Podcasts

Nothing to Fear, Just a Dislocation Here

We discuss what every physician should know about the management of acute orthopaedic injuries that any of us may encounter in our lives and when to worry and when to reassure.  And how to reduce a dislocated shoulder.  We also discuss what sports she wouldn’t let her son play and the answer certainly surprised me.  

Dr. Nancy Yen Shipley is a board-certified orthopaedic surgeon, with additional fellowship training in sports medicine and arthroscopy. Her professional interests include sports medicine, arthroscopic surgery, injuries and conditions of the shoulder and knee, fracture care and general orthopaedic surgery.

Dr. Yen Shipley received her B.A. degree in Psychology at the University of California, Los Angeles. She spent time after her undergraduate training working in the snowboarding industry and event planning, before finding her true passion, medicine. She attended Drexel University College of Medicine, in Philadelphia, where she discovered her love for Orthopaedics. Dr. Yen Shipley completed internship and residency in orthopaedic surgery at Virginia Commonwealth University in

Richmond, Virginia, then completed additional fellowship training in arthroscopy and sports medicine at Orthopaedic Research of Virginia.

Dr. Yen Shipley is a partner at Multnomah Orthopedic Clinic. In addition to her her clinical practice, Dr. Yen Shipley enjoys caring for athletes of all levels, as a team physician for  U.S. Ski and Snowboard Team, Multnomah University and Portland Interscholastic League. She has also been involved as a part of the medical team for track and field’s IAAF World Indoor Championships, the University of Richmond and the Virginia Special Olympics.

Dr. Yen Shipley is passionate about sharing her path to medicine with others, in particular our next generation of future physicians. She is a mentor and champion for women and diversity in surgical specialties, and brings awareness to this through speaking engagements and an active online presence. She has been a featured contributor on KevinMD.com, called “a must-read blog” by Rebecca Ruiz of Forbes, among multiple other online sources of medical news.

In her free time, Dr. Yen Shipley enjoys spending time with her family, snowboarding, stand up paddleboarding, playing (i.e. learning) tennis, and enjoying the great outdoors and the great food in her adopted hometown of Portland. 

She can be found at 

www.NancyMD.com

www.instagram.com/_nancymd

https://www.youtube.com/channel/UCRHOG_6gCyGJd0bQerfFPOw 

www.facebook.com/nancymdpdx 

www.linkedin.com/in/nancyyenshipleymd 

Doctor Identities on the Blockchain

Leah Houston, MD had her physician identity used for billing after her employment concluded.  This led to the epiphany that caused her to start HPEC.IO, an organization that is trying to give physician’s back control of their identities using blockchain technology.  This could be useful for doctors that want to switch jobs or states without having to have every bit of information independently verified.  We first discuss what blockchain is and then get into how she plans to implement it to not just help us keep our identities under our control, but to create bureaucracy-free virtual physician communities.

She is a board-certified Emergency Physician, founded Houston Health in 2013, and has a personalized private practice in Manhattan. While practicing medicine across the US for nearly 10 years she recognized a common problem: uncompensated administrative burdens related to physician employment and credentialing are a leading cause of administrative waste and physician burn out.

She began HPEC in 2018 when she realized that Blockchain could solve the obstructive regulatory problems with its distributed ledger technology. HPEC is building a platform that will give every physician a self-sovereign digital identity attached to their credentials in order to create the Decentralized Autonomous Organization of physicians and surgeons.  This will streamline the current antiquated and laborious process of hospital credentialing, save on administrative costs, improve access to care, and give physicians sovereign ownership of their data, professional brand and employment rights. HPEC will also create an opportunity for physicians to communicate more efficiently about policy and practice and in turn improve patient care.

She can be found on her Social Media Handles (linkedin, twitter, Facebook, Instagram)

