Podcasts

Poopisode

The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of our respective employers.  This podcast is intended for medical professionals.  The information is to be used in the context of your own clinical judgement and those 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 even though the magic of podcasting may make it seem like I am speaking directly to you, this does not constitute a physician – patient relationship.  If you have a medical problem, seek medical attention.

 

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.

Unknown Speaker  0:04
Welcome to the physicians guide to doctoring Episode Three, what every doctor should know about gi issues. We’re interview Dr. Daniel Marino, gastroenterologist at the University of Rochester and currently the fellowship director about things that every doctor should know about gastroenterology. And when I say every doctor, I mean, like myself and otolaryngologist, a pathologist, radiation oncologist, what are gi issues that every doctor should be familiar with? We talk about the fun stuff. Diarrhea, went to be worried about it wouldn’t be less worried about it.
Unknown Speaker  0:44
GIP
Unknown Speaker  0:46
when is that potentially a catastrophe. And when can you wait a couple days before really starting to worry. What’s up with gluten? We get an interesting take on gluten from the gastro Just add some fun cocktail party facts about the GI tract. It was a fun conversation. I enjoyed it, and I know you will. Welcome to Episode Three of the physicians guide to doctoring. This episode is about gastroenterology. We have one of my
Unknown Speaker  1:22
good friends from medical school Danielle Marina. Danielle, thank you for being with us today.
Unknown Speaker  1:27
Thank you for having me bread.
Unknown Speaker  1:29
So Danielle and I were at SUNY Buffalo together. And then after we graduated, where do you go?
Unknown Speaker  1:37
I did my internal medicine residency at Yale in New Haven, Connecticut. And then I started fellowship at the University of Rochester. And I stayed on there as faculty. So right now I’m an assistant professor of medicine there, and I’m the GI Fellowship Program Director.
Unknown Speaker  1:55
Fantastic. Look at what you’ve done with yourself. So That definitely gives you a lot of street cred when talking about all things gastroenterology. And so today’s show, we’re just going to be talking about everyday facts that the general population should know about gi. But more specifically, doctors should know because, you know, we’ve all had situations where one of our neighbors asks us for advice, and you might be a pathologist, and you don’t know anything about gastroenterology except for one or two clinical rotations that occurred five or 20 years ago. And so, you know, you’re expected to know things because you’re a doctor, but they may be completely outside of your specialty. So, so today, Danielle, I want to talk to you about some things that that that both of us think that just the every doctor should be somewhat familiar with. As a disclaimer, Danielle is employed by the University of Rochester and I’m a partner at NT and allergies. So associates, both of us are currently representing ourselves and other organizations. And so anything that you hear does not represent the views of those organizations, but are solely of our ourselves. That being said, we’re also going to be talking about some clinical information and we can bear no responsibility for outcomes that occur based on advice that you take here. So as the radiologist like to say, clinical correlations are recommended. So, so Danielle, let’s start off talking about one of my favorite
Unknown Speaker  3:38
activities against one of my favorite pathologies, diarrhea.
Unknown Speaker  3:45
All right. So this this should be a fun one. So So one thing is, let’s say the scenario that I have before my my neighbor is mowing his lawn and has to keep running inside Because he has very bad diarrhea. So he sees me blowing my lawn and says, Wait a second. You’re a doctor. Let me tell you about my diarrhea. Mm hmm. Yeah.
Unknown Speaker  4:14
Yeah, that happens to me regularly.
Unknown Speaker  4:17
I would imagine, but hopefully those of your patients and not your neighbors,
Unknown Speaker  4:21
sometimes the mail lady, okay.
Unknown Speaker  4:24
Okay. I guess she sees those offers for a job in the Midwest by Lake an hour and a half. Exactly. And she knows that you’re being offered gastroenterology, so she kind of figured it out and can now ask you, she’s carte blanche to ask you for advice. And you have to give it to her otherwise you’ll get your mail. So, okay, so diarrhea. So, so I want to break this down into to two things. Really, when is it time to worry? What are we looking Four. So what are the important questions that we want to ask said, neighbor? And what are the potential catastrophes? But what are the horses? Right? What are the things that that it probably is? So first, what are the red flag questions that you’re going to ask to make sure that it’s not some potential catastrophe?
Unknown Speaker  5:18
And say the main thing is like, is there blood in the diary? So if it’s bloody diarrhea, it’s probably something serious, it could be an infection. But if it lasts for more than a week or so then it’s probably something more than just an infection. So, if there’s blood in it is probably the first question I would ask. If there is, you know, I’m thinking something like inflammatory bowel disease like ulcerative colitis or Crohn’s disease, maybe even something like colon cancer. So, those are bad. Then you want to ask like, Are you having nocturnal diarrhea, so usually, you know it’s normal that people have bowel movements, usually first thing in the morning or after eating. And that’s because we have something called the gastro colic reflex when your stomach descends with food, it leads to parasitosis of the colon and you dedicate and but if you have some sort of pathology going on that may have you have diarrhea even at night. So usually if it’s at night, that’s something organic going on, again, like inflammatory bowel disease. Things like irritable bowel syndrome, which is super common and probably the most likely thing causing diarrhea and most people, people wouldn’t be waking up in the middle of the night have bowel movements. So nocturnal diarrhea is definitely a red flag. blood in the stool and then I’d say you know if it’s going on for a long time, and it’s not a beating. If there’s any weight loss or signs or symptoms of dehydration, like lightheadedness, dizziness, palpitations, Or any other kind of symptoms that go along with it like vomiting or severe abdominal pain, those are all kind of things that mean that your neighbor should probably go see a doctor and not just talk to you while he’s smelling.
Unknown Speaker  7:14
So, so what but what can we use to differentiate an ER visit from an hour waiting for an outpatient appointment? So clearly dehydration, if you’re showing signs of dehydration, you can’t make an appointment for doctor that may occur in a couple of weeks. Right clearly, that’s that’s an emergent issue. So if there’s, if there is, are there signs of dehydration, go to the ER, if there’s blood in the stool. So we have we’ve talked about this before just to take a little aside.
Unknown Speaker  7:47
Should they have a Hema called test?
