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com

Please be sure to leave a five star review, a nice comment and SHARE!!!