@LeahHoustonMD

@HPECDAO

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.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians were Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned 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.
Unknown Speaker  0:27
Today’s episode was triggered Dr. Leah Houston, an emergency medicine physician and the founder of the humanitarian physicians empowerment community, a startup that is seeking to help physicians to keep their credentials in blockchain format, so that we can not only own our credentials, but the data we generate. It will help us to more easily move between institutions prevent physician identity theft, and use that proof of identity to create a physician ecosystem where we can communicate with each other free of the barriers of bureaucracy. We started discussing just what blockchain is, and then Discuss how she sees that ecosystem evolving. They’re still looking for early investors and she wants to keep this physician owned. So if you’re interested, be sure to check her out at HP ec.io this and all of my episodes are produced by car and Gill free, professional voiceover artist and she can be found at ca ri n. gl f ROI calm. And now Dr. Leah Houston. Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Leah Houston. She’s an emergency medicine physician who actually has temporarily left the practice of medicine to focus on the blockchain. So we’re going to talk about how that happened, why it happened, why it’s necessary for physicians to enter into this. Thank you, Dr. Houston for for being on the podcast.
Unknown Speaker  1:51
Thank you for having me. It’s great to be here.
Unknown Speaker  1:53
So first, let’s just talk about what blockchain is because in preparation for this podcast, caste, I did some reading. And by doing some reading, I mean, I listened to a bunch of podcasts about what blockchain is. And so before we even get into how it can be used for physicians and our patients, let’s just talk about what the heck it is because I feel like when you talk to someone who, who’s not familiar with it, it’s like saying the cloud, right? It’s just this big, nebulous place. And it’s really hard to define, but in essence, it’s not. It’s not really that hard to define. So, whereas something like the cloud, if you have a bit of information that is saved on one computer somewhere, and the word that they use in the field is that information is siloed, meaning it’s all in one place. Whereas with the blockchain, and correct me, if I’m wrong, Leah, the blockchain rather than information being siloed in one place, it’s spread out Among them bunch of different places. And each one of those places is password protected. And, and there’s some redundancy in it. So it’s almost like you have a couple of pieces of a puzzle in each different silo. And some of those pieces are repeated in different silos. And you really need to open all of them in order to put the puzzle together. But if you lose maybe one or two, you can still put it together. And so, so this is a way of keeping things secure, because even if you break into one, you really need to break into all of them in order to have access. And in addition, it’s referred to as the ledger and the ledger is just the history of the data. And so the ledger data is kept in these multiple silos and my anywhere near
Unknown Speaker  3:54
you are very, very, very close, I would say almost perfect. Thank you.
Unknown Speaker  4:00
Yeah, I mean that that’s a, that’s a really good explanation.
Unknown Speaker  4:04
And to like make it a little bit less obscure, you know, blockchain solves the, the problems that the internet can’t solve related to trust. So if you have all of your data in one place, um, you know, there’s there’s risk for security breaches, but also means that you need that one place for your data. And without them, you’re not able to store it and you’re not able to use it. So, when you’re able to distribute your data, and you have you, you, as an individual are the one that has the copy of your data. You no longer need a trusted third party because all the information is distributed. It’s not trapped in this one space.
Unknown Speaker  4:50
So yes, because I’ve been trapped in that one space, it can be corrupted and you no longer trust it, right? Like it’s like in a bank account, right. So it’s If someone gets my password and logs into my bank account, then they can just spend it and and whoever’s receiving that money can’t necessarily trust that it’s coming from me because my account can be so easily hacked. Whereas if you really need to put all of these pieces together, it leads to more trust for more security, whereas there’s something more to it than just the security.
Unknown Speaker  5:27
Um, well, it comes from security, but also, you know, if it prevents censorship, you know, so right now, we also have social media platforms that are centralizing our data as well. So it’s secure, it creates more security on both ends. And could you explain just what the ledger when people are using the term ledger,
Unknown Speaker  5:51
right? That that’s what blockchain technology is it? It’s a ledger
Unknown Speaker  5:57
legendary
Unknown Speaker  5:58
hyzer and good writer and the calculator and he’s keeping a ledger like a old school account. Right? Like, what is the ledger that they’re referring to?
Unknown Speaker  6:09
Right? I mean, so the term ledger is not really wasn’t really commonly used phrase outside of the accounting world until fairly recently. But essentially, you know, we need to document everything. And we need to make sure that that documented documentation is correct. And that nobody’s going to alter it, especially if we’re basing a lot of important things on that documentation. So you’re basing whether or not you’re getting a mortgage on your home on your credit, which is a documentation of your ability to pay, you know, your bills, then you want to know that that is a secure, verifiable document that’s immutable, meaning that it’s not able to be changed. And so they say the ledger, you know, but it’s really just a form of documenting the truth.
Unknown Speaker  6:54
Okay. And so how are you proposing That physicians use this technology to their advantage. How is it? What is it that? What is it that you’re doing?
Unknown Speaker  7:09
There’s a lot of blockchain technology out there that’s being built in order to fix a lot of problems. You know, there’s problems with transactions. There’s problems with supply chain management, and the healthcare industry. You know, they’re trying to solve some problems with research and development and documenting what’s happening in research. They’re trying to solve problems of patient records and giving patients access to their records and making themselves sovereign. And so there’s a lot of people trying to fix the user experience for enterprise and for patients. From what I can tell h Peck is one of the few blockchain applications that aims to fix the user experience for physicians. And as we all know, our user experience has been pretty crappy. A lot of us are leaving medicine. Some people are committing suicide. It’s so bad Trying to pivot into entrepreneurial endeavors, cutting back on hours retiring early, etc. And I think that for the most part, in my opinion, from what I’ve gathered from my physician colleagues, the majority of people were having these experiences of what’s called burnout really is a result of systematic abuse. They’re having these these feelings, but it doesn’t necessarily mean that they want to leave medicine. They just don’t like the way they’re experiencing it now. So how does blockchain step in? If we are able to create a decentralized physician database of physicians, everybody that practices medicine, and we’re allowed to give every physician and identity where it’s attached to their credentials. Then we essentially created a physicians Guild, a digital Guild of doctors, where we’re all in One space yet because it’s on the blockchain decentralized ledger. We’re free to do whatever we want. yet we’re also able to easily and quickly come together and form a consensus around policies and practices when we need to,
Unknown Speaker  9:16
should be a way for us to communicate with each other.
Unknown Speaker  9:19
That’s correct.
Unknown Speaker  9:21
Well, let’s let’s take a step back because I know with h pack first, what what was it that each pack stands for? Again, it stands for humanitarian physician empowerment community. Okay. And what we were discussing when we were offline was that inish or at least the first stage of this would be credentialing. Correct? Correct for physicians,
Unknown Speaker  9:44
right. So in order to make sure that a physician is a physician, and that we’re not making a distributed database of non physicians, we need to first check the credentials. So in order to create a physicians identity, we need to first check their credentials and then Once their credentials are checked, they then become part of their identity, that’s part of your data as a physician, that’s part of your immutable data, you became a doctor once, it’s not going to change, it can’t they can’t take your medical degree away. So your credentials can become part of your identity that are now portable owned by you. And so that is the first step to this process.
Unknown Speaker  10:22
So I think even before we get to the physicians guild aspect of it, there are a lot of inefficiencies in the credentialing system. When I first went into practice. Even before I finished residency, I was filling out tons of forms, including information that was clearly redundant because if I was finishing residency and and clearly I must have finished medical school, I must have passed step one and step two. And yet, I’m filling out all these forms and have to get all this evidence that I that I did all these things. And so there’s there’s a lot of redundancy there. And now each time I apply to be on an Insurance panel, I’m filling out the same forms and giving up the same information. And that redundancy is time and time is money. And so, so there’s a lot of waste in the system. And we’re talking about trying to make the house of medicine and the delivery of medicine more efficient, and more fiscally responsible. So it stops being the the GDP of a, of a large country. And it sounds like if we were to keep our data in the way that you’re describing in this immutable way, we’d be able to get a lot of rid of a lot of this redundancy and save a lot of money.
Unknown Speaker  11:40
Absolutely. And that’s, you know, that’s part of, you know, that’s one of the biggest parts of this, you know, having your credentials that are yours that are immutable, that are valid, already validated and authenticated once and they don’t need to be validated and authenticated again, and having you as the individual physician in control of those credentials. Not some legacy system, not you know, your hospital, not the insurance company that will allow physicians to move freely, and, you know, move to different health systems and, you know, get, you know, get on to the roster of insurance companies if they choose to do that much easier and much quicker because it’s validated authenticated on this cryptographically secure ledger.
Unknown Speaker  12:24
So why wouldn’t we just have this? Like, what’s the importance of having this on the on the blockchain and in the possession of the physician? Why can’t I just submit when I pass my boards when I when I finish residency, submit this to some siloed possibly government organization that just keeps all of our information in some central location that way, if a hospital or insurance wants to know, they know that they can trust the government and in theory can trust the government and just get that information there from this silo location with Is there an occurrence or something that that happened with that we talked about online that offline rather, that that gave you the idea that we couldn’t do that, that that would be a bad idea?
Unknown Speaker  13:12
Right. I mean, so we already are kind of in the system where we’re giving our information during credentialing to health system. And where, you know, we have our MPI, we have the federal state medical licensing board, we have the, you know, the state licensing boards. And, you know, unfortunately, because these centralized areas of our data are controlled by one entity, somebody on the inside could make a mistake, and improperly use our data. They could sell our data without our permission, which is a very common occurrence that people don’t realize. They call it de identified data. But oftentimes, you know, if you really look at who’s who especially, you know, physicians is only a million of us are so you can figure out Who’s Who if you look at where they weren’t, you know, some of the IDI supposedly de identified information. And, you know, something did happen to me that, you know, as this was occurring, I realized that this is a potential solution. And what actually happened, we you know, people don’t even realize that we have something called the medicare medicaid p 10. Number, PTA and and that number is a necessary in order the bill for Medicare and Medicaid. And so most of us have billing people that deal with this stuff. And so the billing person has, you know, everybody who works in the hospital and a file cabinet or in some on some floppy disk somewhere. And if they put your number Joe Smith’s p 10. Number In, instead of Jim Smith on accident, then all of a sudden that’s Medicare fraud. And because you’re the one with the license, you’re the one committing the fraud, not the billing person because they just made an honest mistake. And this actually happened to me I was You know, working in a different state, and in a hospital that I used to work for was continuing to build with my P 10. Number. You know, they they claim that they were doing it on accident, but because my license lapsed in that state during the period, it made the Center for Medicaid care and Medicaid, think that I was working without a license. And you know, chugging along, and all of a sudden they get a note from Medicare Medicaid, saying that my privileges to bill for Medicare and Medicaid are revoked. And I’m like, for what, and you know, it was a bureaucratic nightmare took almost two months just to find out that they thought I was working without a license. Now, I’m very grateful that I was actually actively working in another hospital because I was able to very easily prove, hey, I was working in this hospital in this other state on those days. There’s no way I was working in both places. And they of course, rapidly reversed it. But that was after almost four months of you know, litigation and Back and forth, and me trying to just figure out what’s going on. Because, you know, this government, you know, government systems are extremely slow and bureaucratic. So that’s, you know, one example of identity theft that happened to me. And when that happened to me, I kind of started going online and, you know, talking to other physicians that have had similar things happen. And, you know, I’m definitely not alone. That, you know, that was a different kind of issue that’s happened to others, but our identity, you know, is is not well kept, and it’s not protected with these with these health systems and insurance companies, and it’s often also being commoditized on, you know, we we control, eight, you know, 80% of healthcare spending, you know, with the physicians decisions were the ones that decide who gets CAT scans who gets admitted who get surgery and who doesn’t. And so that’s, you know, 80% of the spending is controlled by us. So our data and how we spend that money, and what we’re doing and how many clicks and how long it takes between clicks. When we’re submitting things, and when we’re not submitting things, filing claims, that data is extremely valuable to industry. And so we’re kind of giving all that data away. You know, we’re spending our, you know, our time on these EHR, that’s all also data, you know, it’s our patients, but it’s also ours. And so this type of solution allows us to reclaim ownership of ourselves essentially, in a digital space, and to not allow our data and our livelihood and our abilities and our hard work and our intellectual property to be coached any longer.
Unknown Speaker  17:37
That I don’t quite understand how, That, to me, that’s a little bit of a leap. So I just need some clarification there because because on the one hand, you’re, you’re talking about our identity, right, like all all of everything that we’ve accomplished in order to have the right to practice our exams, completing residency and fellowship and any credentials that we might have. Having licenses and in different states, there’s there’s that having that on the blockchain so that we have access to it, and then it’s immutable and verifiable. And that way with a click of a button, we can just let this hospital know that we’re legit, and we can work there. How does that doesn’t translate to control of our data?
Unknown Speaker  18:21
Well, because, you know, our identity is our data nowadays. You know, people don’t realize that it’s, it’s becoming one of the same, right? our identity in a digital space is our data. Our date of birth is part of our data, our you know, when we’re doing what, and when we’re clicking what that’s data that we’re generating. And that can be that can be collected in our own digital wallet for our data that’s attached to our identity that we control.
Unknown Speaker  18:55
So like, Facebook has my data because I log in, they know what my behaviors are, they know what I click on? They know on, they know how long I spend on each screen, how long I spend scrolling, how often I log in, they have that data. So you’re saying that once we have that I identity and becomes ours, then all of that data is logged under that identity. And so because it’s under that identity that belongs to us, that the data associated with it also belongs to us.
Unknown Speaker  19:26
Yes. If it’s if it’s properly designed from a cryptographic standpoint, yes.
Unknown Speaker  19:31
Okay. Okay, that that, that makes more sense.
Unknown Speaker  19:36
Thank you for clarifying. So. So it seems that this could also be used
Unknown Speaker  19:43
for patient data. Right. Is that is that something that’s happening right now?
Unknown Speaker  19:48
Absolutely. And you know, it’s it’s very interesting, because there’s a lot of people that are talking about patient data. And so there’s lots of patient data, there’s, you know, how many steps you’re taking, and you’re actually exercising, sometimes you can get that data off Fitbit and other wearable devices and the internet, medical things can capture this data. There’s your lab studies that you know, you when you get your lab draws, that’s part of your medical health data. There’s your electronic health records, which are created by people that are caring for you. So you know, we as physicians create a large portion of those those medical records. So, in this scenario, for example, if if you really want to be a patient who has freedom to go to the hospital that you want, and to see the doctor that you want to see, the only true way for you to have a self sovereign health record is for you to have a physician on the other end is also self sovereign and how they practice medicine and where they practice medicine, and how they get paid for their time and how much time they’re alive. To spend with you needs to be a decision between you and that physician, not a decision that the healthcare system or an insurance company is imposing on the relationship.
Unknown Speaker  21:10
So, if more what I was getting at was, you know, with with em ours, right, we figured they would just all be able to talk to each other. And the reality is that they can’t write. One has next gen one has epic one has all scripts, and they can’t communicate with each other. So it was mandated by the government that by a certain I don’t remember the date, but that you had to be on on EMR. And one of the benefits that was sold to us was these EMRs would be able to communicate with each other. And that way, if you got a CAT scan on one place, your doctor would be able to have access to that CAT scan another place. And the reality of the situation is, at least when I was in residency, if you had a CAT scan at a community hospital, and unless they put it on a CD and physically sent it with you, we might have to repeat that CAT scan when Got to our hospital because we have no idea what the heck is going on, get you someone else’s report, we need to be able to see it ourselves. So because there’s no cross talk, you can’t have that. But if you had patient information that was on the blockchain one, it’s not siloed. So you would be extraordinarily difficult to, to hack it to get access to it. But then, as long as you gave your physician the key to your ledger, then they would have access to all of your patient information, whatever we determined that to be right. You wouldn’t need all of their nursing notes from the time they spent in the hospital four years ago, but we could determine what was really high yield information like their labs, their imaging, their operative notes, their medication lists, things like that. So now suddenly, using blockchain technology, we can the patient what you were saying before can go to any doctor they want, because they no longer have to stay within their health system, just so everyone has, oh, I’m a this hospital patient. So I have to go to this hospital doctor so that everyone has access to my information, they can really go anywhere.
Unknown Speaker  23:15
Right? Absolutely. Now you’re talking about the high tech act of 2009, where they essentially were like, HR for everybody. And they started imposing this on everybody, but they didn’t creating standards for interoperability. So, you know, we now have all these electronic health records that don’t communicate with each other, and are in some ways, purposefully, not communicating because if a health system has to repeat a CAT scan, it’s money in their pocket. So you know, they’re they’re not really incentivized with the fee for service model to create interoperable records. I mean, now, you know, people are starting to wake up to this idea. You know, there’s a lot of really smart people working on identity and working on Mash master patient indexes where they’re trying to get all patients into one space so that they can, you know, have identities and access their records. And it’s really interesting. You also mentioned, you know, the nursing notes from four years ago might not be important. I think that that’s part of why I think this type of solution with physician identity is important, because the physicians notes number one are usually more important. And the physicians are usually the ones that help communicate to the patient’s, hey, this is what we’re going to be doing. This is actually what’s going to be happening. And those are the important the important parts of the records that need to be easily accessed.
Unknown Speaker  24:38
Right, because not that that nursing nose wasn’t important at the time. But if that note was a significant event, it would make its way into the physician note that would then go into the patient’s chart and then ultimately influence their, their care and be part of their ledger later on. NGO Yeah. So sounds like you’ve solved the problem for physician identity, you’ve solved the problem for patients being able to take their care wherever they see fit. With this with his technology is just a question of implementing it, which is clearly the larger problem. But I actually want to take a step back to to the physician identity. Let’s say you, you’re already in the process of creating this platform. So first, just just tell us where you are with that.
Unknown Speaker  25:30
Well, um, you know, there’s a lot of really smart people working on identity. And there’s also people working on governance, and they’re still figuring it out, for the most part, you know, they have the the world identity conference, and they they all get together, and I actually was speaking with some of them today. And you know, they’re really working hard to make this an interoperable system to try to not duplicate the mistakes of the past. So you know, at this point, you know, we are crowdfunding From physicians to try to build this, I’m really trying to keep it integrity base by keeping it physician owned. And you know, I have a technical team that’s ready to start moving on this process and start building on these platforms that, you know, we’re not reinventing the wheel, these technologies already exist. And so that’s where we’re at now, you know, I’ve been traveling all over the country this past month. So you know, Washington DC, where, you know, other leaders, physician leaders gather to, to kind of try to get a game plan and you know, you know, practicing physicians of America, physicians for patient protection, physicians against drug shortages, you know, the American Association of physicians and surgeons, and a lot of other groups. I was in LA speaking with some of the, you know, the leaders in the blockchain healthcare industry, and I was sitting on some panels with some really, really bright people. You’re also coming up with really great blockchain solutions. I was just also in Orlando with the DPC conference talk, you know, talking with leaders of the DPC movement, including the docs for patient care Foundation and the you know, DPC Alliance and dBc frontier
Unknown Speaker  27:21
dBc being direct primary care, correct. That’s correct.
Unknown Speaker  27:23
And their model is very interesting. And they’re they’re actually
Unknown Speaker  27:28
decentralizing already, their decentralizing power back towards the, the old way of doing things where there was just the doctor and the patient and that’s it. And, you know, that was part of why it was important for me to be at that conference because, you know, these physicians are really the revolutionary it eaters and they’re really trying to, I don’t even want to say they’re trying to they are, they’re creating a new healthcare system. They’re showing the world that this can be done. more efficiently if you get the government and the insurance companies and the third parties out of the doctor patient, you know relationship and let the doctor practice medicine. And their model is really, really revolutionary. And it’s, it’s, it’s really picking up speed. I’m like so impressed. It was one of the best conferences ever been to.
Unknown Speaker  28:22
And I think that makes sense. But But that being said, limited to a primary care
Unknown Speaker  28:29
arena, because when you get into the specialties, right, like you can’t have a radiation oncologist who is doing direct patient fee direct patient fee for service, because the overhead required for something like that is going to be so astronomical that it would need to be paid by insurance, which is pooled resources from a number of people who are all paying for that. Right.
Unknown Speaker  28:54
Right. Well, I don’t necessarily think that it has to be paid for by insurance. But it does need to be paid for in a risk pool type model. And you know, I don’t really love the word insurance because from what I’ve learned, after kind of spending some time on this issue and my time doing some, you know, doing public policy, the cost of insurance is artificially inflated. And that creates artificially inflated cost of medical care. The real cost of medical care is completely hidden. And that’s another blockchain application for, you know, for the payment of healthcare. You know, price transparency is something that can be achieved with this technology as well. So, yes, I mean, I don’t want to say that, you know, in what the what the public is led to believe is that you need insurance to get health care. But I do you think you need to have risk pools, but I don’t necessarily think the current model for insurance is the way I actually think it’s artificially driving up the cloud.
Unknown Speaker  30:02
Absolutely. I think you’d find it hard to disagree with that, because of all the bureaucracy that gets involved with the administration of that. I mean, there are just so many third parties involved in getting from the patient’s pocket to the physicians and the overhead in the care that Yeah, they’re they’re clearly a lot of inefficiencies in the system that that that could be done better. But we’re, we’re getting a little little circle back to blockchain. And I appreciate that. But But we should talk about h h pack just a little bit more. So you sounds like you’ve been speaking to a lot of advocacy groups for physicians and for patients. Because let’s say you do get a number of physicians and actually you didn’t want to toot your own horn. Sharon, I’m going to I’m going to do it. Because I’ve heard you say before that you’ve been approached venture capital to fund your idea. But you have declined because you want to keep this position own. So I think you’re to be really, really applauded for that. Because you’re trying to create a physician ecosystem here where we can we can control our our destinies. And if it gets sold to venture capital, it’s kind of right now, what you what you want to
Unknown Speaker  31:25
be, it’ll become more of the same because, you know, the whole consolidation of health systems and buying up a doctors practices and things like that is what this is trying to fix. It’s trying to reverse that trend. You know, so allowing a mouse aligned incentives back into the system that we’re trying to build wouldn’t be helpful. You know, I’m, I’m really trying not to be myopic on that because if if this is going to fail, unless I take some, some venture capital money, I would prefer not to fail. But I also you know, just, this is a very, very big idea. And if it’s implemented in the way that I’ve conceived it, and how, and how, you know, after speaking with other physician leaders that have decided to come on board, and how, you know, they, you know, they really agree that if this is built this way, this has the potential to, you know, decrease dramatically decrease the cost of health care for patients, and improve compensation to physicians for their time, which previously, you know, we hadn’t been being compensated for. There’s a lot of, you know, uncompensated, administrative burdens that would fall away. And that time would now be able to be for the care of patients, which is what it’s supposed to be for.
Unknown Speaker  32:41
So instead of filling out tons of paperwork, you’re actually seeing patients which is better for the physicians, because they’re earning more income and it’s better for the patients because then they’re being seen more, more more efficiently. So let’s say you do get a number of physicians to to keep their information on the blockchain, who are the gatekeepers? that needs to be addressed so that a hospital can get you can give the hospital access to your information. So they’re able to verify that you are who you say you are and have the credentials that you say you have. Right? Who’s Who are the gatekeepers there? Because right now, what’s the stop? Why would Why would a hospital say? Sure? h pack? I’ve heard of that we can just get your data from there rather than using the same inefficient system that they’re using.
Unknown Speaker  33:31
Well, you know, what they’re doing right now is they’re calling hospitals. And they’re making sure that your, your medical degree is real. And they’re making sure that you weren’t had don’t have any recent lawsuits. You know, so, if you if your hospital or if your health system that you used to work for is, you know, has permission to access to your identity, and they can put on the chain that you’re in the middle of a lawsuit. You know, Number one, is this going to completely eliminate the need for them to do anything other than just connect with you and your identity? Probably not, they’re probably going to want to do their due diligence on their end. But this is creating as a system for physicians to not have to do any more burdensome paperwork around this for the physicians part to be done on this end, if that makes sense.
Unknown Speaker  34:21
So you would then say to the hospital, here’s my key, here’s all my information. But what might actually happen is the physician the hospital says, great. Here’s this stack of paper, you still need to fill that out.
Unknown Speaker  34:34
Well, so my so the way it’s this is built the way that I can see that that won’t happen. And the reason it won’t happen is because there’ll be so many people on the platform, they won’t be able to do that.
Unknown Speaker  34:47
Okay, so you get enough positions that just say, if you want me to work for you, with you, this is how you get my information. And because we have so many physicians in the ecosystem, if everybody’s saying that, so that’s where the leverage is the leverage isn’t convincing the government or convincing the hospital systems that this is okay. You get enough physicians on the ecosystem that then say, this is how you get my information. And if you don’t want to do it this way, then you’re not going to have any anyone working there because this is how you get all of our information. Okay, that’s quite a few physicians that you need to get in order to have that type of leverage. Yeah,
Unknown Speaker  35:36
my goal is to have 200,000 by 2021.
Unknown Speaker  35:37
Fifth of physician, I think that’s, what is it one quarter right there 800,000 practicing physician so that’s, you’re saying one quarter of us physicians would need to be on this platform.
Unknown Speaker  35:50
I don’t think that they need to. I think that if we reached 50 to 70,000, it would still be powerful. But my goal is bigger than that.
Unknown Speaker  35:57
I think maybe regional Right, you’re in, you’re in New York, I’m on Long Island. We’ve already got two physicians in the ecosystem. We just build from there.
Unknown Speaker  36:09
I totally agree. And the thing is, is, you know, I’m not, I’m not suggesting that we’re strong on the industry into doing it our way at all. You know, I’m suggesting that we create a system and a front facing application that’s so you know, user friendly, that’s so trusted because it’s on this, this cryptographically encoded and secure ledger, that they’re happy to use it because they’re, you know, that these systems spend a lot of time and money on this on this credentialing problem. There’s a lot of redundancies, there’s a lot of mistakes and there’s a lot of waste. If we create something that’s easy for them, that makes their life you know, that makes their life easier than you know the only Why wouldn’t they want to utilize this this platform. You would probably just need some bold early adopters that then show how simple it is, and cost effective it is. And then it it snowballs from there. Absolutely.
Unknown Speaker  37:07
So there was something that you discussed earlier that I want to circle back to just because because we’re running low on time, you know, I keep on referring to it. And I don’t know whether I did or I got this from you as the physician as the ecosystem where physicians can communicate with each other because that’s the other end of this that you started to talk about. And then kind of went to went to a different place. So, you know, physicians are a guild, right? We know that because who decides how many physicians there are? Well, physicians who decides how you get your license, and this is all decided by us and that makes us a guild. So So how would you use this technology for us to be able to more effectively communicate with each other and thereby make some collective decisions?
Unknown Speaker  37:57
Yeah, any anybody who’s been a member of any national regional level Association knows that, you know, as the group’s grow, they begin to kind of collapse and implode on each other when it comes to decision making. And you know, a lot of times you put in layers of regulations, you put a board of directors, you put coat committees, co committees, and as this happens, efficiencies start building in efficiency, sorry, not efficiencies. So, you know, as groups grow, and as people kind of aggregate around a shared idea, in the movement towards actionable outcomes towards that idea starts becoming slow and sluggish, because it’s just, it’s not an efficient way of or there’s no, there’s no efficient way of organizing. So blockchain governance platforms allows the individual to, you know, tag their identity to different ideas. Yeah, you can create micro communities around shared ideas. You can collaborate and convene. What appears to be honest, a front facing app like a social media platform or like slack or Facebook, where you can kind of come up to come to a consensus with groups and not have hierarchy not have a need for a board of directors not have a need for committees? Because you can, I know have a cryptographic code that allows people to organize through through the blockchain.
Unknown Speaker  39:26
And you said, there are some inefficiencies, but some might argue that we we have this system through our specialty societies or the American Medical Association, but those also sometimes have some conflict of interest, right, where, where the people running the organizations have have an agenda and do their best to work with their their members, but there are some inherent conflicts of interest there. And so it seems like decentralizing that you get rid of those those underlying contract flicks of interest that are in the organizations
Unknown Speaker  40:08
where you get rid of the conflicts of interest. And then you also get rid of the the temptation for conflicts of interest because there’s nobody on the top.
Unknown Speaker  40:16
But without the bureaucracy, how do you then affect your will? Right? Like, let’s say, all of the laryngologist in the Mid Atlantic states decide to vote on someone proposes a vote on something and we all unanimously vote to, I don’t know, do something and what what then happens to that that sounds like that might just go into the right how do we then use that to affect change?
Unknown Speaker  40:45
Well, let’s take the no balance billing law in New York state right now. That’s something that’s that’s actually happening. And subspecialists are refusing to cover the emergency departments because they’re not being guaranteed payment anymore. And They’re not being paid. They’re not even if they don’t get payment, they’re not allowed to build a patience. So they’re disincentivize to cover emergency departments. So, you know, a lot of physicians were against this legislation, but it was put, you know, it was created anyway. And a lot of it had to do with, you know, people didn’t even know what’s happening. The people that didn’t know it was happening, we’re too busy to do anything sometimes. And the ones who did try to do something they were out and money’s not numbered by special interests. So um, you know, imagine if you could very quickly and easily be made aware of things like this on a monthly or weekly basis. You know, delegate and physician champions be incentivized to do research around these issues. And then, you know, to be able to vote and say, Hey, okay, of all the alerting colleges, how many of you would stop covering emergency departments and then we’ve helped That data to the public. Hey guys, did you know that if you know this bill is passed, and you have, you know, a car accident, then you might have to maxillofacial plastic surgeon to fix your face? You know, and that kind of thing would have the potential to change the votes of the people and to make people aware of what’s actually happening. And if we can do it in an efficient way, where, you know, physicians aren’t spending so much of their time, you know, trying to figure things out, and where, you know, if something’s affecting more than one specialty, those specialties can collaborate together. We’re right now, if you’re only a member of the, you know, I don’t know what the specialty society is for Ottolenghi ology, but you’re only a member of your specialty society and then the GI doctors are only a member of theirs and the plastic surgeons are only a member of theirs. There might be legislation that, you know, affects everybody but because, you know, they’re all kind of stuff Right out there, not potentially not communicating. And they could be, you know, collaborating on these types of things. So you know, and the way the way the H pack platform aims to do this is by incentivizing every physician on the network to generate income on the network. So if you get paid through the network, you’ll be incentivized to do so. And when it when it happens, a small transactional fee 2% will be taken and put into a pot. And that pot will then be delegated to different services, whether it be direct payment, malpractice, you know, legal aid for physicians who have had, you know, a run in with, you know, the system that in an unfair running with the system, you could delegate a certain amount of money to lobbying efforts and you could do that with your individual vote. So right now, a lot of people don’t like to give money to these legacy systems. Partially because of the potential collusion and the corruption, but also because they don’t know that their money is going directly towards something they care about. But in this type of technology, you can delegate your financial contribution directly to what you as an individual are voting for. And so I, you know, I think it solves a lot of the problems that we as a physician community have around us, you know, kind of having different opinions, being fragmented, not really wanting to work together, you know, feeling very patient, you know, connected to your specialty and things like that it, it encourages community and it encourages, encourages a more tribal mentality around the practice of medicine as a whole. You know, we all went into this to take care of people, and how are we going to fix the system so that we can take care of people again, how are we going to do that together while also preserving our own sovereign rights.
Unknown Speaker  45:01
I think that is an excellent way to, to finish up the talk and excellent summary of, of what you’re trying to do. Where can people find you?
Unknown Speaker  45:11
h pack.io? So www.hpec.io that’s our website.
Unknown Speaker  45:21
Any Anything else? This is quite a comprehensive talk. Was there anything else that you want to mention? Before we wrap things up that you think we may have missed?
Unknown Speaker  45:28
No. I mean, I think I just I want people to have hope. I want people to realize that you are still the person that you you were when you entered medical school, you’re still that person. You still can make a difference. It’s not you know, I know that there’s been a lot going on that makes people feel helpless lately. And, and it’s, it’s, it’s not a hopeless situation. We do have the power, we have a new technology that can help amplify that power. We just need to agree to use it. That’s it.
Unknown Speaker  45:59
Well, if you can bounce back from having your identity stolen and someone built under you and then not be able to work for a while. Well, if you can bounce back from that, then I think we can we can all bounce back. So thank you very much for taking the time to talk to me tonight. I’ve really learned a lot and it’s Thank you for everything that you’re doing for the physician community and for patients.
Unknown Speaker  46:19
Thank you. Thanks for having me, and thanks for listening.
Unknown Speaker  46:25
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest send a message or post a comment.
Transcribed by https://otter.ai