Unknown Speaker  7:51
Oh, Jesus, no. So a Hema cult test is called that for a reason. It’s looking for a cult blood, meaning blood You can see. So I mean, if it’s frankly bloody, you don’t need to do a Himachal, we know that it’s bloody. So if someone’s complaining of bloody stool, that doesn’t necessarily mean they need to go to the emergency room. I mean, it kind of depends on the situation if it’s a copious amount of blood or if it’s just rectal bleeding without diarrhea, per se, yeah, that’s probably warranting an emergency room visit. But if it’s a little bit of blood mixed in with your diarrhea and it’s been going on a bit, see a doctor as long as you don’t have you know, signs and symptoms of significant anemia or dehydration, you don’t have to go to the emergency room.
Unknown Speaker  8:37
So anemia dehydration, which can have similar symptoms, those would be reasons to go to the ER otherwise, you know, just get to your at least your internist if not a GI doctor pretty pretty quickly. Okay. Fantastic. So you also mentioned GI gi pain, with with the diarrhea, let’s say the let’s say he’s mon as long And he’s he’s, he’s a little slow because he’s got a stomach ache. So he doesn’t have diarrhea, doesn’t have nausea, vomiting. It’s just stomach pain. So, you know, acute stomach pain, chronic stomach pain. Well, let’s let’s talk about acute, really, first. When when is this an ER visit versus an outpatient visit?
Unknown Speaker  9:25
I’d say, you know, there’s a million things that can cause acute abdominal pain, but I think if it’s someone that doesn’t normally have abdominal pain, and they have severe abdominal pain, there’s a lot of serious things that could be happening. So if this is a person that has no gi symptoms normally and all of a sudden has severe abdominal pain, no matter where it is, they really should go to the emergency room. It could be something serious like coli cystitis or colon Titus, diverticulitis, and abdominal perforation from for some reason, you know, perforated peptic ulcer or perforated colon, mesospheric ischemia. So there’s a lot of like serious things that could turn into like a surgical emergency if ignored with acute onset of severe pain. That being said, you know, there are a lot of people that have actually like chronic abdominal discomfort and people who have irritable bowel or some what we call like functional abdominal pain, which is more of like a nerve related issue. And those people who have kind of chronic abdominal pain may have acute bouts of and they don’t necessarily mean to go to the emergency room every time I think, you know, we need to take it in context of what the baseline is and things like that and where the pain is and if it’s related to deprecation and such.
Unknown Speaker  10:48
So clinical correlation recommended
Unknown Speaker  10:50
absolutely, always.
Unknown Speaker  10:53
Disclaimer, right. So he’s saying, This is the worst stomach pain of his life, he should probably go to the ER But if he says, but it’s pretty similar to the stomach pain I had yesterday and the day before and the last few weeks in the last few months, that speaks to the lack of lack of urgency, because there seems to be.
Unknown Speaker  11:10
Yeah, and we’ve all seen the patients who claim they have 10 out of 10 or 12, out of 10 pain as their, you know, on Facebook role. So, like, you know, you kind of have to take it with a grain of salt and see what, you know, if they’ve had it before, and things like that. But
Unknown Speaker  11:27
I actually have a personal aside about my own gi pain, because I have you on the phone. So free comes to take advantage of the opportunity. Yeah, Indeed, indeed. It’s actually it’s not a concept. It’s just I think it’s an interesting story. So my wife and I were on our honeymoon, which was a safari in Tanzania. So we were on the flight back. And it was it was amazing as we were on the flight back and I started to get some stomach pain. And it was pretty bad, pretty bad. And it would happen After I got back every time I ate, and I was just I just stopped eating because it was so severe. And I thought it was constipation. So I just tried treating myself with some over the counter stuff and you know, nothing was working. And ultimately, I saw gi I hadn’t Ed, everything was fine. Here’s what it was. She was pregnant with our first child. And this is apparently a phenomenon. This is not unheard of for for like anxiety and I’m sure you see this anxiety related abdominal pain, and it had nothing to do with a trip to Africa, or having eaten something I didn’t have God. It was just because I was anxious because he was pregnant with our first kid. So
Unknown Speaker  12:49
So I as I like to say the GI tract is the window to the soul. So whatever
Unknown Speaker  12:58
feeling on the inside, usually presented itself with, you know, some gi distress, or, you know, they say butterflies in the stomach, you know, all those things are related to kind of what’s going on in your life. Stress definitely affects the GI tract significantly. And that’s because there’s almost as much nerves in the GI tract as there are in the spinal cord.
Unknown Speaker  13:21
And really, Mm hmm.
Unknown Speaker  13:24
There’s like a ton of nerves and neurotransmitters and it’s really complicated between the brain and the gut connection, but definitely they both interact with each other. So stress can cause gi symptoms and gi symptoms can cause severe stress or anxiety or depression or, you know, other neurological symptoms. So it’s pretty interesting. Yeah, and it’s hard to sometimes it’s hard to tease out, you know, what’s an organic, you know, structural problem versus more of a nerve related issue.
Unknown Speaker  13:57
Yeah, that’s probably one of the things that’s more challenging. For you to figure out when you’re doing your outpatient console, isn’t it?
Unknown Speaker  14:04
Absolutely. Definitely, history is like huge. It’s all about taking a really good history. And sometimes, you know, patients aren’t really able to give you a good history. So sometimes it’s difficult. You have to do you know, some tests that maybe you didn’t necessarily want to do, but you have to roll something out.
Unknown Speaker  14:22
Sounds like that is the post nasal drip of otolaryngology,
Unknown Speaker  14:26
I can imagine, or LPR
Unknown Speaker  14:29
or or LPA. Well, that’s the those two things are intertwined. This like mucus sensation in your throat when they have normal nasal exam and laryngeal exam and everything and all this throat clearing and that can be very, very challenging to figure out. So I guess we all have our own. Every specialty has their own post nasal drip. Yep. So that was interesting what you said about the number of nerve endings in the GI tract. So it was Something else that we wanted to talk about? What are some other cocktail party facts that you might be able to share with our listeners? is there is there anything else that you even if you might find it interesting for you, and you might think it’s boring to us. I doubt that I think I’m gonna find it interesting.
Unknown Speaker  15:20
Well, um, okay, one thing that people don’t realize is that like, there’s no set definition of like diarrhea or constipation. So like, it really just depends on the patient. And the variation of normal is pretty big. So we consider normal anything from like, one bowel movement every three days to up to about three bowel movements today.
Unknown Speaker  15:46
The rule of threes, the poop, the poop rule of threes,
Unknown Speaker  15:50
so race, so every area
Unknown Speaker  15:53
or every three days, all normal,
Unknown Speaker  15:57
but even I mean, that’s kind of wishy washy. Because if someone tells me Well, you know, my whole life I’ve had four bowel movements today and that’s just been me my whole entire life then that’s probably normal for them. And I’m not overly worried about it, especially if it’s not bothersome to them.
Unknown Speaker  16:14
I think it’d be hard to hold down many jobs with
Unknown Speaker  16:22
Yeah, that’s gonna, my patients would get pretty upset. really willing again, cuz he’s, again,
Unknown Speaker  16:30
really well that’s, that’s something that I find interesting. You know, some people take about 30 seconds to have a bowel movement. And for some reason, it seems many men take like three hours. I kind of think you use it as an excuse to like hide away in the bathroom with your phone and like, fall down a rabbit hole in the internet or something shouldn’t have to take that long.
Unknown Speaker  16:56
Listen, those those patients then end up getting hemorrhoids. True keep keep colorectal surgeons in business.
Unknown Speaker  17:05
Oh, here’s a fun fact.
Unknown Speaker  17:08
So you don’t have that may or may not include me.
Unknown Speaker  17:12
So you know how we sit in this country we sit on a toilet to go to the bathroom. I know, Brad, you’ve done a lot of traveling. And you see like in other countries, people don’t necessarily sit on the toilet like they’ll swap
Unknown Speaker  17:25
down toilets. Yep,
Unknown Speaker  17:26
yep. And so that’s actually the best way to dedicate because it opens up the anal rectal angle. There’s a muscle that kind of as a sling muscle and pulls on like the rectum. It’s called the pubic talus. And when you when you squat down, that actually opens up the pubic talus muscle and opens up that angle so the poop can come out easier.
Unknown Speaker  17:49
I would also imagine that you’re because you’re folded up like an accordion. You’re also squeezing things a lot more.
Unknown Speaker  17:56
Yep. And it helps your abdominal muscles, musculature, you know work better than if you’re Kind of stretched out. And
Unknown Speaker  18:03
this is why have you seen the Squaddie party?
Unknown Speaker  18:06
Yes, but the like the weird unicorn
Unknown Speaker  18:09
rainbow ice cream? Yeah.
Unknown Speaker  18:12
We didn’t do any disclaimers at the beginning. are you receiving any compensation from the squad?
Unknown Speaker  18:16
I have no financial
Unknown Speaker  18:18
disclosure. So I’ve made financial disclosure.
Unknown Speaker  18:21
I am a big fan of the squatting money because that is the correct way to put their right. So I do recommend that to my patients a lot and it avoids straining and kind of prevents you from developing Hemorrhoids and it makes a really good Christmas present. I have given it to many people
Unknown Speaker  18:38
really.
Unknown Speaker  18:40
That’s funny because we give for for newborns we always give the snot sucker. Oh God,
Unknown Speaker  18:45
that thing freaks me out.
Unknown Speaker  18:50
Like gifts that are related to what we do. specialties.
Unknown Speaker  18:54
Yeah, well, we realized we find it useful. OK, so the Squaddie party seems a good alternative to standing on your toilet seat and then squatting down.
Unknown Speaker  19:06
I have had a pinch tell me that they do that though. Like, just casually mentioned. Oh yeah, my whole life I just put my feet on the toilet seat. Now was
Unknown Speaker  19:13
that person born in a country where that is a routine? Oh, no. It was a good idea.
Unknown Speaker  19:20
She actually I think she she has a definite contrary disorder. She has a problem where her you know sphincter doesn’t relax and she kind of figured it out realized that without knowing exactly what it was and kind of worked around it on her own and never talked to any doctors about it.
Unknown Speaker  19:34
So some people self treat things like anxiety with marijuana and she self treats her erectile dysfunction by squatting. Yeah, well that’s that’s I have to say that is pretty impressive. That she was figure that out and had just been doing it her whole life.
Unknown Speaker  19:54
And when and when the patient told us that like when I went back in the room with the fellow the fellow is Pretty like shocked that the patient made her own diagnosis. Yeah, that’s like okay, we know what the problem is. Thanks.
Unknown Speaker  20:09
So, fun facts one
Unknown Speaker  20:11
fact. So I have a question. Just things that can turn your poop. Different colors, not not pathologies, right? Like remember there’s something that causes khaki colored poop, right?
Unknown Speaker  20:22
Oh, yeah. Well like clay clay colored. Yeah, that’s when you have like a billionaire obstruction. gonna lose the Bible because the Bible is what makes your poop brown makes it because if you lose your Bible, you can have like a white. Sorry.
Unknown Speaker  20:46
biliary obstruction.
Unknown Speaker  20:49
She knows now, biliary obstruction.
Unknown Speaker  20:55
What about stuff that you can
Unknown Speaker  20:59
that you can eat that We’ll turn your different colors.
Unknown Speaker  21:03
So beats concerned your poop red. Okay? I do not like beets thankfully but beats continue to poop red pepto abysmal concern or poop black and a lot of I can’t tell you how many times like we’ve been consulted for melanoma, which is you know black stool it’s supposed to mean an upper gi bleed. But really it just turned out the patient was eating a bunch of pepto abysmal and so that’s why it was black iron pills can also turn your stool black.
Unknown Speaker  21:32
Well, hence the need for a humid cold right because then because that’s not Frank. That’s like water not like what about the patient right? Like, then you’re doing a Hema Colton someone because you can’t tell if it’s blood or beats.
Unknown Speaker  21:46
So you can kind of tell the difference, actually, yeah, it’s red, but it’s like, it’s like a weird red. It’s not like a blood. Right?
Unknown Speaker  21:53
That’s, that’s what I tell my patients about tonsillectomy. So one of the things that you read on the internet after tonsillectomies, don’t drink anything, Read because you won’t be able to tell the difference. If you’re if you’re bleeding, which is a common problem after tonsillectomy, you won’t be able to tell your if you’re bleeding or if it’s Hawaiian Punch. And so what I tell my patients is one of the risks is dehydration. So if all you can get your kid to drink is red Gatorade or Slurpee or Hawaiian Punch, like we can tell the difference between Hawaiian Punch and just get them keep them hydrated. Absolutely. Those those misconceptions start.
Unknown Speaker  22:29
Yeah, so have you ever smelled melanoma? I’m sure you. I mean, people know like, you can tell the difference between that at this point.
Unknown Speaker  22:38
I’ve been doing total laryngology for, you know, four years in residency and seven years and so 11 years. So if I’ve smelled Melanie, it was over 11 years ago, but I you know, I can still remember it.