Doctor Identities on the Blockchain

Leah Houston, MD had her physician identity used for billing after her employment concluded.  This led to the epiphany that caused her to start HPEC.IO, an organization that is trying to give physician’s back control of their identities using blockchain technology.  This could be useful for doctors that want to switch jobs or states without having to have every bit of information independently verified.  We first discuss what blockchain is and then get into how she plans to implement it to not just help us keep our identities under our control, but to create bureaucracy-free virtual physician communities.

She is a board-certified Emergency Physician, founded Houston Health in 2013, and has a personalized private practice in Manhattan. While practicing medicine across the US for nearly 10 years she recognized a common problem: uncompensated administrative burdens related to physician employment and credentialing are a leading cause of administrative waste and physician burn out.

She began HPEC in 2018 when she realized that Blockchain could solve the obstructive regulatory problems with its distributed ledger technology. HPEC is building a platform that will give every physician a self-sovereign digital identity attached to their credentials in order to create the Decentralized Autonomous Organization of physicians and surgeons.  This will streamline the current antiquated and laborious process of hospital credentialing, save on administrative costs, improve access to care, and give physicians sovereign ownership of their data, professional brand and employment rights. HPEC will also create an opportunity for physicians to communicate more efficiently about policy and practice and in turn improve patient care. 

She can be found on her Social Media Handles (linkedin, twitter, Facebook, Instagram)

@LeahHoustonMD         

@HPECDAO        

No Fibs about A Fib with Doctor A Fib

Dr. Percy Francisco Morales is a fellowship-trained electrophysiologic cardiologist who felt that he could help more people by developing an alter ego and creating online content.  As physicians, we tend to answer the same questions again and again, so he thought it would be helpful for patients if he made an atrial fibrillation FAQ and thus Dr. A Fib was born.  We discuss the risks associated with a fib, management options, why coumadin is becoming a thing of the past, and new procedures.

www.drafib.com

 