Unknown Speaker  22:51
It’s one of those things. Yeah, don’t forget. Yeah,
Unknown Speaker  22:53
it’s one of those things. I remember hearing in a lecture in medical school. Yeah, their poop really smells bad. Everybody’s poop. Oh, wow. Yeah, Melanie, okay. Yeah, no, that is a whole different level. So you don’t really need to just remember cold because oh my god that is room clearing. Yeah.
Unknown Speaker  23:11
Right? And Hema cold. So Hema calls is actually made for colorectal cancer screening, there’s really no indication to use it otherwise, it’s not to look to see if someone’s bleeding because it can have a lot of false positives, you know, someone has Hemorrhoids and they can have a
Unknown Speaker  23:28
positive from sitting on the toilet for three hours at a time absolutely going down or you know, rabbit hole,
Unknown Speaker  23:36
and especially getting like a rectal exam and then doing the chemicals. That’s like a huge show. Now, even just putting your finger in can cause some minor, you know, trauma that can cause the chemical to be positive. So if someone’s gi bleeding, like will know, like, you know, you check the credits. Blood is a laxative. So if they’re actually gi bleeding, they’re going to be going frequently. They’re not going to Just have like one bowel movement a day or whatever their normal. So like builds a clear themselves. We don’t need the chemicals, it’s not going to help us. Stop doing him and GM and chemical positive is not a color. So we always ask what colors is still and they’ll say positive. I’ve never seen that on a crayon.
Unknown Speaker  24:20
It’s like red, brown or black. Like that’s what we care
Unknown Speaker  24:24
or khaki, I meant Klay
Unknown Speaker  24:29
whatever fun facts Oh. So your colon actually sees like 10 liters of fluid every day. And it’s like really good at absorbing water. So it absorbs like nine liters of fluid every single day. That I don’t know. I find that to be a fun fact that is.
Unknown Speaker  24:48
I’ll supplement that fact with another fact. You generate a leader to a leader and a half of mucus a day between your nose and your mouth and that gets swallowed. That’s a lot. That’s a lot. So yeah, grow. That’s the whole post nasal drip and people like but I feel this mucus dripping down the back of my throat. Yes, it’s called us I know it’s called sorry mucus, ciliary flow, the sinuses and the nose make mucus it’s pushed post yearly, by the cilia purpose and on purpose in a very intentional way in a very specific way. Actually, you can, if things go off course, you can end up with something called recirculating mucus and that can be a night as for a sinus infection, so it ends up getting swept back post here early and then you swallow it. So all of that mucus is supposed to is post nasal drip so it is in fact,
Unknown Speaker  25:40
normal.
Unknown Speaker  25:42
Now it can be abnormal in the same way that you were you were saying about the GI tract right like if you absorb a little too or I guess a little too much like if you’re dehydrated, right like you take a little too much water out of your still you’re going to get constipated, very hard to lose are a little too late. Just a little bit too little. And then the end of the diarrhea, you know, people are very sensitive to the sensation of mucus dripping down the back of their throat, so a little little too much in a cold and it can really bother you. Or, if your mouth is really dry, you end up with this very viscous mucus and people end up spitting and thinking that they’re making too much mucus, but really, it’s just their throat is dry. So it’s a little little otolaryngology aside for you. So just another aside, please stay tuned, because Dr. Marina will be back with another episode if you’re enjoying this one. And I hope you are because I certainly am. About more more fun and interesting gi facts, but we’ll get a little more technical in the next one. And we’ll talk about reflux and we’ll talk about other other workshops. It may get controversial, and it will certainly get exciting. But for this episode, I wanted to talk a little about gluten. Yeah, we’re going to be a little controversial now. So So Not good, not not celiac specific Because that is a my understanding it is a pathology based diagnosis, right?
Unknown Speaker  27:07
Absolutely. You need to have to auto biopsies showing vilest blunting to make a diagnosis of celiac.
Unknown Speaker  27:14
Okay. But what about all of those other patients who complain about gluten sensitivity? And are celiac negative and just to be clear, gluten is a protein that’s present in wheat. And it’s what gives dough its stickiness and in doing this
Unknown Speaker  27:39
so, for the bait Baker side of me, there you go.
Unknown Speaker  27:43
Nice. So, um, yeah, so there are a lot of people that are sensitive or intolerant to gluten but don’t necessarily have celiac. And that’s because, you know, we’re not really made to digest gluten all that much and we end up to and way more than we can handle. And so actually most people would probably feel pretty good on a gluten free diet. It’s hard to do. But gluten is one of those things that gets fermented in the GI tract, and can cause a lot of gas and bloating and discomfort. And so there’s a ton of people that just, you know, have symptoms with gluten. But it’s actually really important to tell the difference between celiac and just gluten intolerance or gluten sensitivity. Because people with celiac, you know, there’s actual damage happening to the small intestinal lining, that can lead to a lot of other problems like osteoporosis. The chronic inflammation in the gut can lead to things like small bowel adenocarcinoma or small bowel lymphoma. And so it’s really important to kind of Make the diagnosis does this person actually have celiac disease? Or can they just not tolerate gluten? And that needs to be done before they go on a gluten free diet. So a lot of times primary care doctors will have their patients go on a gluten free diet or or patients themselves or their read on the internet and they’ll go on a gluten free diet and they feel so much better and then it’s really kind of hard to convince them Well, okay, go back on. So we can
Unknown Speaker  29:26
have this loaf of bread, right? That’s gonna make
Unknown Speaker  29:31
me uncomfortable, right and so we can take a piece of so we can put you through a procedure where we actually take a piece of you and give it to some other guy to look at under slide.
Unknown Speaker  29:41
Right. It’s it’s really hard to convince people to do such things but it is important to know the difference and then plus it has you know, implications for families because it is hereditary. So, if patients do have celiac then we would recommend getting their kids tested and stuff. So it is important to kind of sort that out. But yeah, lots of people just, you know, don’t feel too good on gluten club cause bloating, abdominal discomfort, diarrhea, gas sounds
Unknown Speaker  30:10
a lot like lactose intolerance, right? Like we haven’t evolved to consume the amount of dairy products that we do in our modern society. And so this is our body telling us that you know what, a little bit good for you fine. Keep the you know, vitamin A and D levels up but
Unknown Speaker  30:34
the volume that you’re eating? Yeah, I’m sorry. I’m sorry, saying
Unknown Speaker  30:38
you can overwhelm your lactase, you know, the enzyme on your small bowel Villa that kind of break down the lactose. And actually, as we age, the lactase goes away. So, like for certain, like European.