EPISODE TRANSCRIPT

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians or Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned that while we were memorizing the Krebs cycle, the ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. This podcast is intended for medical professionals. The information is to be used in the context of your own clinical judgment. And those on this podcast accept no liability for the outcomes of medical decisions based on this information. As the radiologist like to say clinical correlation is required. This is not medical advice. And even though the magic of podcasting may make it seem like we’re speaking directly in your ears, this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention. And now here’s Dr. Bradley Block.
Unknown Speaker  0:56
Welcome back to the physicians guide to doctoring On today’s episode. We speak to Dr. Percy Francisco rallis, a cardiac electrophysiologist in Houston, who’s also known as Dr. A fib. Because of all the online content he’s created under that moniker. We talked about the main tenets of managing a fib. Why getting your patient to an electrophysiologist sooner rather than later hopes, their long term prognosis in new onset a fib. Why we expect most people to be off Coumadin soon, and some of the procedures he uses to get patients out of a fib, or off of anticoagulation. Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Percy Francisco Morales, a fellowship trained cardiac electrophysiologist, who is sometimes known by his alter ego, Dr. A fib. He’s created a lot of online content to help his patients and other patients understand atrial fibrillation. And so he’s on the show today to help the physician community better understand this pathology. So Francisco, thank you so much for being on the show today.
Unknown Speaker  2:00
Thank you, Brad. Thank you for having me on the show. I enjoy listening to your podcast.
Unknown Speaker  2:04
Thanks as always, always nice to meet a fan. So
Unknown Speaker  2:09
So first of all, just introduce our introduce yourself to establish some street cred with the audience. Where was your training? What was your training in and then we’ll, we’ll start off talking about that alter ego of yours.
Unknown Speaker  2:21
Okay, well I’m originally from Chicago, born born and raised and went to college at the University of Illinois, but then I eventually went over to Washington University for medical school, which is great medical school there a lot of great teachers over there. However, when I was there at school, I actually ended up doing my general surgery rotations through the month of December, January and February and there was a lot of brutal cold at that those times years and scrape the ice off of my car. And that’s when I officially said that I am done with the cold weather and so I pretty much when it came time for my intro Turn year and applying for residency, I was only looking at stuff in the in the southern hemisphere of the south of the country for the most part, and that ended up matching Baylor College of Medicine for my internship and residency, and they ended up staying there ever since. For the next several years for training, I did my general medicine residency there. I did my cardiology fellowship there, as well as my electrophysiology training. They’re all in the Baylor College of Medicine in Houston. And then once the my training finished about six years ago now, I ended up joining a private practice group over in the northeast Houston suburbs.
Unknown Speaker  3:37
I can completely empathize with your cold situation. I went to medical school in Buffalo and I just remember leaving the library and my eyeballs freezing open because it was so cold. The one benefit though was, of course is as medical students, we were the last ones to leave the library we were close it out. So an empty Park. Lot full of snow was was great to learn how to do spin outs in your car.
Unknown Speaker  4:05
Well, I will say in the past 13 years I’ve been in Houston, I’ve probably only seen snow, maybe two or three times it doesn’t stay on the ground and I don’t really miss it.
Unknown Speaker  4:15
You don’t miss it. Yeah, you can always. You can always travel somewhere if you want to go skiing. But
Unknown Speaker  4:21
yeah, I mean, growing up in Chicago, I feel like I’ve had enough snow to last in my lifetime. I’m pretty good with that.
Unknown Speaker  4:27
So how does your Alter Ego feel about the snow?
Unknown Speaker  4:30
Well, my alter ego is Dr. A fib and which is an online educational platform that I started about a year ago now actually, just recently just hit my one year mark of starting my online platform. And I recently I really started this because you know me, I’m sure you see this an EMT, but you just get a lot of the same questions, you know, and people ask a lot of the same questions about their diseases. And for me doing electrophysiology, I mean, atrial fibrillation was probably over 90% of the patients that I take care of. And so about a year ago I started thinking, you know, is I was really kind of reaching for a way to kind of extend my reach in a way to be able to education, educate patients better, and just to create something that you know, belongs to me that I could create and control and kind of control the content and control the direction of where it would go. And so I created Dr. A fib, bought a year ago now and you know, started off with a few small videos on Facebook and soon realized that this is something that people were genuinely interested in. There’s somewhere around 5 million people in the United States with a fib and over 30 million across the globe that have a fib and it’s still a disease that a lot of people don’t really understand. And it can be pretty complicated to really understand some of the features of disease and that’s why I started doing Dr. phibes. A year ago and you know, wanted to give it a catchy name to and it seemed
Unknown Speaker  6:04
like the name as well. So how does
Unknown Speaker  6:07
the dynamic work in your office? I was wondering about that because if I were to create some content about say tonsillectomy, right, if I were to tell parents Well, I think your child would benefit from an ad no tonsillectomy here, watch this video that I made. I’ll be back in 10 minutes while I go see my next station. You know, I can’t see that dynamic working that well because you know, that they need to trust you the rapport I feel like there’d be an issue with the reporter. Is that how you use this content?
Unknown Speaker  6:42
Oh, no, no, not at all. I mean, this doctor a fib is completely like a side gig, educational content, educational platform, you know, my day job of you know, being electrophysiologists and seeing patients you know, the report has never been No different, you know, I still answer the same questions all day, you know, to the patients and in person, you know, this online platform was to kind of extend my reach and to reach patients and and educate people far more than what I could do just by seeing people in person. So the kind of separate things factory fed there’s a little bit separate from Dr. Morales even though there’s a lot of intertwined between the two I kind of, like far as how I manage patients is, you know, really hasn’t really changed at all.
Unknown Speaker  7:29
Okay, so you don’t, you don’t use it during the office visit as a way to educate the patients you direct. You might tell them about it. after they leave the office. Hey, if you if you want to learn more about your condition, I have this platform here where you can find more information. But as your answer you’re still answering the questions. It doesn’t change that physician patient.
Unknown Speaker  7:52
No not at all my office visits are still exactly the same but like you said at the end I do have I have made some doctor a business cards which I kind of say, Hey, if you’re interested in more educational content, if you’re interested in completely optional, take a look at this site, you know, but the actual encount patient visit, you know, really hasn’t changed.
Unknown Speaker  8:11
So most of it is is tailored, we’re all of it is tailored for the patient population. But the reason you’re on the show today is actually to talk to the physician and clinician population. So if you had a medical student rotating with you, and you didn’t know what specialty they were going into, what would be some of the things you would want them to take away from atrial fibrillation, or you can even talk about elect other electrophilic physiologic issue. Although given that you said 90% of what you do is a fib. We should probably focus most of it on on atrial fibrillation,
Unknown Speaker  8:46
especially if someone was a medical student. there be a couple of points for me to point out I mean, first thing I’ll try to tell people is, don’t be intimidated by this disease. I think people get kind of like, they just look at an EKG or they see a person’s heart rate. Going 130 minutes, just throw their hands up in there and they say, I don’t know what to do with this, you know, or, or, you know, fix it, you know, like it’s not, it’s okay, just settle down, you know, it’s a control the heart rate understand their risk of stroke, you know, and it’s this is very manageable condition. And then I will try to tell try to encourage people about how interesting it can be to manage people who have atrial fibrillation or doing electrophysiology because I’m not really as aware of other fields and medicine, they have so much of a mesh between health as, you know, healthcare and medicine, but as well as technology. I mean, there’s so much technology in the world of electrophysiology as well as with taking care of a fit patients when it comes to the equipment and the ablations and all the monitoring devices. I mean, it’s, we get called the electrician for a reason, but it’s kind of a nickname that a lot of electrophysiologist get because there’s a lot of mess between technology And and the diseases as well as health as well as managing them.
Unknown Speaker  10:05
So what are some of the cooler gadgets that you end up using? Because I, I finished medical school. You know, we talked before the show, we’re about the same age I finished medical school in 2006. And so I would imagine there’s a lot that’s changed technology wise since then. So what’s some of the newer cooler stuff out there that people might find interesting?
Unknown Speaker  10:28
Well, the newest stuff has been all the kind of home monitoring and wearable technology mean they’re really getting like even apples getting into the world of atrial fibrillation. You know, the Lewis generation Apple Watch is going to can automatically tell you if you’re in a fit or not. And there’s several other like I said, a basic I’m sure they haven’t didn’t say that specifically I fit but that’s probably a name that they’ll probably come up with as well. But at the Apple Watch can do it as every other wearable home technology as Well, big company called the cardia is the name of the product that they do also the same thing. And you can kind of just put your, your fingers on a sensor, and it’ll tell you on an app on your phone if you’re in a fit or not. They’re pretty accurate. They have an FDA clearance and so they’re pretty accurate device. And so this whole world of at home map monitoring and at home technology is just rapidly growing.
Unknown Speaker  11:24
So are you with this new technology? Are you catching more patients that otherwise might not have been diagnosed?
Unknown Speaker  11:32
I wouldn’t say that I’m catching more patient being diagnosed just yet. I’m sure that that will change. I mean, the latest generation Apple Watch was just announced like in September, so I can’t really say I haven’t been seen it much change things in practice, but probably the biggest use of it now for me and my patients is that, you know, I have plenty of patients and you may have some to that they live far away from your practice, you know, and sometimes it’s hard for the patient feeling to know that In a film, or they just say, hey, my Harvey’s calling fast today, from a Caribbean a ship. And instead of coming down to the office, you can send this trip from home and send, send it through email over to our practice, and then I can tell you what’s going on. And so this kind of helping to manage things for people, especially who are further away from the from the office has been a pretty useful thing about these at home monitors.
Unknown Speaker  12:22
So how do those monitors work used to the patient puts the leads on themselves.
Unknown Speaker  12:26
So that now there’s a couple of different options. And so there’s probably one of the more popular ones is a little device called the cardia. And it’s, it’s about three or four centimeters long, it’s got these two little electrodes that you put your fingers on, and think you put it back, you put it on a table, and you put your fingers on there. And then that little gadget transmits to an app on your phone, which has, like, you know, its own kind of algorithm that will tell you if you’re in a fit or not, and it’s like the skinniness single lead EKG, so they’re pretty cool.
Unknown Speaker  12:56
Wow. Yeah, that is that is pretty interesting. So you mentioned Before, if there is a rate of 130, don’t let it intimidate you. The two things are rate control and stroke risk.
Unknown Speaker  13:09
I mean, those those are treatments one into for any patients that have atrial fibrillation and, and I frequently describe these to patients. And there’s like two hands in a sense, like you have to treat the symptoms and one side and then treat the risk of stroke on the other side. And they’re very separate things that people like, people think that they’re both kind of together, you know, but you have to kind of manage them kind of separately, you know, there’s either controlling the rate or controlling the symptoms or minimizing symptoms, which can involve a variety of different medications and whether it’s something simple like beta blockers or more complicated medications, like anti-arrhythmic medications, and then there’s risk of stroke and that’s what typically involves your blood thinning medications like your war friends or your newer medications like xarelto analysis. Those are the types of blood thinners.
Unknown Speaker  14:02
Speaking of which, so as an EMT, I encounter this a lot in my practice the atrial patient with atrial fibrillation and an active nosebleed on blood thinners, whether they’re on one or multiple blood thinners, and sometimes it’s not such a bad nosebleed, it’s fine Stan your blood thinners but then sometimes it’s pretty challenging to control. And so sometimes I try and figure out for the patient, what their stroke risk is going to be if they go off of their blood thinners for just a little bit, so correct me if I’m wrong, and clearly there’s going to be a range because some people have proxies. Molina some people are always in a fib. But the main risk is like 5% per year, not on a anticoagulation, but I think it’s 2% per year on anticoagulation.
Unknown Speaker  14:53
So in general, when people are on anticoagulation, and most of the studies the risk of stroke was somewhere around 2% but in the big antic regulation reduces risk of stroke usually somewhere around 65 to 70%. As far as the risk of stroke, not being on a blood thinners is based off of their risk factors, and that’s what we’re the Chad’s vast risk score comes in when you’ve taken account people’s age, and whether they have high blood pressure, diabetes, and we’ve had a stroke. And that kind of factors in what their risk of stroke is, which can range from zero for people who have very low risk of stroke always around 18% if they have all the risk factors for risk of stroke, but going back to your question about being off of blood thinners when somebody has, you know, may significant bleeding, and you know, when I’m managing my patients is the fact the matter is you have to go with what the clinical scenario is, you know, I mean, those risks of strokes are based on an annual risk stroke, you know, so there’s no really way to calculate the say if a patient is often blood For two days, the risk of stroke is going to be x or y, you know that number that the risk scoring system that we have is based off of a annual risk of stroke, you know, so there so happens all the time where my patients are on blood thinners. And they either have a clinical bleeding issue or they have a procedure that they’re coming up that we have to stop the blood thinners and just go with the clinical scenario. And, you know, there’s very, very few people that in my practice, that I actually will say like, either No, you can’t, or you have to use short term blood thinners like Lovenox. But for the most part, it’s perfectly fine to stop the blood thinner for a day or two, especially these newer blood thinners. I mean, they’re halflife is somewhere between 12 to 18 hours and so the usual recommendation for like eliquis or xarelto, that since they’re very popular, newer medications, is that, you know, one day off for minor procedures and two days off for more major procedures.
Unknown Speaker  17:01
So I just did a little quick math. And if it’s the highest risk, highest risk patient, which is 18% per year, and you take them off for a week, so let’s say, you know, 52 weeks a year, so 18% divided by 52 looks like it’s around a point 3%. And that math might be wrong. I think there was like an negative number and maybe an imaginary number in there when I tried to do that. But I think it’s like, point 3% per year. So if I asked my my patient who is actively bleeding, to just stop their xarelto even if they’re the highest risk patient, it looks like they have a point 3% so I can tell them that you know, your risk of stroke in this one week is extremely low. And given that you’re actively bleeding, but in the end, probably I should just call up their cardiologist and have that conversation with them. Anyway to to let them help me mitigate that risk.
Unknown Speaker  17:57
Yeah, that’s always the safer But in general, I mean, it happens all the time. You just have to go to clinical scenario. And I mean, I wish I could say I haven’t seen any patients that had a stroke after just being off of blood thinners for, you know, very short amount of time, because it has happened just but it’s pretty rare. And it my overall kind of practice is that, you know, the clinical need for you go ahead and stop the bulletins.
Unknown Speaker  18:23
Well, you know, if you see enough patients, you’re going to see some of those outcomes. So, yeah, I volume practice. So, let’s say you have, say a rural physician who doesn’t have easy access to interests and electrophysiologist. And they are in a community hospital, they encounter a patient who just had a stroke there because their stroke, they’re diagnosed with a fib. How do you begin your workup?
Unknown Speaker  18:55
Well, when they’re first diagnosed with a stroke, Of course, first important thing is, you know, we have from the stroke and you know, kind of getting better from whatever their initial hospitalization is. And as far as the initial treatment versus somebody who’s a, either primary care really doesn’t take care of a lot of a few patients, you know, probably one of the most important, most common treatment strategies geez that are given are probably just re controlling medications like beta blockers or calcium channel blockers. Many physicians, whether you’re a cardiologist or not are very comfortable with using beta blocker medications. And then pretty most people are very comfortable with starting them on entik regulation, you know, if they’re there for stroke, I always kind of make sure that a neurologist kind of is saying it’s okay to start them on anticoagulation but sometimes if it’s a big stroke, you know, they may say Okay, wait 2448 hours makes you don’t have to memorize your conversion or something like that, you know, but once they say it’s okay to start blood thinners, you know, you go ahead and start the blood blood thinners immediately. I tend to Like these normal blood thinning medications like xarelto, Alec was better just because they pretty stable, consistent blood thinning option. And you know, the level of the levels of the anticoagulation effects are pretty steady with those medications.
Unknown Speaker  20:14
So are we going to see everybody off of Coumadin? Now? Is that is that what’s going to happen with these newer medications?
Unknown Speaker  20:21
I’m probably, you know, I honestly, rarely ever start medication people on Coumadin nowadays. Really the main 100% these days is still mechanical, heart valves, you know, you there’s really none of those medications have been tested in that scenario, but when it comes to a fib or other things that need you know, DVT or PS like these medications are becoming a standard usage now, and honestly, probably the only reason why I use criminalities tends to be because of cost related reasons I’m and there’s a lot of patients that these newer medications, the CO pays are just too expensive for them and you know, and they may try painful for a little while, but then especially patients who are on Medicare, this is too expensive for them. And in those cases, you know, the probably the one of the main ones that I put them on Coumadin.
Unknown Speaker  21:11
Because they’re the labs that go into Coumadin. I guess, just the way the coverage works, maybe a bit more of the labs are covered rather than the medication, because I’m sure that in the total cost plays into it, because you don’t need to monitor these medications with serum or like you do with Coumadin.
Unknown Speaker  21:28
Yeah, it’s true. I guess that the out of pocket amounts of the patients and the pain that ends up being more with these
Unknown Speaker  21:34
medications.
Unknown Speaker  21:36
Yeah, which is just a product of our system rather than the genuine difference in costs, although I’m sure there’s a genuine difference in cost there to even with the labs just because Coumadin it’s so it’s so cheap.
Unknown Speaker  21:47
Yeah. Yeah. And obviously, I’d have to think about the actual costs the labs and everything together, but I’m sure that the cost of the newer blood thinner is probably still more expensive at this time, but You’re the first ones to come out, which I believe was Pradaxa. I think it’s somewhere around seven years old now. I mean, so it’s probably not still several years away before any of these medications and become generic, but it’s not super far time from now.
Unknown Speaker  22:15
Well, but and then and then
Unknown Speaker  22:18
everybody’s off coming in. Probably unless you have, like I said, a mechanical hard mechanical hard up clear indication that you have to take take for for mechanical valve.
Unknown Speaker  22:28
So let’s let’s talk about some of those other gadgets that you have maybe not gadgets, but procedures. ablation ablations versus cardioversion when when you use one, when do you use the other and what are the indications for either of those?
Unknown Speaker  22:44
Um, well, I think this brings up a pretty good point that I kind of wanted to emphasize to your audience is about the whole area of rhythm control procedures where there is lesions or cardioversion, you know, I think for a lot of doctors out there, especially people who maybe have a little bit of experience, or a little bit who have managed someone a little bit patients where they fit, there’s some people out there that have impressions that, you know, ablations or party versions don’t work, or the aphid comes back, you know, and some of that is true, you know, I mean, there’s certainly no 100% cure for a fifth meaning, there’s no one shopping and you get it done, and you never, ever, the rest of the patients like have to worry about the fib anymore. But but the patients can be dramatically improved, and they are the hospital, certainly a lot of benefit from it. Now, what I wanted to point out was that a fib is a disease of progression. And the more that people have a fib, the more the heart inherently changes. And, you know, even on a molecular level, the heart changes now We’re not going all the way back to the Krebs cycle. But you know, we’re talking about like, action potentials. I thank you for the sodium calcium channels. Yeah. I don’t remember too much about the Krebs cycle, but I know, potential, you know. And, you know, they inherently changed. The longer people have a fib, the heart from a molecular standpoint changes, they get more dilation, they get more scarring in their heart, and the heart inherently changes and people to be able to have higher success rates and have better outcomes in the treatment. They’re a fit, the earlier that they get treatments like a cardioversion or an ablation, the less long term damage has been done to the heart and so that success rate will be better and I think that’s something that a lot of lot of other doctors don’t really know or understand. You know, a lot of times I’ll get a patient sent to me who’s, you know, their previous doctor or you know, they’ve had a fit for year or two, they’ve been trying around different medications that is not working. And I say, Well, I wish I would have met you a year or two ago, you know, when it was just kind of in this early starting out process and we could have had a higher success for trying to really have a really good handle of your atrial fibrillation. So I just kind of wanted to emphasize that it is a disease that progresses and the sooner that people get expert consultation, the sooner they get put on either whether the medication of their car diversions or ablation procedures, you know, the, the better that success rate is
Unknown Speaker  25:33
so that that stroke patient in the rural hospital, in all likelihood probably just statistically had that atrial fibrillation for a while until they developed a stroke. So that’s not the patient that you’re referring to. And plus they’re right, clearly in the stroke or to the hospital. They’re not gonna, you’re not going to be in your office anytime soon. But if, say that same rural physician in their outpatient practice sees a picture that maybe has a couple of days of fluttering in their chest, get that patient to get that patient to get in the car or however the safest mode of transportation is, but get that person to an electrophysiologist as soon as possible, because then you’re going to have the highest likelihood of controlling that patient long term.
Unknown Speaker  26:21
Yeah. And and obviously, there’s been changes and all of this, you know, doesn’t mean they have one episode of a fear that they have to go get in an ablation done or, you know, have a procedure done or have to see an electrophysiology. But there’s certainly a progression. I mean, when I meet patients where they said, though, going to tell me a common story, they had an episode of a fib and then maybe they didn’t have anything again, for a year or two, they started getting them more frequent and lasting longer. And it’s just, it’s a disease of progression. And you know, and the further along along that progression that the patient is, the less the success rate of any type of procedures for a fit.
Unknown Speaker  26:54
So then when are you using those procedures to tell me the indications for an ablation versus the indications For cardioversion,
Unknown Speaker  27:01
so, cardioversion, I tell people is sort of a simple quick fix, you know, it’s trying to get, you know, basically, it’s like, you know, I tell my patients, you have your phone and TV doesn’t work and you turn it off, you turn it back on again, but it doesn’t fix the, what is the whatever the inherent problem is inside of the heart and so, but it’s a very simple thing to do. And so a lot of times cardioversion, that I’ll do them because maybe the first time the patients have a fib and you just put them in back into normal rhythm and they may have normal rhythm for a long time, or some people are a little bit too sick to really undergoing an ablation procedure, which is certainly more aggressive and so a cardioversion may be a better option. And another way I kind of do a use Akari virgins a little bit of a test run and I guess I say to see if their heart has advanced too far to where, you know, more aggressive options I can ablations are really not going to be so festival, you know, to see if there are at the point of no return where no matter what I do, it’s just not going to be successful to try to keep a personality out of a, a fair. But when it comes to ablations, you know, the actual indications are pretty variable based on the stage of a fear. You know, when people have a fear that comes and goes, you know, and you’ve been on at least one medication and you’re still symptomatic from it, that’s a class one indication for doing an ablation. Now, if you’ve been more advanced stages of a fit, you know, it becomes more of us, I believe it’s a to a indication to do it, and a place and because the success rate is is not as good but it’s certainly it’s still can be a better option than medication for a lot of people.
Unknown Speaker  28:50
And do you have a favorite procedure was one that you enjoy doing more than the others, because cardioversion. It makes you feel like you’re You’re one of the doctors on er.
Unknown Speaker  29:04
You know what, when it when it comes to cardioversion, you know what I, I wish, you know, they make it seem on TV like people have the paddles that the shock of people, they don’t have those anymore so it’s never as exciting anymore to shock somebody just pressing buttons on the machine now, you know, like I always wanted to have those kind of little paddles in the gel
Unknown Speaker  29:25
the way they do on TV, but you know, they don’t really have those kinds anymore.
Unknown Speaker  29:28
You’re like, you’re like swiping right instead of shocking the face and
Unknown Speaker  29:32
yeah, pretty much already swipe. Okay.
Unknown Speaker  29:37
But when it comes to ablation, there’s all different types of equipment that I use now and some of it just again, it depends on where the patient is in their stage of a fit. You know, people who had earlier stages of a fit, you know, the ablation procedure is a little bit simpler. And there’s all sorts of kind of one shot balloon technologies to help with the ablation procedure, which kind of makes the procedure little more faster and more efficient, which I started to like to use a little bit better. Who are more? Yeah, so there’s a freezing balloon called the cryo balloon, and basically you put a, you put a balloon and where the pulmonary veins are in the left atrium, that’s where the most of the ship comes from. And so the balloon kind of inflates in each one of the pull of pulmonary veins and it freezes the antrum. And it’s kind of like a one shot of area of bleeding area that can triggers most a fib. And so you can do these procedures in probably about an hour, hour and a half to the last shorter than a lot of more traditional ablation procedures. Obviously, as people advanced more into a fib, but you know, you kind of need to change the equipment and do more of a traditional kind of burning catheter to kind of get a better control of their duration. But all this is always in flux. I mean, there’s always constantly new research coming out with new equipment and new techniques to do it.
Unknown Speaker  31:01
I feel like there’s a balloon manufacturer out there that just visits every single sub specialist and say, Hey, hey, where can we use this balloon in your patients? Because there’s the sinuses there’s a balloon for tracheal dilation there. There’s a balloon for electrophysiology. I feel like there’s a blend for everything you’re not sure what I’ve done probably alone. choosable balloon just use it for something and then a laser because there’s, you know, everything I have a laser to do you have a laser. I’m
Unknown Speaker  31:32
really a laser there. Now, practical laser and I’ve seen some stuff in like, trials and describe but nothing that’s really commonly used for laser
Unknown Speaker  31:43
device looking for a home. Yeah.
Unknown Speaker  31:47
The patients ever asked you that. Do you? Do you use a laser for that?
Unknown Speaker  31:51
Um, no, but like I said, I at least when I was in fellowship people were one of my my mentors was doing some clinical trial that involved balloon that use the laser, you know, and I
Unknown Speaker  32:02
got them both. He’s got balloons and lasers.
Unknown Speaker  32:05
And the patient, I remember seeing one, but he was very excited like, I want the laser and, and I don’t think that that technology has been has panned out because I haven’t really seen it being used, you know,
Unknown Speaker  32:17
I totally just completed my balloon. Yeah.
Unknown Speaker  32:22
Okay, so is there anything else that we haven’t touched upon that you think every physician, whether it’s someone who treats a fib or someone who doesn’t treat a fib should know about atrial fibrillation,
Unknown Speaker  32:33
that there’s actually one more thing that I think that’s a
Unknown Speaker  32:36
key thing that I think is important for, you know, people who see people bleed a lot on blood thinners, whether it’s an EMT or gi doctor or or urologist was keep seeing people bleeding over and over on blood thinners and that’s there are other options. Now, you know, the main risk of stroke for people who have a Fed come from formula thrombus, no left atrial appendage, which is a simple Little kind of pocket pouch does it on the side of the left Hmm, I kind of tell my patients it’s like the appendix of the heart, it doesn’t really contribute much to the heart function, but it’s kind of like this little blind pouch that that’s where most of the thrombus forms and then where that’s where the main risk of stroke comes from. And there’s actually an emergence of procedures and particularly one called a watchman, where you basically put a plug in the seal that area off and the watchman has been approved about three years now. Basically, it just goes through a catheter through the groin up to the heart and basically deployed is plugged into the left atrial appendage, and they thought this day on blood thinners only for about six weeks after about six weeks, we checked with an ultrasound which everything looks nice and sealed off and then they don’t need it anymore. And it’s that watching plug was not inferior or equivalent to being on warfarin in terms of risk of stroke. And so there’s a lot of patients out there to have these ever going cycles of okay put you back on blood thinners because you have a high risk of stroke. You’re bleeding now you stop the bleeding for a little bit. Okay, let’s put you back on. Let’s take it off. And they just keep going through these cycles over and over and over again. And there are better options for them now, and this is this Washington procedure has been a very good option for those types of patients.
Unknown Speaker  34:14
How long has that been around
Unknown Speaker  34:17
for about three years now?
Unknown Speaker  34:19
Okay, so I mean, it sounds if it’s if it’s equivalent, that sounds like that might be a new trend for patients who are at high risk for the procedure itself, right? Because if I’m a patient, you know, you can either be on blood thinners or you could potentially get this procedure. Some patients are very fearful of procedures, especially something new like that. But some patients have great concerns about being on the blood thinners so especially with an active lifestyle.
Unknown Speaker  34:44
And one thing that I’ve always why I’m a big, wide been a big proponent of this watch and procedures that if it was studied for a long time, and actually went to two clinical trials in the US. I was approved in Europe A long time ago. So there’s many years of data behind it to show how Well, an effective they can be, you know, compared to just, you know, like the being compared to being on a blood thinner it’s equivalent, but compared to not being on a blood thinner for people who have legitimate bleeding, history or bleeding issues, I mean, this is an excellent option for a lot of patients.
Unknown Speaker  35:17
Wow, that’s, that is exciting. So,
Unknown Speaker  35:22
again about your website, where can people find you? So my main website is Dr. A fit calm. That’s where all my content is there on my blog posts, you know, my videos, links to my social media as well. I’m also pretty active on Facebook, as well as Twitter. Dr. Ha bondo kind of uniform, brand new platform through our doctor a fit, especially Bernie that other doctors may want to reach out to me You can always find me on there, Francisco merliss, my personal Facebook page as well.
Unknown Speaker  35:55
Well, thank you so much for creating all that content to help not just your own patient, but A lot of patients out there and thank you for taking the time to educate us about atrial fibrillation. Dr. Percy Francisco Morales.
Unknown Speaker  36:08
Thank you, Bradley. Thank you for Thank you for having me here. Appreciate it.
Unknown Speaker  36:12
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest send a message or post a comment.
Transcribed by https://otter.ai

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.