Unknown Speaker  30:57
derive, derived, I guess European ancestry
Unknown Speaker  31:01
said yes descent Thank you.
Unknown Speaker  31:05
There’s a very high rate of lactose intolerance like as we as you age, so by the time you’re like in your 70s I think it’s like something like 60 to 70% of like Eastern European Caucasians will have lactose intolerance. So it’s very common as we get older.
Unknown Speaker  31:20
Hmm. And can you up regulate it? Like by fighting the good fight and just kind of pushing through
Unknown Speaker  31:26
just pushing through and eating more and more cheese?
Unknown Speaker  31:31
No, no, no.
Unknown Speaker  31:34
Yes, unfortunate.
Unknown Speaker  31:35
It is. It is because I love a good
Unknown Speaker  31:38
cheese. Yeah, but fortunately, I have not yet developed lactose
Unknown Speaker  31:42
intolerance that will be associated cheeses are some of the best. My wife is Swiss. So we every so often, we’ll have a good stinky cheese. It smells like feet, but it’s delicious.
Unknown Speaker  31:56
Yeah, so the the good thing though, is that there’s like a ton of gluten free products out there and they don’t taste that bad. So, you know, for the people that it does bother are the people with celiac, there are good options now, whereas like a decade ago, people were it was hard. There were
Unknown Speaker  32:10
no yeah. Yeah. I mean, there’s restaurant menus and yeah, it’s hopefully for the lactose intolerant community. There will be a similar revolution. But
Unknown Speaker  32:27
you can just take
Unknown Speaker  32:29
you can do that. Well, Danielle, this has been Dr. Marina. This has been very informative. Thank you very much for your time. I appreciate it. It was a lot of fun. I can’t wait to have you back for future episodes.
Unknown Speaker  32:44
Cool. Thanks for having me brand.
Unknown Speaker  32:51
This was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher or wherever you get your podcasts and register review. If you have something nice to say. You can also visit us on Facebook search physicians guide to doctor
Transcribed by https://otter.ai

Poopisode

The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of our respective employers.  This podcast is intended for medical professionals.  The information is to be used in the context of your own clinical judgement and those 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 even though the magic of podcasting may make it seem like I am speaking directly to you, this does not constitute a physician – patient relationship.  If you have a medical problem, seek medical attention. 

Introduction to Advocacy for Physicians

The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of our respective employers.  This podcast is intended for medical professionals.  The information is to be used in the context of your own clinical judgement and those 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 even though the magic of podcasting may make it seem like I am speaking directly to you, this does not constitute a physician – patient relationship.  If you have a medical problem, seek medical attention.

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.

Unknown Speaker  0:06
Welcome to the physicians guide to doctoring Episode Two, Introduction to advocacy, where I interview Jennifer Tassler, an expert in medical advocacy, and currently the Director of Policy and programming at the associated medical schools of New York, where we discuss how physicians can do a better job of advocating for ourselves some easy ways to get more involved, and why donating to a pack is important and where the money actually goes, as well as some high return on investment activities for advocacy. So the lowest effort with the highest yield the ideas expressed on this podcast, those are the interviewer and interviewee and do not represent those of our respective employers.
Unknown Speaker  0:47
Without further ado, Jennifer Tassler
Unknown Speaker  0:53
Jennifer Tassler, thank you so much for coming on the podcast today. I’ve known Jennifer for Quite a few years, I actually did residency with her husband, which is how I know her. And we’re going to be speaking today about advocacy for physicians, but certainly being married to a physician doesn’t make her an expert. But nor does being a friend of mine, but she has quite a background in it. And I think she has a lot of interesting and useful information to share with us today. So, Jennifer,
Unknown Speaker  1:24
well, thank you for having me, I appreciate it. And I’m always happy to talk about ways physicians can advocate for themselves in their profession, especially since I am married to one and his profession is also my livelihood, in many ways, um, so my background is that I’m an attorney, but I’ve never litigated I went directly from law school to the Congressional Affairs Office at the Food and Drug Administration, and learned a lot about politics and what makes someone effective and getting to the people who can make things happen. And from there, I went to the American Psychiatric Association which is the Industry Association for psychiatrists. And it has many analogs and pretty much every medical specialty and allied health profession. Everyone’s got a society or sub specialty society. And so this one is for psychiatrists, and I did a lot of Congressional Affairs as well as federal affairs sort of regulatory policy there. And in that role, I did a lot of working with physicians in advocating for on payment issues, scope of practice, issues around patient issue. Now, consumer rights organizations, and we did a lot with patient advocacy, especially in psychiatry, a lot of their patients don’t necessarily have the means or the ability to advocate for themselves. So that’s something we did a lot of there. And after that, I took a little break when I had children and Andrew did his fellowship and I’ve recently gone back. We’re now in New York and I work for the associated medical schools of New York. Also doing government affairs, I do more state side stuff a lot with New York state politics, and some federal and a little bit of city work. So again, in that sense, I’m advocating for the medical schools of New York State.
Unknown Speaker  3:22
Wow. That is
Unknown Speaker  3:26
quite a bit of experience that you’re bringing to the table today. So sounds like also you’re very busy. So again, thank you for taking the time especially with with the children at all. Thank you for taking the time to talk to me today and talk to us. So right off the bat, as a physician, I have gone through tons of training as you experienced yourself. Lots of long hours, lots of studying and I feel like I shouldn’t have to advocate I’ve I’ve done all this work, I really shouldn’t have to advocate for myself. Why? Why is this in necessity? And I feel like a lot of physicians are going to feel this way. I just, I don’t feel like I should have to. Why is it that I do?
Unknown Speaker  4:17
I heard that a lot, especially when I was at a PA that, you know, this isn’t what I do. I hear this a lot from Andrew as well that you know, I went to medical school so I can operate so I can take care of my patients. And this isn’t what I do. I think there’s a lot of rightfully siloed stuff that this is not my expertise. I don’t you know, somebody who is better equipped to handle this should do it. And that is true to a certain extent, but it’s also not because while we do have advocates for you, I mean your specialty societies, the or medical societies, your hospitals, or advocate for you. You are your own best advocate. You are the person who is in the office or in the operating room or out in the VA wherever you work, dealing with patients dealing with billing, dealing with office staff, insurance companies, you are the best person to advocate for yourself your experience, the way you can talk about what you do and how you do it is much better coming from you than it is coming from me or anybody else who does this work. And we can be there most of the time and relaying that message but hearing from you is invaluable to any elected official or anybody who’s making any kind of change. They really, it drives home the point of, you know, what you do, what you’re experiencing, what the problems are, how they can help you more than anything. And to that end, especially with elected officials, you employ them and they should be working for you. I mean, everybody these days needs to speak up and say What affects them? And for a lot of physicians, a lot of things affect you, and not just, you know, payment policy or regulatory issues. But everything I mean, we deal with dealt with things about building codes, how they affect physicians, I mean, it’s really very broad. And each person has their own slightly smaller or personal point of view that they can get across better than anybody else can.