 

No Fibs about A Fib with Doctor A Fib

Dr. Percy Francisco Morales is a fellowship-trained electrophysiologic cardiologist who felt that he could help more people by developing an alter ego and creating online content.  As physicians, we tend to answer the same questions again and again, so he thought it would be helpful for patients if he made an atrial fibrillation FAQ and thus Dr. A Fib was born.  We discuss the risks associated with a fib, management options, why coumadin is becoming a thing of the past, and new procedures.  

www.drafib.com

Helping Doctors Heal the World Through Coaching

Dr. Dianne Ansari-Winn had her own battles with burnout until she turned to a physician coach, then became a coach and now teaches coaches.  There are executive coaches, sales coaches, tennis coaches, but until recently, not many physician coaches.  With the increase in physicians dissatisfied and unfulfilled by their careers, the “physician coach” is responding.  Dr. Dianne and I discuss why our field has been slow to realize the importance of coaching, her five-step physician vitality recovery system, some of the most common issues she encounters as a coach and I even get a free mini-coaching session!

http://www.dianneansari-winn.com

Please see the above link to learn more about her coaching and be sure to check out her podcast, The Doctor’s Life.

 

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.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians were Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned 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.
Unknown Speaker  0:25
Today’s episode we speak with Dr. Diane and sorry, when an anesthesiologist who suffered from burnout and managed to find her way out. She took that experience and turned it into a passion. Now she not only coaches physicians that are suffering from burnout, but she coaches physicians who want to coach other physicians. We discuss the importance of having a coach and why this is common in many other high performing fields. But not in medicine, at least not yet. The function of a coach and tips for physicians who may be suffering from burnout or know someone who is and I even got a bit of coaching myself during that interview. She even followed up with me the following day about what we discussed. This in all of my episodes are produced by car and Gill free professional voiceover artist. And she can be found at ca ri n g i ll fry calm. And now, Dr. Diane and sorry when Welcome back to the physicians guide to doctoring. On today’s episode we have Dr. Diane and sorry when, who’s a very accomplished anesthesiologist who, after 15 years in practice, pivoted and is now a full time physician coach. She not only coaches other physicians who may be experiencing the also common physician burnout, but now she’s actually teaching coaches teaching other physicians how to coach other physicians and extending herself in that way. So Dr. On sorry when did her undergrad and medical school and mph at the University of Michigan dinner anesthesia residency at Illinois State Sonic, and then a fellowship at the University of Chicago in both cardiac and pain, and was then an anesthesiologist for 15 years in Denver, Colorado, before pivoting into coaching. She received her certificate in CO active coaching from the coaches Training Institute, and is a graduate of the CTAs year long leadership incubator, the CO active Leadership Program. She is a physician development coach, and currently started and is managing the physician vitality Institute in order to coach physicians through difficult times, or even not so difficult times because kind of like therapy, it helps people that are living well, to live even better. She’s also the host of one of my favorite podcasts, the doctors life podcast, which serves our physician community in a similar way to this one, and that we’re both trying to help physicians to live their best lives. So Dr. I’m sorry when Thank you So much for for taking the time out of your extremely busy schedule to come to talk to me today about about coaching, the importance of coaching, how you got into coaching, and and what we can all learn from someone who’s studying, coaching as much as you have.
Unknown Speaker  3:16
Well, thanks Jackie read is great to be here this evening. Thanks so much for the invitation. And the that very warm introduction. I just wanted to make a slight correction just so that so the folks in the audience kind of know what I’m doing. I left corporate pivoted as you said, I left clinical practice six years ago and I actually started working in industry. So I, my I actually have two jobs. My day job is a medical director in industry, and then my passion project and the work that I do around That work so read evenings and weekends is, is the coaching the physician vitality Institute, the podcast. So, just like all of you guys, you know, sometimes transitioning from non clinical or clinical and non clinical doesn’t mean that you’re less busy because we have our interests and the things that we love to do. And, you know, we’re doctors, so we don’t want to miss out
Unknown Speaker  4:30
at all. Wow. Yeah, I’m sorry. I’m sorry about that. That that mistake, because as you are, it seems like that is not a side gig. It’s
Unknown Speaker  4:41
a full time job. Wow.
Unknown Speaker  4:42
Well, you know, it’s a it’s a doctors part time job, which is anybody else’s full time job.
Unknown Speaker  4:49
Yeah, definitely. That’s how we were all so so. coaching, how did you get into coaching? How did that become something that was even because a lot of us, we don’t even know Realize that a physician coaches is a thing you hear about executive coaches and, but but I know it’s something that’s that most of us could probably, if not all of us could benefit from so how did you discover that this was even a thing and then and then get into it?
Unknown Speaker  5:14
Yeah. Well, you know, interestingly, physician coaching has become a lot more prevalent, which I’m so excited about. now. I’ll talk about that specifically a little bit more later. My role and in creating more physician coaches, but how I got into physician coaching was probably about nine years ago when I really started to feel like I was burning out like I was not enjoying what I was doing. I was really feeling like it was you know, it’s really tough because I had been super high achievers you you know, you’re so kind introduction it’s you know, I went straight from a graduated from high school. It 16 I went to college at 16 straight into med school you know right into the very you know competitive residency I was chief resident married someone that was in my medical school class was also you know super high priorities pulmonary critical care you know went to Denver private practice had two kids and you know in the fight first five years did my practice and became partner bought the house the starter house so that one got the VIP Dr. House you know, so just plugging along being super high achiever and then I just started feeling really tired I started feeling fatigued. I started feeling trust not trusting myself in my work, even though I was still doing very good work. You know, I was the kind of doc that I was. would get requests, you know, from the nurses and from other docs if they wanted a family member to be cared for. Or if they had a patient that needed TLC, they would look for me. I did a lot of ob because I loved being with the patient’s ob anesthesia meeting. I love being with awake patients. I you know, and I was really good at my work, but I started to feel like I was sliding and even though I wasn’t, you know, on the outside, but on the inside, I could definitely feel the science of burnout coming on. And so I was looking for help. I was looking to talk to other another doctor about it, you know, I didn’t really feel honestly, you know, I didn’t feel so I could talk to my friends. My colleagues, most of my friends were surgeons, no offense, Dr. Brad, but you know, like, you don’t want to talk to other docs that are in your circle because the concern is that they’re going to think that you are Nothing just you think you’re sliding. But if you you know, if you say that you might be feeling like you’re not enjoying your work or you’re, you’re really tired or you know, it just doesn’t sound like just, you know, the regular doctor, doctors lounge complaining that we do all the time. But
Unknown Speaker  8:16
you have an episode a little while ago
Unknown Speaker  8:21
that were you were discussing that with someone. And they talked about just how frequent that is that so many of us are experiencing those symptoms, right? And if you were to, you know, reach across the drape as it were, and try to discuss something like that with someone. It sounds like you’d be surprised how often we’re feeling like that. That being said, if you’re anesthetizing one of my patients, and you said, Listen, Brad, I’m really not feeling so into this right now. Probably wouldn’t get the best reaction
Unknown Speaker  8:55
on it. Yeah. And then you know, Yes, exactly. And then you have to keep in mind, you know, you’re talking now I’m talking nine years ago, this is before Facebook. They’ve before LinkedIn before Twitter, before this sort of movement around physician burnout that starting to come out before all the research came out on physician burnout. So basically, you know, we we learned in med school and residency, like, never show your weakness, never, never. And so for me to even say anything like that, I felt that was, would be. It was scary to do. And so I was looking for a safe place to land a safe person to talk to you.
Unknown Speaker  9:44
And so in the dream, you had the house, you had the family, you had the job you had the career, you had everything that we aspire to have, how dare you be unhappy? That’s what that comes down to.
Unknown Speaker  10:00
Well, it is that and then also like, is she gonna crack in the middle of a case and like, just leave that or like, you know, like, Could she be dangerous? Could she be you know, Could she be dangerous to me my patients, you know, so that was the fear. And it’s still a fear, actually, if I you know, when I talk to physicians, that I coach is still a fear. But anyway, I was looking for someone to speak with, I found one physician coach, he left clinical medicine and she had learned coaching, and I found her and then as far as like other coaching, I actually started seeing a psychiatrist because I just thought there was something wrong with me, you know, I’m, but I learned I was burned out. There wasn’t anything wrong with me specifically except those for now. So, so I got into coaching because I was inspired by the coach that I was working with and I thought this is really cool. Like You know, night, I don’t want to go back to residency and study psych. So it’s like, well, coaching sounds really great and it’s such a great community of supportive people, not just docs, but non physicians. They are an amazing group of people and some of my best friends are our coaches. I just love the coaching community so but I got into it because of my own need search and my own needs at that time.
Unknown Speaker  11:31
So we do have that movement that is now prevalent where we’re all becoming more aware of physician burnout and but the the coaching, I still think is something that is very undervalued and underutilized in our industry. You know, executive, like I said, executive coaches, sales people have coaches. It’s very prevalent in in so many industries, but we’re all taught to be so self sufficient, right? don’t show any signs of weakness because like we’re, you know, you’re at the top of your class. This is this is who we are, this is what we do. You can’t show any cracks in the armor. All right. Well, why do you? Why do you think clearly you think coaching is important in it? you’d be hard pressed to find someone that disagrees with it. But But why do you think we were so late to catch on? Do you think it’s just this? It’s in our culture?
Unknown Speaker  12:33
Yeah, I think I think that’s the primary driver. And as you are, you already pointed out a lot of the reasons you know, we self select into medicine. We’re very driven group of people were very resilient group of people self sufficient. And that is reinforced in how we learn medicine, how we communicate. to each other as colleagues in medicine, and I think also that we’ve kind of can confuse the compartmentalization that that sort of is required of us to be professionals. And we confuse that and just put put all of like the emotions and everything that we have when we’re working, we put them away. And then sometimes forget that we need to like take them back out and process some, you know, if you if you and I were together in the ER, we had a difficult case. You know, where you’re, you’re at, and at one point, you’re kind of, you know, like, oh, holy crap that was going on. But then you switch into your doctor boat and so you just, you know, and that’s, that’s the thing to do, you know, so that your emotions don’t confound your actions. So we do what we need to do. But then, you know, at least we know when I was in practice, like we might have gone like who that was tough one and thank God, you know, just tuck them away and the unit or wherever. And then what will we do? Though we’re late rego go do next case like we’re not, you know, like, how did you feel wasn’t that scary or like we’re not doing any of that
Unknown Speaker  14:22
we’re just there’s no decompression.
Unknown Speaker  14:24
No, no, we’re just it’s going on to the thing. And then and I think that’s where we kind of take that for granted. And then maybe so we wouldn’t take that time one. We may we may be running late. So maybe if it’s lunchtime, and we’re running late for the next case, do we go eat? No, we’re not going to eat. We go and start the next one. So like we’re neglecting ourselves on multiple fronts in order to get the work done, and and that’s that’s laudable and it’s way but it takes it to
Unknown Speaker  15:00
And ultimately, right you get those signs of burnout and it can lead to apathy, which then ultimately affects patient care. And the reason that you’re, you’re skipping lunch is because you’re trying to look out for the patients and the schedule and the other doctors and you’re trying to take care of other people. So ultimately what you’re trying to do is ends up being self destructive. So, so if you
Unknown Speaker  15:20
said Well said, Thank you.
Unknown Speaker  15:22
So so if you if you have someone like a, let’s say, you meet another doctor at a cocktail party, right, okay. And you tell them that you’re a physician coach, and they give you the incredulous look right? Like, what is that? Who would? Who would need a coach? What? What’s your what’s your spiel? to use my East Coast? what’s the what’s the spiel? Why, you know, how do you convince someone who,
Unknown Speaker  15:57
I guess, I guess we can start with the How do you convince someone who comes to you feeling like they have a problem? That the coach that the physician coach relationship is a valuable one and what a coach can do for them? And then I guess from there, we’ll move on to Well, what about those skeptics that feel like, Oh, we don’t need to this is ridiculous. This is, too whoo, whoo. So but let’s start with someone that recognizes that they have a problem, and they’re looking to you for help. How do you explain to them the role of a coach? Yeah, thank you. Well, I think the primary role of a physician coach least appear physician coach, first and foremost is to give just like I was describing what I was looking for when I was burning out, is to give a doc a safe place to land and a safe place to talk about what’s happening in their lives because and most of the time, they don’t have that they can’t speak to their colleagues. They not in a in a way that they might that they can completely safe and confidential all the time.
Unknown Speaker  17:06
And then also, you know, a coach is trained to listen and to give feedback in a constructive way. And then we also if you think about it, you know, we have goals that are around our careers. Well, interestingly, like a lot of Doc’s don’t necessarily have goals around their careers, like they go into practice. And then their goal is to practice long as they can, unless you’re in academics or something. But you know, when you look at it, like when I asked people like stocks, like do you have goals around your career, like how do you want your career to fit into your life? How What do you see yourself doing in 1015 years and that’s, you know, then there’s look kind of changed from like in credulousness to like, Oh, I never thought of that.
Unknown Speaker  17:55
Yeah, I had that moment when I started. When I started in practice, because You know, I went through the motions college medical school residency, and then got my job, you know, and then eventually would, I made partner, but like, this is my office forever, let’s say, unless I move move jobs in, I love my practice. I’m a big believer in it. But I saw the chair, I saw the exam rooms, and then I saw the next 40 years, like, this is what this is it this is and then like, just it just because, you know, every we work in, in our through our stages, like spend four years here and four years here in five years here and then and now. 40. Like, so. Yeah, that’s an excellent, I think it’s an excellent point, right? Like is this this is and and for many people, that’s totally fine. I mean, and for me, I have no intention of leaving, right this but I Have a creative outlet. This is why I’m doing the podcast.
Unknown Speaker  19:04
Right? Well, that’s the deal. It’s it, in addition to looking at, like, Where do you want your career? What do you want your career to look like? Right? So it can look like yours, where you’re practicing full time, you know, we just have more options now. And then docs are also interested in talking to me because I have transitioned from non from clinical to non clinical medicine. And I do have a lot of interests and pursuits. So they want they want to know, like, how, you know, how did you do that? How can you do that? And then look, so that’s another category people that speak to me and then and then there’s people who are, they’re kind of soul searching, they’re looking for their next step, what they’d like to do next, or they’re feeling tired and burned out and they know that I’ve recovered from burnout so they want to learn how they can either recover from burnout or
Unknown Speaker  20:01
Or, you know, prevent burnout from occurring.
Unknown Speaker  20:05
So And just to be clear, you recovered from burnout while you were still practicing medicine and continue to to practice clinical medicine right? Because you said it was nine years into practice.
Unknown Speaker  20:17
Well, I started burning out nine years into practice but i i left clinical medicine because of physician burnout. Yo, okay. I did Yes, I didn’t recover from burnout and then leave like I I, you know, when people ask, like, how when did you burn out it’s like, well, when I hit like, probably started to really get kind of crispy about three years before I actually left. And you know, I don’t want to go into all the details, but I actually did a podcast episode on on this not too long ago, but there’s also another one called What do we call it? Going to the dark side I did about a year ago with one of the Well another doc that went, he’s the he was a thoracic, cardiothoracic surgeon and NIH fellow. And he went in into doing clinical trials and industry. So he’s doing research so but for industry and yeah, we call it going to the dark side.
Unknown Speaker  21:18
Oh, but so many people would would salivate. Just, you know, the opportunity to do something like that.
Unknown Speaker  21:26
Right? Right. When you know, again, like we’re talking contextually so this, you know, when we made that transition, I was six years ago, and I think he was like, eight years ago, like, even when I was thinking of leaving medicine and going to industry, that’s what I got, you know, like, Oh, so you’re gonna go to the dark side, huh? Yeah, I think I am. So, so about three years before I actually left is when I started realizing that I probably should consider an exit strategy, but I wasn’t really sure. And that’s when I started putting things in In the place slowly but I started looking at and I just like I said, we did a whole episode on how to do it but you know, you start need to start looking at your finances, your you know, you need to start looking at Would you be willing to take a pay cut, looking at your overhead your debts, your kids in private school, your nanny, you know, like, all that stuff. You know, it’s if you’re smart and you can do it, it’s good to look at all of those things so that if you decide to leave clinical medicine, that it’s not such a big leap or a big impact because leaving medicine alone is a huge impact. It’s a loss, you’re going to feel grief around it. Even if you wanted to do it. I swear my medicine was in my bones and I think it still is, but it’s so it was one of the toughest things that I ever did, but it was definitely necessary for me to do My own well being, just taking too much again, there’s a cost right there. So what you love to do, and then there’s the cost that it takes to do it. So for some people that becomes out of balance, and they, you know, it makes sense to cut back or transition and for others, you can recover that it is possible to recover from burnout stay in practice. And I think maybe what were you’re referring to is that I haven’t had a single client of my life.
Unknown Speaker  23:37
Clearly not a great, great example.
Unknown Speaker  23:40
she recovered and practice medicine for another six years. No, that is incorrect. But But you do coach people who then go on to stay in medicine. Yeah, they do. Okay.
Unknown Speaker  23:53
I’m super happy about that work. Yeah. Because I want to see docs. I want to see docs. Do that. work that they love to do, I want to see them happy. I want to see them fulfilled and on purpose and on track. And so whatever that looks like for them is what they should be doing.
Unknown Speaker  24:12
So that the so we started this part of the conversation with how would you discuss what a coach does with a someone who recognizes the benefits of coaching. Now, how would you respond to a coach skeptic? And that that answer might be well, I wouldn’t, and that’s totally fine. But, but how would you start convincing someone who’s skeptical about the benefits of a physician coach, or even the role of a physician coach, right knowing knowing what physicians are like,
Unknown Speaker  24:46