Unknown Speaker  6:30
So if I’ve never even dipped a toe in this arena at all just seems very abstract. I recognize that I can call my Congress person but I’ve never done that before. I don’t know the issues. I don’t know. You know, what, what’s a good first step for someone who’s never really been involved before?
Unknown Speaker  6:49
I think the best first step is to take a look at what your specialty society is doing. I think that that’s sort of the best way to localize some of your issues, I mean, there may be, especially if you’re in a smaller specialty, like I’m thinking I’m thinking not internal medicine or general surgery. But even those, you know, if you go to their website and see what they’re advocating for, maybe there’s already something going on about this, there could be an alert out or something like that. And to and I think one of the most important things that physicians can do just to be just a pure head count, is to join your specialties society. I know that when I was with the psychiatrists, you know, every comment every letter, everything we say, says how many members we have, and that makes a difference. So the people who read those letters, they want to know that there are 43,000 people who want us to speak up on an issue. And just from just a pure numbers perspective, it helps if you are a member that you can stand up and be counted among those physicians. I think I think that’s sort of like the simplest, easiest thing you can do, and you get journals. So that’s, you know, When, when, but there’s also, I mean, it also helps to be in touch with your specialty society. I mean, I think a lot of people, particularly in the larger ones that have a presence in Washington, you know, they don’t necessarily we have, you know, our general issues that we work with, with, you know, a lot of combined meetings and things we do across specialties. But we need to hear from our members, what’s affecting them. I mean, I used to get calls sometimes from somebody saying, I’m having a problem with Medicare. And you know, this carrier isn’t doing this and I’m not getting paid and what’s going on and they can make a call for you and either find out what’s happening or see if this is a larger problem. Sometimes we will put our alerts and ask if you know something else, if anyone else is experiencing this and if it ends up being a larger problem. You know, then you have the full force and effect of a specialist society going to bat for you. Another thing I think that is very key about your specialty society is that they do outreach to you. So when you said like, I’ve never called my congressional office, I wouldn’t know where to start. I don’t want to call them and just complain about, you know, the fact that I’m not getting paid this much for an office visit versus that much. The specialty societies will often do what they call action alerts, or they’ll send you an email and say, this is an issue that’s happening. There’s a vote coming up on the floor, there’s a bill we’re pushing in Congress, call your legislator, and they will often give you not only the phone numbers, the names will give you a script, they’ll tell you what to say that’s in line with their position and you can either act on it or not. And you know, that’s up to you, but it’s a good way to get connected plugs in it also tells you what they’re working on. Because if they’re working on a bill related to scope of practice, and that’s something that, you know, now that you think of it, that’s a problem for you, you know, there, there’s an easy way to get access to the issues, the language
Unknown Speaker  10:19
and the way in which you can be effective.
Unknown Speaker  10:23
I just for emphasis, I just want to reiterate some of the things you just said. So one, one thing I thought was important was be a member of your specialty society. It sounds like that is literally the least you can do at least you’ll be counted in the roles. When your advocates go to advocate for you, you’ll be one of many and you won’t be counted if you’re not a member. So their voices are more likely to be heard if they represent more people, right. So if there is an issue with scope of practice between nurse practitioners and in Internal Medicine. And there are more nurse practitioners that are a member of their specialty society, they’re going to get more of a voice from their Congressman, or they’re going to more likely to be heard by their congressman than the internal medicine doctors, because there aren’t as many of them. So in order to be counted, you need to be at least be a member of the specialty society. And the other thing that you said that I think was hugely important was one thing that I think can get you the biggest return on your investment as far as your time goes, is, if you’re involved in your specialist as I do, at least you’re you’re you’re getting their emails, they can give you these talking points, they can tell you exactly what to say exactly who to say to. And if you agree with them, it’s just a phone call. You can make that call on your way to work. It doesn’t take that much of your time. And you can and there aren’t that many people that are calling their Congress people about scope of practice issues, right, right. If it’s gun control, Everybody’s getting on the phone and one way or another, right? Like, you’re going to be one of many, many voices. But if it’s a scope of practice issue or reimbursement issue, which, as you told me in our pre interview, phone call, these are the two biggest issues scope of practice and reimbursement. So you’re you’re going to be one of very few voices getting on the phone with your congressperson who might then say, you know, what I heard from Dr. Block in my district, and he is very upset that you have people that are not very well trained, we’re going to be treating their patients, and it’s going to be putting them at risk. But if you’re not making that phone call, all they’re hearing is well, there aren’t that many practitioners out there and there’s issues with access to care and we need more boots on the ground. So we need to give more people prescribing privileges or whatever the issue is with their they’re going to hear the opposition they’re not going to hear you which really gets to why we need to do this exact, you know, You know, at the beginning of the call, you know, begrudgingly, I shouldn’t have to advocate myself. But the fact of the matter is, don’t hate the player hate the game. Because the game is out there. And if you don’t admit that it’s out there, then you’re just going to put your head in the sand, then then your scope of practice is going to get encroached on and your reimbursement is going to continue to go down. And administrative costs are going to continue to go up and you’re going to be very unhappy, and you’re going to complain, you’re going to be complaining to the wrong people.
Unknown Speaker  13:30
True. I mean, it will certainly fall on deaf ears if the years are not being open to that message. And I think the other thing is that, especially aside as we often target it, you can make the most effect. So a lot of times they’ll do what they won’t, they’re not going to do a blanket announcement, a blanket action alert for everybody on a very specific issue where only, you know, two states have senators that are on this committee that’s voting on a bill coming out. I mean, those tell you. So if you’re getting that alert, you are probably more important at this juncture. So, you know, those are really areas where you can make a difference. Again, like you said, large national issues, everybody’s flooding the phones for something. This is something where you can really get into into their office and get a bug in their ear about something that can really affect them that this boat is coming up tomorrow. I need you to vote now. And this is why and I think, you know, you’re probably not going to get the member but a staffer can send that along or you can call the district office. It’s not always about I have to be in Washington, I have to be, you know, in their office meeting with people glad handing that’s not really what it’s about. It’s about just making your voice heard. Those things are all good, but certainly for somebody who’s busy, a physician who’s not interested in going down to Washington and doing Advocacy day, this is a great way to start and a great way to make your voice heard.
Unknown Speaker  15:05
So I think there’s there’s an issue that some physicians have with the AMA, right, the group that’s supposed to represent all physicians, and there is a thought that they don’t necessarily represent my interests some of the time. Maybe they don’t represent my interests most of the time. Like, let’s like they’re advocating for universal health care. Let’s say I’m a physician who doesn’t agree with that. I’m certainly not but you’re, you’re finding a reason to disagree with them. And so you don’t want to join the society, right? You don’t want to join just I mean, your specialist is is it is a different story, because they’re more focused on your specific needs. But as a specialist, you know, the American Medical Association is, is certainly they have many more generalists in there as members. So that’s going to be more of their concern. But But if if, if I do I’m a member of the AMA, how do you explain to a physician that it actually is? And is it actually in their best interest to be a member of the American Medical Association? If their concern is that they don’t feel like they’re advocating for their views?
Unknown Speaker  16:18
Um, I would say that’s tricky. I think. I mean, I would certainly say that most physicians I know who are not generalist are not members of ama. I think being a member of your specialty society is probably the most important and I know at least for Andrew who so specializes, he’s a member of those sub specialty societies. But again, like you said, ama does not represent the interests of all physicians. It is very broad, and to expect them to cater to a minority is difficult. However, I will say that and they did a certainly when I was in DC they held multi specialty cold So we often did meetings where it would be literally every specialty you could ever think of in medicine sitting around a table, talking about our issues, and sometimes people would speak up and say, my members are not for ACA, you know, we’re totally against it. I hear from them all the time about this problem, this problem, this problem. Others specialty societies would say members are for, you know, majority we’ve decided, I mean, there’s a board structure within each messages society that sets their policy. And so in that sense, you are being represented at the larger table. And a is very effective at getting very high level policy interests of physicians known. I think, if you feel strongly about being a member and you do feel like they represent you, I would certainly join. I don’t know if I’d say for everybody, it’s the right choice and for a lot of people in It’s simply expensive and not necessarily worth it in other respects. But I think, like I said, joining your own specialty society is very important. And I think, you know, you’re certainly always welcome to make your voice heard at ama, I’m sure they hear from lots of people all the time. But again, you’re even if you are not a member of ama, if you are a member of your specialty society, your voice is being made her around their table. So those interests are percolating up and may not make it to their policy decisions, but it is discussed internally, I would say.
Unknown Speaker  18:43
So there is a way for some of these smaller specialties to be heard. Yes, a massive organization like that, but
Unknown Speaker  18:52
and we often do reiterating that point,
Unknown Speaker  18:55
right. I mean, and a lot of times, a lot of the work we did was on if it was abroad. issue that affected physicians. Ama would circulate a letter to the specialty societies and we can either sign on or not sign on. And in that sense, its safety in numbers, there’s it makes it very clear that there are a wide range of physicians specialties that are against or for certain policy and that can be very effective in and of itself. And there are different reasons why MA would, you know, put out their own letter versus trying to get a consensus. But in that sense, there is a way to work together to try to make our policy decisions known and for physicians, I think that you know, there are certain things where within specialties there can be like very, very strong disagreements over you know, reimbursement policy, or practice models or me There, there are crazy crazy amounts of distinctions between different specialties. And so when they can get consensus they do and when they can’t, you know, sometimes they don’t sometimes they’ll be smaller letters like sometimes groups of like sometimes the surgical subspecialties will sign on to a letter or, you know, American College of Surgeons will do something similar will they’ll try to gather up all the surgical societies or there are there are ways to sort of band together to be more effective, because like you said, it’s it’s the same type of thing or if it’s one, it’s, you know, it’s hard sometimes to rise above the noise. But when you get a bunch together, people start to notice. So there are all kinds of different ways to do it. But I think that’s why I think the specialty society is so key because it really helps your interest. I think that’s the best That’s going to be the best fit for you probably. I mean, there are plenty of people. I mean, I, I encountered plenty psychiatrists who would say, I’m not a member of APA, I have no interest in joining. They don’t speak for what I want that, you know, I have no interest and and that’s fine. But for the larger group, it does help to be a member. Well,
Unknown Speaker  21:20
it sounds like it sounds like for that individual, they should get on the phone with their advocate in the specialty society, right, they should become a member and become engaged. Because if they feel like their voice isn’t being heard, there’s a fairly easy way for their voice to be heard. Yeah, joined the specialty society. And you get on the phone with the advocate, as you said, you know that your Congress person works for you. Well, if you’re a member of the society, then your advocate works for you. And it’s true. And the only way that they’re going to be aware that you’re disgruntled with the position that they’re taking is to get a seat at the table. Absolutely. So all the more reason to be to be a member of the specialties. But what about what about the political action committee? So so every so often we get these letters in the mail from our political action committee that looks like our dues are due and it’s, it’s a little deceiving. Should I say, the way that it’s worded because it makes it look like oh, it’s this is a bill have to pay this. When really, it’s the elective news for the political action committee. And so, you know, you said the least you can do is to be a member of your specialized society. highest return on investment is to actually get their alerts and get on the phone. Um, so does does the pack fall somewhere in between like, what’s what’s, what’s the difference between the specialty society and the pack? It seems like the pack is the advocacy arm of the specialty, is it solely I’m a member but I don’t donate what’s Could you clarify that for us?