right? Well, you know, I think, and it’s not that it’s like the skeptic at the cocktail party. This is an ongoing discussion in our physician community. We know when you start looking at the reasons for Why docs burnout, right? Because there’s there’s three components to it. There’s an individual component, organizational component, and the cultural component. They all contribute to a physician burnout. So some people say that, you know, Docs, docs don’t burn out because themselves, they burn out because the system sucks. And it’s like, yes, the system does. And what I do is to help dogs that are still, you know, working within the system to do what they can for themselves, including advocating for themselves, so that they can, you know, have the best career that they want to within the system. So I think what I you know, for a skeptic, that’s like, because I’ve had skeptics come and talk to me, they’re like, well, what’s the difference between you and a friend or you and a therapist, and I will just say that the difference between a coach and a friend is that a coach is completely and totally invested in your agenda and your goals. They don’t have a You know the gender of a friend and they don’t and they whatever wacky crazy goals you think you might have, the coach is going to help you achieve them. And then and coaching is not therapy, although there is a lot of process in coaching, you know, if you come in you talk about your feelings, and you talk about your fears, and you talk about your big dreams, that’s process work. And so that but that is not therapy. The nice thing though, about a physician coach is that they can, they can kind of see a little maybe a little more readily than someone that’s just like a plain old life coach, that you might need therapy now or that you might be depressed, and then in refer you, you know, to the proper person, you know, it might be and I you know, I talked about this when I talk to docs about recovery, and one of those pieces is to make sure that you’re in good physical health. So if you come Me and you, you told me that you’re tired all the time. You know, I’m like, when’s the last time your family doc? Have you seen him in the last year? You know, you might have a medical condition that has gone undiagnosed, you know, because you haven’t been caring for yourself as well. And, you know, with a lot of docs, don’t go see a physician regularly for checkups. I’m, you know, I’m in that number. You know, I went not long ago, but it’s been a couple of years. Before that, I must admit so. So that I think in that way, as physician coaches a little bit more adept and making sure that you we still keep the eye on the ball in terms of looking at your, your health, but but coaches look at your entire life. They look at not just your career and your goals, but we help you look at what’s happening in your family, what’s happening with your finances, what’s happening. You know, your mindset and terms of, you know,
Unknown Speaker  28:03
do you feel like you
Unknown Speaker  28:05
can’t leave medicine because you don’t deserve to leave medicine or you know, there’s just a lot of factors involved. But I would say that the thing about a coach, position coaches, they get it, they have been through it. So they’re unlike any other kind of coach in that respect. You know, when you when you use acronyms when you refer to your medical education, when you talk about getting pimp drive, when you talk about staying up for 36 hours, you know, we get it, we get it, whereas you just so you don’t have to explain that safety. that camaraderie, it’s right there for you. So and so I’m like, Well, if somebody doesn’t want that, then that’s that’s all good.
Unknown Speaker  28:59
That was An excellent sales pitch
Unknown Speaker  29:04
not liking pizza.
Unknown Speaker  29:09
We could have a debate about Chicago versus New York.
Unknown Speaker  29:13
And I just tire on the deal. I love Chicago. New York pizza. I love holding it.
Unknown Speaker  29:21
Right now with a knife and fork right you gotta
Unknown Speaker  29:24
like I love the big slice and folding it now. Yeah, I love New York.
Unknown Speaker  29:31
We week. We were
Unknown Speaker  29:35
my husband ex husband’s family’s from from New York. And so we call Chicago pizza. Cheese pie. Yeah, a
Unknown Speaker  29:44
lot of Dan.
Unknown Speaker  29:47
Yeah, a lot of cheese. It’s dough filled with cheese.
Unknown Speaker  29:53
So, so you you started the physician vitality Institute. Correct. That’s yours. That’s yours. Yes. And your five step system that you go through with people when you’re coaching them. So can we go through those? Those five steps? Yeah, we’ll just talk about some of the common issues that you see, and how you help people to address those issues. Yeah. Oh,
Unknown Speaker  30:20
yeah. I’ll be happy to go through them briefly. And I’ll also say to that, I’m excited to announce I think this is the first time I’ve announced it on a podcast that I’m actually wrote up my system and so as a book, and that is going to be the talk about a busy for like, want something done, ask a busy person. So that’s going to be released on January 2. And yeah, it’s called doctor heal that myself physicians guide to health and wellness. So that’ll be released. Yeah, thank you. So, so just briefly, what I talked to Doc’s about is this first principle is energy management. So looking at things in terms, looking at your life and your actions and the things that you do in terms of energy, meaning things that energize you and things that deplete you, not just in terms of tasks, right? So like you say, have surgery, right? And if you know it’s going to be a long surgery, but it’s like you geek out, it’s like your favorite surgery. You love it, you know, so when you come out of that six hour case, in some ways, you’re tired just because of the time that you spent, but like because it was so fulfilling to you. How do you feel at the end? you actually feel energized, like or imagine like having to spend like six hours studying for boards. Six hours, right? How do you feel after that? Probably depleted his mic. That’s, that’s how I would feel Yeah, you can spend the same amount of time doing a task that like energizes your depletes do. So just keep that in mind as you’re, you know, you know, if you did learn take nothing else from this, start thinking about energy management as opposed to like your task management.
Unknown Speaker  32:21
Because it may be things that you think you enjoy, because you should enjoy them. So you’ve convinced yourself that you enjoy them, but in fact, you don’t. So they’re, yeah, they’re depleting you without you recognizing it, because they’re the things that you’re supposed to like,
Unknown Speaker  32:36
right? And it kind of hinges ideas like between work and play, like some people go to work and they’re like, well, I can’t wait until I finish work so that I can go like play with my family, whatever. And then, you know, you can feel kind of guilty because like childcare and housework and stuff like that, you know, may may have some may feel good in some ways, but in some ways, it’s hard work and it can be depleting. So it just takes away those labels of like what is work in play? It’s okay to, it’s okay, if your work energizes you, it’s okay if you know, housework depletes you, and kind of knowing those things will help you when you’re trying to figure out where you need help. Because you’re looking for more of the activities that are going to energize you, or at least put them in a sequence, where you’re not like doing all the depleting tasks together on the energizing tasks together. So, you know, in some ways, that’s why like, if you schedule things and you’re like, I can’t wait, so I go on vacation, and then you do a vacation. That is, it’s fun, but it’s also can be like, you know, taxing, like, you know, like, we I live in Colorado for 15 years, right? So, you know, people would come from Texas, they go skiing, and they would have a great time. But you know, it’s like, sometimes it’s not as relaxing as it would have been to choose something else like so you kind of look at the you know, what was the purpose of the vacation. It was like to relax, would you renew rejuvenate? So you have to learn, you know, it’s like Dr. Hill myself needs to learn, you know, who you are. And you know what, what does energize you What does deplete you, and it’s different for different people. So that’s the first thing just to keep in mind. So that’s what I started to teach docs. And another thing is, I want to really emphasize is that it’s really important to care for yourself and to make yourself a priority in your life. And I know particularly for doc set have work and kids and family responsibilities that that can really fall by the wayside. But it is so true that like, you can not have the capacity to do everything that you need to do especially at such a high level if you don’t take good care of yourself. And so it’s not selfish, and it’s not rude and Not me, like it’s just something that you need to do so that you can be at your best sell. So those are the two things I kind of want people to be thinking about. And then I teach more specific strategies about how to renew your energy in different ways. So, and the whole system is called the physician vitality system, like based on the physician vitality Institute. So things that energize us connecting with others. So there’s a, you know, a module on that there’s a chapter on that in the book. So not so friends, family colleagues, you know, maybe it just taught and I teach ways to do that, how to make better connections. And then inspiration. So connecting with things that inspire you, it doesn’t matter like you know, whether it’s doesn’t have to be like traditional spiritual practices. But even like walking outside in nature, meditation, looking at a picture of your kids, like the things that get to your heart, what makes your heart feel glad, that’s inspiration. Then the other thing that I teach docs are calming techniques. So things that you can rake and help you to calm your mind. So that you have relaxed and focused thought like during your day and then how to recover from your your day. So, simple practices that will help you give you more energy during your work day and then also help to energize to, you know, before the end of your workday. Then I also teach about caring for your body. So again, you know, like, getting that checkup getting the exercise, eating meals, I mean, these are like simple things sometimes but dogs we just, we are just, you know,
Unknown Speaker  36:57
we just our
Unknown Speaker  36:59
schedule was packed. I didn’t eat dinner.
Unknown Speaker  37:01
Did you eat lunch today, doctor?
Unknown Speaker  37:05
Actually, my wife was not gonna appreciate this because she gets mad when I skip meals But no, not lunch and then by the time I finished seeing all my patients and made all my phone calls, it was time for this interview. So know your dinner. Yes,
Unknown Speaker  37:18
you are.
Unknown Speaker  37:20
And that’s the thing is there’s this is there’s this chest thumping mentality in medicine that like I got two hours of sleep last night, and I’m just gonna power through because I’m the toughest guy and I you know what, I just sucked it up. And I didn’t need anything today because I just took care of patients because I’m this martyr. Right? Like, yeah, I could have made my schedule a little lighter and Yeah, actually, actually lunch or really would have served my patients better had I stopped for lunch and taken a walk around the block outside. Right cleared my head room. Reset me a little bit. Right? That sounds like what you’re saying, right? walk off a couple spots, take a walk around the block, and then my afternoon patients will be better served by me having having done that.
Unknown Speaker  38:14
Absolutely. Absolutely. So yep, and last but not least, emotional fitness. So being aware of our thoughts, particularly our negative thoughts, and how to recognize them and how to turn them around as best we can. And that’s, it’s just simple, simple. You know, it’s old, good old fashioned, offering. conditioning, basically recognize the thought, you know, let it, identify it, recognize it, and see like, how it’s how it shows up in your body, or how it showing up and then ways to to switch those Let those negative thoughts go away because those in themselves, not only are they obviously their negative thoughts, who wants to feel negative, but you know, those get passed on to family, friends, colleagues, patients, and turn on yourself. So being emotionally fit is the last of the five, like major components of the system. But I think if you’re, you know, take the one thing away, like you’re saying, you know, just ask yourself, Is it like, is what will really happen if I take 10 minutes to eat? And, you know, go to the restroom, like, like, what really happened? You know, what, like, how much better could it be? If I know like, I’m going to be late seeing patients, and I take two minutes, and I send a text to my wife or call my wife or husband. Just say, Hey, I was thinking about you. can be late. Whatever. Like that’s the connection to others.
Unknown Speaker  40:05
Oh yeah. But in it when you’re when you’re seeing patients in the office, what happens is that that snowballs right you start seeing patients late, and then that puts you further behind and then then the next patient you have to apologize and that takes a minute and then that adds to your and then by the end of the day, you’re running like an hour behind and nothing’s few things stress me out more than seeing a whole bunch of patients that are waiting for me. So yeah, that’s how I keep my stress level to a minimum is by actually skipping, like taking my time with my patients using my lunchtime to catch up and then putting on time so but I should just make well that’s
Unknown Speaker  40:44
it you’re going to turn this into a coaching session, but you could find a way you know, to eat the meal still because you didn’t like you didn’t have to. You’re like how can I get a meal because the whole purpose is just to get food in so yeah, can I get the meal and and like, does it have to be all or nothing. So, does it have to be the whole 20 minutes? Or could it be five minutes? Can I take, you know, in order to like get my stress level down? Could I, before I go into the next patient’s room? Take five deep breaths and just center myself. Yeah. And and get rid myself of the negative thoughts of that somehow being a being late equates with your value as a physician or as a husband or whatever. And, you know, like, I’m always like, back it up to the present moment. Just back it up. So take those couple of deep breaths and walk in and like, you know, I’m Dr. rad. I’m so glad you’re here. Let’s look at what can I do for you be present for them. They won’t care like that. You’re we’re five minutes late. You’re there. For them, not like rest. They won’t care. Believe me, I’ve been on both sides of it.
Unknown Speaker  42:06
These were two lessons that you said were actually in previous episodes episode for the where I had a patient experience representative. One of his big tips was before each visit, stop, take a breath, and then open the door and see the next patient that was. And then a show that hasn’t been published at the time that we’re recording. This was with Dr. Stephanie SOG is a PhD in psychology. And she works at the Harvard weight management center. And we talked about how to talk to people about that are having issues with their weight about that issue. And what she was one of the things she talked about was there negative self talk, catch people having these. Oh, I’m so stupid. Oh, I’m so right. Make them recognize that they’re saying it and point out how destructive it can be. So the same thing applies to us you have these negative thoughts. If you I think the saying is, if you if if you talk to your friends the way the thoughts in your head talk to you, you wouldn’t have any friends. So recognizing that you have these thoughts that are devaluing you and and helping to turn those around.
Unknown Speaker  43:24
Absolutely. You guys can’t see that Dr. Bad Niren zoom and I am just like nodding my head like a bobblehead and all the things that he’s saying you’re trying not to interrupt but I have the hugest grin on my face and just smiling and nodding and acknowledgement. You are on the money. Dr. Brad I so appreciate
Unknown Speaker  43:44
applying it is a different.
Unknown Speaker  43:46
Yes.
Unknown Speaker  43:48
Now that I’m hearing it again, it’ll hopefully it’ll help me to then you know, this is obviously I’m not recording this just for me. It’s for the listeners as well. I think we’re running short short on time. But I’m I’m really enjoying this, I’m hoping you can stay on just a little longer. And just mentioned if you have some some of the issues that you see that have relatively simple ways to correct them. So when your code of your coaching clients, you probably see some common threads. So if you could just mention one or two things that have relatively simple solutions. What would those be?
Unknown Speaker  44:34
Well, I would say that, you know, one of the things is that we’ve already talked about it, so I’m not going to like go into like a whole nother, you know, discussion. But I think that that a lot of Doc’s come in, and they feel as though they aren’t valued. They are they are working hard and they’re doing their work, and they’re feeling bit undervalued and misunderstood. And so So I think one of the things to help to ameliorate that is to do just a simple practice. When you get home at night or before you leave, just write down three wins for the day, three things that you did good related to your work or some the way you communicated with someone or whatever it is three wins, just so that’s one thing you can do. You know, just the simplicity is real simple. They’ll just give you simple structures. The other thing is that doctors often feel like disconnected and they feel lonely. You know, interestingly, in part, I think because we do have to assume the role of superhero, superhuman, even though we’re just simply human and we have a special skill set. We always have a very special skill set and we are truly People not going to deny it. Like we’re, like I said before, I think doctors are awesome, we’re resilient, we’re bright, we’re motivated, we want to give to the world. And you know, and, you know, I, so I’ve, I’ve given you four wins right there, like just who you are. So just keep keep that in mind that that you are doing the superhuman special work, but that you are, you know, simply human and it’s okay to have needs, wants desires, hunger, thirst.
Unknown Speaker  46:42
It’s all it’s okay. And I think that as slowly but surely, we’re going to change the culture, you know, medicine as we go through and, and will be more supportive of each other. You know, it’s like you said executives have coaches. therapists have groups that big Why? Because They know that their work is hard. So they talk to each other about their work. Why so that they continue to continue to do their work at a high level. So, you know, take a page out of their playbook. It’s it’s not an admission of weakness, to just admit that you have needs human needs.
Unknown Speaker  47:21
So if someone wants to take a deeper dive into this, where there are a multitude of places where people can find you, where can people find you?
Unknown Speaker  47:28
Yeah, thanks. Well, you can find me on all social media at Dr. Diane MD. So you know, I’m not going to run through all this social media but you can find me there. You can find me on my website www.dr. Diane, calm, and that will tell you more about me and also gives you links over to the physician vitality Institute. You can listen to the Dr. Side podcast, through that website. And then you can also Find out about the spirit more interested in helping other docs and becoming a physician coach. And I actually launched a training program for doctors. It’s running its first session now the spa and we are we’re already enrolling for a second session that starting on October 15. So it’s called the physicians Coaching Academy. And in three months, you can learn how to become have coaching conversations with other physicians. And so I have a few docs in that group that want to be coaches. I have docs in that group. I have one doc that’s for example, she’s a residency program director. She has doctors coming to her already for advice. She wants to know how to have coaching conversations with them. So So come one come all. ww www.dr diane.com. Find out more about that. So Send me a note through that website, check things out and just feared or, and, and how and, and grow this wonderful community just to try and help docs heal the world. It’s my mission. So join me
Unknown Speaker  49:20
put that book one more time
Unknown Speaker  49:25
that the book is entitled, Doctor heal thyself. So that’s easy to remember. And that will be released on January 2. So well you have a you know some more information about that as it comes closer to launch.
Unknown Speaker  49:44
Fantastic Well, I appreciate you with all these different things that you’re juggling taking the time to have this conversation with me and, and to be on the podcast and for all the great you’re doing all the great work that you’re doing with and for the Physician community and the house of medicine it’s, it is it is it is desperately needed and much appreciate it. So thank you very much.
Unknown Speaker  50:07
Well, thank you. It is it really has been my pleasure to speak with you this evening and I can’t wait to let you go. So you can go.
Unknown Speaker  50:22
Halloween candy.
Unknown Speaker  50:24
There you go.
Unknown Speaker  50:26
I thought that was the breakfast of champions.
Unknown Speaker  50:30
bookending bookending.
Unknown Speaker  50:32
Right. Yeah. started the day off with
Unknown Speaker  50:34
graham crackers in juice.
Unknown Speaker  50:37
Exactly. The doctor says
Unknown Speaker  50:40
that’s something only only doctors will understand. graham crackers, cranberry apple and ginger ale.
Unknown Speaker  50:56
Thank you so much.
Unknown Speaker  50:58
That was Dr. Bradley. Lock at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest, send a message or post a comment.
Transcribed by https://otter.ai

Helping Doctors Heal the World Through Coaching

Dr. Dianne Ansari-Winn had her own battles with burnout until she turned to a physician coach, then became a coach and now teaches coaches.  There are executive coaches, sales coaches, tennis coaches, but until recently, not many physician coaches.  With the increase in physicians dissatisfied and unfulfilled by their careers, the “physician coach” is responding.  Dr. Dianne and I discuss why our field has been slow to realize the importance of coaching, her five-step physician vitality recovery system, some of the most common issues she encounters as a coach and I even get a free mini-coaching session!

http://www.dianneansari-winn.com

Please see the above link to learn more about her coaching and be sure to check out her podcast, The Doctor’s Life.