Unknown Speaker  22:52
Sure. So a pack political action committee is sort of a it’s a fundraising tool. So typically, when you contribute to a pack. It goes into a fund that helps pay for fundraising for elected officials. So often a member of Congress is running, they need to raise money. I mean, the joke, our pack directories to make it a PA is what’s the first thing a member does when he gets the Congress, he says he needs to raise money. That’s what he has to get reelected. So you know, the pressure to constantly fundraise is immense. And they’ll often hold fundraising activities where the member of Congress will meet with people to ask for donations. And so a lot of what those things do is it helps your advocates get a seat with a member bend their ear for a little bit at an event. And, you know, I will say there’s a quid pro quo at all but there is certainly access that is gained by donating to a members pack. And it can be it can be a little deceiving in some ways I’m you know, I think the specialist as eyes that I’ve worked with have all been more than above board and but there is like a, there is a perception. I think that it’s it’s not and I don’t think it is. But it definitely helps your advocates meet with members and have your concerns rise to their level. And then when we talk about staff hearing about things, and this is a direct access with the member and we’re also another thing I talked about the specialty societies is that they often band together for pack events. So often, a pack event would be a round table with a number of medical specialty societies meeting with a member of Congress or another elected official and it’s your chance to Talk about issues that are concerning you. And I mean, it’s a very effective tool in that you have an audience and you can talk freely about the things that are affecting your members and really get a chance to make a difference. I think there are certainly different ways that packs are run, like, you know, across not just medicine, but you know, across all packs. But the way our work to API is that, you know, all the donations coming from members were 100% used for donations, political donations, and that I think the staff time was funded elsewhere. So that’s something I think is really important. And I know it’s important to our members that like they knew that their dollars were going specifically to where we thought we can make the most impact to help the People who are going to help us get elected stay in Congress and have that opportunity to talk to them in that way. You know, I think if you’re inclined to donate to a pack, this is optional. I know, like you said, it might not seem optional, but it usually is.
Unknown Speaker  26:20
But you can
Unknown Speaker  26:23
certainly ask anybody, your pack should be able to answer your questions about where the money is going, what it’s doing, it’s all public information. And you can ask them what goes on or what they’re talking about, or a lot of times we sometimes have members come to a pack event, which is again, another great way to make your voice heard is that you know, if their special society knows that you’re interested, and you’re, you know, concerns or something that echo our policy and you want to make a difference, sometimes we would have in district meetings with these members, and we would bring Physicians with us and that’s another way of just making your voice heard and it comes to you in that sense. But, you know, you could, if you’re interested, you can give $25 or $10. I mean, it’s really not you don’t have to be giving tons of money to a pack if you don’t feel the need. And if you don’t want to, don’t donate, it’s really know something.
Unknown Speaker  27:26
Something that I want to clarify actually comes from our previous conversation before the interview was that in order to be counted, it’s being a member of your specialist society. It’s not being a member of your pack. I was under the impression that that you’re you’re not counted as an individual so to speak, like you that your pack doesn’t speak for you unless you’ve done it to the pack but the pack speaks for you. If you remember this specialist. This is everything that goes to the pack is icing on the cake. And one of the themes of this podcast is trying to get the highest return on investment and From what you were just describing, it sounds like the job of the advocate is to make sure that the money that gets donated to the pack gets the highest return on investment. So so they’re they’re going to make sure that it’s going to the trickiest issues, the most important issues. And the only way to make sure that your issues are seen as the most important issues or are up there is to donate to the pack, and then go to the meetings and make sure your voice is heard or the very least donate to the pack and then get on the phone with your advocate because then, you know, they’re there. Your voice then carries more weight. It’s an unfortunate situation that that money talks like this. Donate the player hate the game. This is this is the way it is, you know, until we get money completely out of politics. It will continue to be because the the Congress people are the ones that decide issues like this and the only way to get a voice in the room is to make sure that your is to make sure that you are donating. So, again, it circles back to the issue from the very beginning, it seems like we shouldn’t have to, but we do. And if we don’t, someone else’s, and their interests are going to be heard over ours.
Unknown Speaker  29:13
And it’s usually seen, I mean, there are sort of, you know, some people know, like size of packs. I mean, like you said, that’s not necessarily a number of people, although, I’m sure the societies keep track of, you know, percentage of members who donate to the pack, and they keep all kinds of data. But it does matter in terms of how big the pack is relative to the society. I’m in some specialty societies, you would think they’re very small societies, but they have huge packs. And that, again, it’s a it’s a similar sort of numbers deal where like that can make a difference in doors that open and, you know, places you can go and people you can talk to, unfortunately, but True. And, you know, I think that it does help if you want a strong society that’s going to advocate for your interests. Helping them in any way you can, is helpful. And I think that even just a little bit is helpful. And, you know, like we used to do something you can always do, like I said, you know, the specialist society, people work for you and you. We used to have meet and greets, at the our annual meeting, where we would the government relations staff would be able to on hand to talk about what the pack does. One why it’s important to donate. And it really, I think it did help put people’s minds at ease because there is, I mean, like, we’re sort of dancing around this issue. It feels a little slimy. But, you know, I think that a good government relations staff is not going to do anything that’s, you know, shady and it really does help. I mean, there are don’ts.
Unknown Speaker  31:05
Not shady, shady. Oh, this is just how the system works and
Unknown Speaker  31:09
the system to the
Unknown Speaker  31:12
to the uninformed physician. Yeah, it certainly seems that way. But I guess just watch a couple episodes of House of Cards or something like that. Right. But okay, maybe not that but but. But the reality is, this is how this system works. It’s not slimy. It’s not underhanded. It’s just, you’re right. If you’re in the House of Representatives, you get elected every two years. And as soon as you’re elected, you need to start fundraising for that for the next election. Right. It’s just an unfortunate reality of having money in politics. And so in order to get a seat at the table, their money has to, they have to in order to get elected, they need the money in order to have your voice heard. You need to, I guess provide them with hope so but that money That’s just Yes, it’s just, this is just the reality of the situation. Well, this was extremely informative. Thank you very much for taking time out of your busy, very busy life, just to circle back to to the point, big return on investment for getting involved in the specialty society and then getting on the phone whenever they recommend because they they value the physicians time. They know that we’re very short on it, and they’re not going to ask you to get on the phone with your congressperson unless they really feel like it’s going to make a difference. In order to do that you have to be a member of your specialty society. And that donating to your pack is important because it does allow your voice to be louder than it would be should you not be a member and that all of your advocates are available to you. So make sure that if you have an issue that you feel is not being adequately addressed and then get on the phone with them rather than complaining which which can be a contact sport for many people. Rather than just complaining, do something about it and I think you’ve made it very clear how we can do it. And thank you very much for your time.
Unknown Speaker  33:08
Anytime. My pleasure. Thank you for having me.
Unknown Speaker  33:15
This was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, wherever you get your podcasts and register review if you have something nice to say. You can also visit us on Facebook search physicians guide to doctor
Transcribed by https://otter.ai

Introduction to Advocacy for Physicians

The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of our respective employers.  This podcast is intended for medical professionals.  The information is to be used in the context of your own clinical judgement and those 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 even though the magic of podcasting may make it seem like I am speaking directly to you, this does not constitute a physician – patient relationship.  If you have a medical problem, seek medical attention.