Bad words: why language counts when discussing weight with our patients

A few months ago, there was a HuffPost article entitled “Everything You Know About Obesity is Wrong,” by Michael Hobbes.  It discussed the struggles of people who have obesity and how the medical system has failed them.  It quoted Stephanie Sogg, PhD, a clinical psychologist at the Weight Center at MGH (notice how it isn’t called the “weight loss center”).  In it, Dr. Sogg describes her approach as “being nicer to her patients than they are to themselves.”

Given that this article lambasted physicians for not being able to effectively discuss weight issues with their patients, I contacted Dr. Sogg to find out how we can improve at this.  She provided me with an article she wrote.  This article should be read by EVERY CLINICIAN IN THE COUNTRY.  It is that powerful and important.

In the episode title, I paraphrased an article she wrote entitled, “Bad words: why language counts in our work with bariatric patients.” In it, Dr. Sogg explains how language can influence they way that we think about things.  As physicians, we are authority figures and community leaders, so thereby, the language we use can influence how our patients think about themselves and our colleagues think about their patients, for better or for worse.  This isn’t a discussion on how to lose weight.  This is a discussion on how to effectively discuss a topic that is extraordinarily sensitive and full of landmines.  This is a discussion on how to avoid those landmines and earn the trust of a patient who is struggling and could use your empathy and understanding.

The article that lambasted physicians:

https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/

Her article “Bad Words: why language counts in our work with bariatric patients”

https://www.sciencedirect.com/science/article/pii/S1550728918300285

Dr. Sogg:

https://www.extension.harvard.edu/faculty-directory/stephanie-sogg

https://www.massgeneral.org/doctors/doctor.aspx?id=18165

EPISODE TRANSCRIPT

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  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians where Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned while we were memorizing the Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. This podcast is intended for medical professionals. The information is to be used in the context of your own clinical judgment. 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 we’re speaking directly in your ears, this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention.
Unknown Speaker  0:57
On today’s episode, we have Dr. Stephanie sock a clinical psychologist at the weight Center at Mass General and an assistant professor in psychology at Harvard Medical School. We go through effective ways to discuss weight management with your patients. But make no mistake, this is not a discussion on how to lose weight. This is a discussion on effective ways to discuss weight, which carries with it stigmas from society and the house of medicine. This is hugely important for establishing rapport with your patients who are struggling with their weight and without rapport. Any advice is next to useless. We discussed the power and importance of language, what person first language is, why and how to avoid such terms as obese, more bid exercise polarizing terms like good and bad, and alternatives to the judgment laden question Why? Welcome back to the physicians guide to doctoring. We have a very special episode today. A few weeks ago, there was an article from the Huffington Post, circulating around Facebook among myself. Self and my physician friends, and it was titled, everything you know about obesity is wrong. And it was, in some ways lambasted the medical community for not knowing how to talk to patients if weight was an issue, and it gave many specific examples of patients who had had interactions with the medical community that were so negative, that they remembered it for four years, and it affected them in in severe ways. And so it really illustrated what the wrong way or the wrong way to talk to someone about this is, but the question for us as physicians is what is the right way. So I reached out to one of the PhDs who was quoted in the article, and she was kind enough to respond and agree to be on the podcast today to talk to us about How we can do that better how we can relate to those patients, it’s, it’s so easy to say something without even intending it to be heard a certain way, and the patient hears it that way. And suddenly, they’re alienated, and the entire relationship is destroyed. So we need to be very careful when we choose our words. And appropriately this this individual wrote an article called bad words about all the words that we tend to use that that we might think are okay to us, but as it turns out, are perceived very differently. So So on the podcast today we have Dr. Stephanie sugg, who is a clinical psychologist at the white Center at Mass General and an assistant professor of psychology at the Medical School. She’s also on the Executive Council for the American Society for metabolic and bariatric surgery. So, Dr. Solid thank you so much for For being on the podcast today.
Unknown Speaker  4:02
That’s my pleasure.
Unknown Speaker  4:05
So so the first thing that you mentioned in that article talks about the power of language how, how words can help shape our thoughts, can it can you speak to us a little about that?
Unknown Speaker  4:16
Yes. Well, I think that’s, that is a subject that’s really near and dear to my heart. It’s a part of every interaction that I have with every patient and also with colleagues as well. And as a clinical psychologist, my main tools are my word. But even going beyond sort of the clinician patient relationship, it’s really important to be considering the words that you’re using because we think in words and so the words that we choose shape how we think about things and that shapes our attitudes about things which ends up shaping Our behaviors are emotional responses to things. I think there’s there’s almost nothing more important than really being careful and thoughtful about the language that you’re using to convey the ideas and the sentiments that you’re trying to get across. Whether you’re speaking professionally speaking to patients, speaking to anybody really,
Unknown Speaker  5:23
and especially with with a vulnerable population like this, but as as an authority right there, they’re looking up to us. And so, these interactions are particularly important. So the, the language is important. And first establishing trust. I mean, myself. Exercises always been a priority in my life, right? And so I’m, I mean, it’s going to seem like a humble brag or whatever, it’s, I’m in good shape. And so it’s I think it’s sometimes challenging for the for me to connect with patients. That have issues that I’ve never encountered. So, so Can Can you talk about the importance of of choosing these, these words in in establishing trust? And and what can happen to an individual if that that trust is broken by someone in authority?
Unknown Speaker  6:23
Well, I think that if we’re specifically talking now about a population of patients who have obesity is, am I right in thinking that that’s the specific thing that we’re talking about right now?
Unknown Speaker  6:35
Exactly, exactly.
Unknown Speaker  6:36
So people with obesity and I, I’ve been in my current position for 15 years, and I have talked to thousands of patients who have obesity and there’s no one profile, no one type, everybody’s very different from everybody else. But there are some common experiences that I hear from many of my patients and Feelings of self blame are very, very strong. And part of the way that patients get to that feeling of self blame is that they’re given messages of self blame all the time. And they are coming into a medical situation, especially if they’re talking about their weight or talking about illnesses or medical conditions that are related to their way. Absolutely expecting to be blamed and shamed and you can sort of see people sort of emotionally cringing waiting for the recriminations, the scolding the instructions and ordering and to pile on to that one, when your patient is already very vulnerable to proceed. That in the interaction even if it’s not actually there. You know, it’s it’s very, it’s very important to be careful to avoid anything that is judging, blaming, shaming, scolding. It’s very unusual that somebody with obesity does not know that they have obesity. There are some studies showing that there are people out there who have BMI in the range of obesity, but don’t categorize themselves as such. But in general, people who have a high weight are acutely aware of that and are just sort of waiting to be called out about it. So being sensitive in your language and making statements or asking questions in a way that telegraph in a succinct way that you are not blaming them and not shaming them and that you’re here to understand what’s happening with them and do what you can How, right from the very beginning and the interaction is crucial.
Unknown Speaker  9:07
So what you’re saying is they come into this thinking that they’ve done something wrong, almost that, that they might even deserve to be this way and are waiting for the doctor to validate what they’re expecting them to say. And so should we, should we put that out in the open and say things like, this isn’t your fault? I, you know, how do I other than trying to avoid saying something that makes it seem that I’m implying that it’s their fault. Do you think there’s any advantage to just putting that out there and saying there are circumstances that are not in your control that have led to this issue and we can help you But you have to recognize that this isn’t your fault. Is that mean? Is that the type of thing that we should be saying?
Unknown Speaker  10:06
I think if you read with this isn’t your fault, it comes across as a bit hollow or goodwill hunting. That’s what I thought. Yeah, that’s what there’s a ways to communicate that without sort of putting it out there, so baldly. I, I actually do this more at the end of the interview once I have more information from them. But I’ll at the towards the end of the interview, I will ask the patient to tell me, what do you think has been the major contributors to your weight? And it’s very interesting how few of them say, I was played on a depot, Primavera shot and I gained 60 pounds or I, you know, I had an injury and was laid up for Six months, or I think its genetic, because everyone in my family has obesity. The most common answer to that is me. I’m lazy. I eat too much. And so I will take that opportunity to gently say, you know, I’m I’m thinking that there may be some things that you haven’t mentioned. You remember 10 minutes ago when you told me that both of your parents had obesity and that three out of your four siblings have obesity? Do you think it’s possible that genetics are playing a role, or sometimes people have medical conditions that they don’t realize are contributing polycystic ovarian syndrome makes it very easy to gain weight and very difficult to lose weight. And many of my women patients who have PCs when I asked them what contributed to their obesity, they leave that out. And often they didn’t even no one even ever told them that this was a contributor or patients who have diabetes who are on in One don’t recognize and and haven’t really been educated that once you go on insulin, it is really easy to gain weight. And it’s really hard to lose weight. So pointing those things out to patients in a sort of educational way, directly give them the message that you’re blaming them less than they’re blaming themselves. I do want to say it’s important to also acknowledge if there are other contributors that are within the patient’s control that could be contributing, because it’s important to address all of the contributors and I’ve really almost never seen any cases of obesity where it was one major contributor that the person just ate too much. And that was it or they just didn’t exercise and that was it. Usually, there’s a number of things some of which are controllable and not which are and orienting the patient to the approach that we’re going Look at all of the things and we’re going to treat them all equally, and we’re not going to judge any of them. But look at them as contributors that we could potentially address together. That’s where a sense of trust and a feeling of not being judged, comes.
Unknown Speaker  13:16
So you’re not completely absolving them of responsibility because I can almost feel some of the doctors listening thinking that like, you can’t just take away all of the personal responsibility there is there has to be an element of personal responsibility. But at the same time, there are a lot more people that have obesity now than there were 20 years ago. And it’s not because there are now many more people who are weak willed than there were 20 years ago. There are external factors that are out of their control that are increasing the likelihood that this is going to be a problem for for For more people, so we have to address those external factors, and that they can account for, as well as addressing some of the internal factors you have to. So what you’re saying is, rather than this is your fault, this isn’t your fault. Where is this coming from? There are certain things that we can control and certain things that we can’t control. Let’s see what we can do about the things that we can control.
Unknown Speaker  14:28
Exactly. And I would also know that to give a patient the message that all you know that the obesity is being driven by things that cannot be controlled, is equally damaging. And I have had patients who, when they’re get when they get the message that there’s there’s biological, genetic and other factors that are contributing, and it isn’t their fault. What they hear is, it’s hopeless, nothing can be done. And that’s very discouraging, also. So you, you really want to get away from what do we blame for this too, let’s look at all the contributors and try to sort out the ones that we can and and don’t get down on yourself about the ones that can’t be controlled. Not that they should get down on themselves about the things that can be controlled, because that doesn’t help them control those things, either. But really looking at, let’s understand the factors contributing,
Unknown Speaker  15:28
you come up with a strategy, you lay it out, lay lay it out there, this is what these are all the things that are contributing, this is what we can do about the ones that we can control. And let’s let’s get to work on that. That that that sounds realistic, and reasonable, and something that that we can do to change how we discuss that in the office rather than just, you know, one some one size fits all because sometimes what happens is People come in and say, Well, what do you think about the ketogenic diet? What do you think about going to CrossFit? What do you think about this? And the answer is, well, it’s a whole lot more complicated in that than that, that that it’s never going to be that simple. So we have to talk about everything.
Unknown Speaker  16:24
Absolutely. And because every person with obesity has different kinds of contributors, contributing in different proportions, there isn’t one treatment that’s going to work for everybody. So the doctor that puts everyone on the Mediterranean diet or the person that is just always prescribing the same medication or sort of touting CrossFit everybody that’s that’s not gonna work. You need it. Obesity is a multifactorial condition and you need an arsenal of Lots of different kinds of approaches.
Unknown Speaker  17:03
So that is actually going to be one thing that we talked about in the pre interview is what those approaches are is a podcast episode unto itself. Oh, yeah. Many. What we’re talking about today is choosing your language carefully. That’s, that’s all we’re going to talk about today. So if you’re, if you’re, if you’re waiting with bated breath with the right diet to recommend to everybody clearly, that’s not what you’re going to be finding here or, or in the future. Or actually everywhere because that information is everywhere, and they’re all trying to sell something. Yeah. Yeah. So I think it’s interesting the way you’re you’re phrasing something in particular, you’re saying that patients have obesity. You’re not saying obese patients. You’re saying patients have obesity KK You talk about why you’re phrasing it that way.
Unknown Speaker  18:03
Yes. So, there’s a concept in healthcare I’m guessing that your listeners are familiar with this concept from from other areas of medicine of person first language, where instead of saying a diabetic patient or worse a diabetic, like this person is the adjective you are talking about the person as having the condition or attribute in question, and I think I would emphasize condition over attributes, especially here in the realm of obesity. Obesity is now recognized by the AMA as being disease. It is a medical condition that is characterized by having an amount Or proportion of body fat that is known to pose risks to a person’s health and be associated with. Many, many people talk about comorbidities, but a colleague of mine talks about complication of obesity, because these illnesses don’t just happen at the same time or happen with it, but are directly caused by obesity. So, I think that talking about somebody as being obese, that’s an adjective, you’re equating the person with the condition, instead of talking about the person having the condition and you’re separating the person from their condition. There’s a great quote from an article that was published in the journal obesity. And the authors are Ted Kyle and Rebecca pool, or it might be Rebecca bull and Ted Kyle. I, I’m sorry, I don’t remember what the order of authorship was. But they say the beef is an identity. Obesity is a disease. And that’s the most profitable way. And I don’t mean profitable in the sense of money but productive and effective way to be thinking about obesity.
Unknown Speaker  20:15
The word obesity has such negative connotations already, that to turn it into an adjective that you’re equating with the person makes it much worse. And that also gets back to what you said at the beginning about the power of language. Because if you as the physician are talking about your obese patient, in your mind, inadvertently, you’re going to be equating the patient with their illness and attributing things that you would attribute to someone with obesity, right, a lot of the stigma is right, individual and and changes the way you think about that person. But if you can separate them in your language, that it can work to separate them and your thoughts and again, because you’re that authority If you discuss it with them that way, it can help them to start thinking about it differently as well.
Unknown Speaker  21:08
Absolutely. And your column and to model that for your colleagues as well. Yeah.
Unknown Speaker  21:17
Because you’re going to have plenty of colleagues that that don’t necessarily put as much gravity into something like this. Well, you know, it’s they, if they’re not motivated enough, then I’m not I’m not going to try I made my recommendations they can choose to do with them what they will. So for those individuals, if you start speaking about it differently, you can kind of you can have this subliminal effect on possibly how they they think about the topic as well.
Unknown Speaker  21:46
Exactly, exactly.
Unknown Speaker  21:48
What about the word obese? We had talked about that article. What’s in a name? People that have obesity. How does They prefer what what are the words that they prefer to hear from us?
Unknown Speaker  22:06
Yeah, so there was a great study done many years ago now and sort of variations of it had been replicated in different populations and younger people, and with parents of kids who have obesity, where it looks at what what people’s responses are to various words that might get used by a provider to talk about weight. And, you know, which will rate them up front on a scale of really negative to neutral to positive and obesity is one of the and I would say probably more the adjectival form of that obese is one of the words that patients sort of despise the most because it carries a lot of baggage with it. I think there’s an argument to be made in the Modeling to patients by using the word obesity as a medical diagnosis and a medical condition and always using it in a person first way, always using it in the noun form and out of the title form. But even then patients can be sensitive to it. Patients, you know greatly prefer things that are more neutral like your weight, or your BMI, your body mass index. I think a lot of people these days know what the body mass index is. I’m not sure that everyone knows how it’s calculated or why we have that measurements or what’s the kind of cut offs are for BMI is and which BMI is would be in the range of obesity versus healthy weight, etc. and another word that is sometimes uses fatness That one’s not very popular with patients. fat and fat net gentlemen Why they shouldn’t do the show should be avoided. Even things like unhealthy weight are preferred to obesity. I will sometimes talk about when I’m getting a history of someone’s weight, I’ll say, you know, when was your weight first over the healthy range? Or when did you first become concerned about your weight? And when I’m asking about family history of obesity, I usually don’t say, you know, Did either of your parents have obesity? I’ll say did Did either of your parents have a high weight? Or I will, when I’m talking to kids, and I will ask them sort of to tell me what what they like and don’t like about their way I’ll say, what are some of the things that you are good or that you like about being your size? And what are some of the things you don’t like about being your side, very little kids sometimes think I mean their height so that can be
Unknown Speaker  24:59
very Young Children sometimes get confused by that.
Unknown Speaker  25:03
But just using language that sensitive, but also not completely shying away from the word obesity, if you’re using it in a way that is clearly positioning it as a medical condition that you are treating the patient for, rather than judging the patient about
Unknown Speaker  25:19
for some of the doctors that might not be used to thinking about it this way, these patients are reminded many, many times a day, about their weight. It’s not like you are never the first person to bring this like you said at the beginning of August. You’re never the first person to bring this to their attention. This is something that they’re that they’re very cognizant about and they’re constantly reminded of and so it’s, you know, saying something like, you know, when did you start realizing that your weight might be a problem? You can very easily phrase something like that rather than saying, When did you become obese? Or what did you mean? When did you When were you diagnosed? Because they don’t need to be reminded of
Unknown Speaker  26:06
it. They know it happened. Yeah, they had 24 hours a day. Maybe not when they’re sleeping, but people are conscious and they’re made conscious of it all the time. Yeah. But I will say that the one the one permutation of the word obesity that I strongly suggest avoiding completely is the term morbid obesity, which is it’s a it’s a medical term, right? It’s accepted medical terminology. The term morbid obesity technically simply means that the person’s weight is causing harm to their health. Although it often gets used to simply signal the severity of the obesity which technically isn’t correct. If you have somebody who has very severe obesity, their BMI is 60. But they don’t have any health. condition technically wouldn’t quite be correct to call that morbid obesity because there isn’t morbidity there. At least there’s not Yeah. And, and there’s also a terrible term that is used sometimes in in my field and in articles that I read super obesity, or sometimes super super obesity was just to me it sounds it just sounds terrible. But there is a classification system class one class to class three work class one is a BMI between 30 and 34.9. And class two is between 35 and 39.9 am class three is BMI of 40 and above and there’s even class three a class three B class three C, and I actually don’t remember what those are. But that is not judging the way more of it is. But you can also talk about perhaps, severe obesity, which does if you want to be emphasizing greed of the condition, then you can say, severe to mean the BMI is, you know, particularly high or what have you. But morbid obesity doesn’t really serve much of a purpose. And it and if you think about what the Latin root is for the word morbid, it’s associated with death and dying, right? That’s, it’s not particularly helpful when you’re talking to patients. And I would say it doesn’t really add much incremental information or usefulness in professional dialogue either.
Unknown Speaker  28:34
I think words like that might have a role in a scientific study, if you are, but then the classes then take the place of morbid obesity. If you’re studying a group with a BMI greater than 40 or greater than 45 or greater than 50. Fine, you need you you might decide to use a term to classify those those individuals, but when you’re speaking to an individual patient, I don’t really see the role of adding that modifier of merit, or even severe obesity, right? It’s not like they don’t recognize the severity of the problem because of what they’re experiencing, they know that it is severe. And then but driving more attention to it, I don’t think is of any benefit to them. Because right, that’s even more of a stigma they’re going to make, it’s going to make them feel even worse about it. They’re going to internalize that, and, and it could really put them on on a bad path. So I would even argue that not even modifying it at all, outside of a scientific study, when you’re doing you’re discussing it with the patient themselves,
Unknown Speaker  29:41
right. And even in the scientific study, there’s no need for the word more but there’s other terminology that can be used. That’s actually more precise. So
Unknown Speaker  29:54
there was a the next part of the article talks about good versus bad, and my My sister in law she’s listening is a pastry chef, and was trying to convince me that dark chocolate is good for you. And as a doctor, I see it as it’s candy. No, it’s bad for you. But your point in the article is that we’re both wrong. So can you you elaborate on that and how that applies to the good versus bad and how that applies to our word choice.
Unknown Speaker  30:30
Yeah, I mean, this is something that I harp on so much with my patients that they learn to kind of pets themselves and self correct. Mid sentence when they’re talking to me. I really advise patients to avoid thinking about certain foods as being good or bad. The problem with good or bad is that that is a clear dichotomy. Those two things are mutually exclusive. They’re categorical. And so you only have two choices either something Good or bad. And if you’re talking about food, and you think of certain foods as being bad, and you shouldn’t have them, well, that may help you not eat them or eat less of them for a while, but eventually you’re going to end up eating these things. Because the things that patients say are bad foods, those are actually delicious. What I would call good food, right, you’re going to end up eating food like that that’s a part of life. It’s an important part of life, to sometimes have the foods that are higher in calories and fat and sugar. But the problem is that if you think of certain foods as being bad, and then you have some of that food, your it’s an all or nothing proposition and you’re going to feel like you blew it, you’re going to conclude that you have no self control, and our beliefs about ourselves, very solid, continue to determine our behavior. If you believe you have no control. If you believe that you’ve blown it, you’re going to behave in a way that make sense if you’re thinking that way, you’re going to say, well, doesn’t matter, I blew it might as well, you know, quite literally in for a penny in for a pound. And that that kind of dichotomy of thinking is it’s part of the human condition, the human brain has evolved to think in terms because it’s quicker and usually more efficient. But it also then lends itself to some negative side effects. And this all or nothing good, bad the economy can be really problematic. So, you know, when I a patient something like a when I eat something bad and I say, Well, what do you mean by bad? And they’ll say, oh, like brownies, I’ll say brownies are bad, they’re good. They’re not. If you have a lot of them, they’re not good for your health. But I tell patients to try to reserve the word bad for foods that tastes bad or have gone bad or are poisonous. And They’re right in thinking they shouldn’t eat any of those foods. Don’t eat foods that taste bad, certainly don’t eat food that’s gone bad or the poison. But everything else it’s a matter of is it more healthy or less healthy, even dark chocolate, even milk chocolate, you know, occasionally, that’s something that’s an enjoyable treat, and we shouldn’t think that is bad and you should never eat. And there’s also other foods that that more more clearly illustrate this. Avocado, right? And we actually talked about avocado is being high in good fats, there’s some fats that are actually helpful for your health. If you eat tons of avocado, then you’re going to be taking in more fat and more calories than is good for your health. nut, peanut butter. Nuts are incredibly high in protein. They’re high in fiber, they make you feel full. These are you know, these are foods that in moderation are quite healthy for you. If you eat lots of them. It’s going to have an adverse impact. On your health and on your way. So if you can’t really say if food is good or food is bad, unless you’re talking about how it tastes, then I’m fine with it. And and patients also use those words to describe their own behavior. So they’ll say I had a bad week or I was bad. And I always really jump on that and request that they restate that in a more objective way by simply describing what happened without judging it. I ate McDonald’s four times last week, we don’t have to call that good or bad. We can say that was three more times than you intended or three more times than they would have liked. But just calling it bad. Not only doesn’t help but it kind of gets in the way. Because if you’re feeling crummy about yourself, eating in a healthy way and maintaining that indefinitely, which is what all of us have to do to maintain a healthy weight or try to control our weight, that’s hard. It takes a huge amount of emotional energy. And if you’re using up a lot of that energy, by feeling crummy about yourself You’re not going to have a lot of energy left over to be taking care of yourself and doing these difficult things that are required to manage your weight and your health.
Unknown Speaker  35:09
And I think that even circles back to something we were talking about earlier, right? The the personal responsibility, and you know, this is your fault. This is this is not your fault. If they’re saying things that are negative about themselves, that then shapes their thoughts, they internalize it, they feel even worse about themselves and then then they end up you know, you it’s very hard to get out of that hole.
Unknown Speaker  35:35
Absolutely. And, and I one thing that I would bring in here is that there’s a very prominent concept in psychology called self efficacy, and I don’t know if that’s something that is, is featured in physician training. But self efficacy is a concept that was the term was coined by a psychologist named Albert Pandora. It is exactly what it sounds like. It means have your own beliefs about whether you are capable of doing something. And it turns out that research very robustly shows that the best predictor of whether somebody performs an intended or desired behavior or reaches a goal, the biggest determinant of that is their self efficacy, whether they believe they can do it or not. So if people are developing these beliefs about themselves that they can’t control themselves, they have the willpower. They’re lazy, that is going to impede self efficacy and it’s actually going to create a major barrier to making change.
Unknown Speaker  36:48
I think I think it was America. Ferrara had written an op ed in the New York Times a couple of years ago about training for the New York City Marathon. And when she was training her coach, right, because she’s a movie star. So she has a coach to help her the marathon. Her coach said something about the thoughts in her head, like something relating to what is going on in your head. What are you telling yourself that’s preventing you from from doing this? And apparently, you know her, she was telling herself that she couldn’t do this. Who she, Oscar, she shouldn’t be here. Who does she think she is trying to run a marathon. She can’t do something like that. That’s not who she is. And once he helped her get past that, then it was like a weight had been lifted off of her shoulders. And so it was the negative thoughts that she was telling herself about herself that were really holding herself back. So any way that we as physicians can help our patients without, like you said, The Good Will Hunting moment. It’s not your fault. It’s not your fault, right without being too saccharin about it. anything that we can do to help our patients think more powerful. positively about themselves are going to help them for that reason.
Unknown Speaker  38:05
But not not just generally more positively. It’s not a you know. But yeah, beliefs about their capabilities. And again, it would be a whole different podcast episode to talk about ways that you can approach helping patients with behavior change that foster higher self advocacy and more success. That’s a different podcast.
Unknown Speaker  38:31
But I think something simple like just catching them when they are saying some negative attributes of themselves. It can be as simple as that, right? Like, I’m so stupid. I showed up late for another appointment right? catching them when they do something like that. I don’t mean you’re, you’re good enough. You’re smart enough and Gosh, darn it, people like you. I mean, just catching something simple like catching them. When they do say something negative, or attribute, give themselves a negative attribute. To to help the right.
Unknown Speaker  39:02
reframe, right. I mean, I, I had a moment like that last week that a patient was trying to show me something on her iPhone and couldn’t figure out how to make the phone do what she wanted to do. And she said, dummy to herself. And then she showed me whatever it was, and I, you know, I said, You know, I want to take a moment and look at at something that you just said that you you. You couldn’t do this thing on the phone and you called yourself a dummy. And I was really struck by that. And you know, I’m wondering what you would do if some somebody else called you a dummy. Would you put up with it? Or would you if a friend of yours was struggling with her phone? Would you call her a dummy? No, why not? Well, that’s really mean it’s not fair. And helping people to notice these patterns of internet Oh, I was just making a joke and I think No, but that, you know, that was the word that you use. And it gives us a little bit of insight on how you’re thinking about yourself. So, you know, I really harp on language a lot, but not yet I try to make it clear that I’m not being pedantic and I explain to patients why I’m, you know, being so vigilant about language and the difference that it makes. And I find that it’s very effective and that it makes a big difference. I think there’s there’s another piece here to looking at overall, all of the different things we can do to avoid making patients feel blamed and shamed and scolded, which is the concept of weight bias, which you kind of alluded to earlier that there is a pervasive bias about people and stereotypes about people who have a high weight or who have obesity, that they’re lazy, that they’re not as smart that they don’t have self control. And what’s Interesting and the research about this is that most stigmatized group, members of those groups don’t also believe me stigmatizing ideas about themselves. But people with obesity are pretty much the only stigmatized out group that also holds stigmatizing beliefs about people with obesity with their same condition. And this is challenging and worrisome for a lot of reasons. But there’s a new line of research and more and more as being contributed to this body of knowledge, all the time looking at internalized weight bias. So, how much does the person stigmatize themselves because of their weight and believe various biases about people with obesity and themselves and it turns out, that being subjected to wait by us from other people, is actually less damaging than if you’ve internalized the weight bias and internalized weight bias is being found to be associated with all kinds of adverse mental and physical health outcomes, that it’s related to eating disorder pathology, it’s related to cardio metabolic risk factors that people with internalized weight bias are at more risk for having these cardio metabolic risk factors and depression and all kinds of other you know, very adverse outcomes. So anything we can do to not only not subject people to weight bias, but to try to model and elicit a change in someone’s own internalized weight bias. Is, is really important.
Unknown Speaker  42:54
Sounds like there are a lot of powerful opportunities there for that will be little Take advantage of
Unknown Speaker  43:01
Yes, I think of especially the first meeting with a patient is being full of lots of opportunities for what I actually have a I call the mini interventions were just the way you phrase a question or little bits of education and information can be very, very powerful.
Unknown Speaker  43:22
And so we’re kind of running short on time now. So there were two more issues that that I wanted to discuss. And one of them is exercise. What is the one exercise that you tell all of your patients to do? Clearly, that’s not recommending here, but exercise among certain circles is considered a four letter word. Right? So some people love to exercise some people don’t. So clearly, it has health benefits, one of which may not be weight loss. So first, can you can you can you men, Can you discuss that and too, how is it that you do discuss exercise? And was giveaway answer that you just exercise with your patients. So
Unknown Speaker  44:08
I’ll start I’ll start there and say that I almost never use the word exercise with patients if you think about it, and for people who are listening right now, when I say the word exercise, think about what picture immediately comes into your mind. Some of you may have wonderful, happy pictures coming into your mind. But even though I’m someone who does physical activity six days a week, when I hear the word exercise, I imagine my miserable experiences in gym class not being able to climb up the rope or having to run laps, or, you know, whatever it is, people have
Unknown Speaker  44:49
very many getting picked last frickin right.
Unknown Speaker  44:51
Well, uh, certainly or being first out in dodgeball or you know, whatever it is. But people have various There’s a lot of negative baggage and connotation to the word exercise. And and people think of exercise in a really circumscribed way they think of it as something that has to be hard and unpleasant. And that you’re sweating a lot or that it’s painful and that whole No pain, no gain thing. So I refer to exercise almost exclusively as physical activity. Because, first of all, you get away from the painful connotations of what exercise is. And second of all, you’re just by using that phrase, you’re opening up the menu of things that people can do. That will get them moving, you know, rev up their heart rate, burn calories, make them stronger. You know, a patient will one of my patients, walks a half an hour to and from the office. Every JY say what are you doing for physical activity? They say nothing. And then they say, Well, except I just I walk to and from work well, they’re walking an hour a day I said, let’s just go activity, we’re when we’re trying to find ways of increasing physical activity, looking at things that can be done that might be enjoyable, or at least not miserable. So a lot of people feel I’m not going to run. I’m not going jog. And I say, you don’t have to run running that required running is actually very hard on your body. And if you don’t love it, absolutely don’t do it. Let’s find something that you find pleasant. So I often prescribe 20 minutes daily dance parties for my patients and their partners and my patients and their children. And I have a patient who her son is putting together a playlist for her to do and there. He’s making them an increasing length, but he’s putting together a list of songs that she can dance around the house to, by herself or with him. That’s fun. And people don’t think of that as being exercise. But if you’re moving around and your heart rates going, and you’re sweating, just because it’s fun doesn’t make it not exercise. So our I talked about, you know, instead of driving five minutes to the store, walk 20 minutes to the store, that’s physical activity. So it broadens the realm of things that can be done and include things that might be fun or enjoyable, or at least not miserable.
Unknown Speaker  47:27
So we tend to, we tend to be very prescriptive about exercise, right? You have to do it this number of days a week, your heart rate needs to get this above this amount. It needs to be for this period of time. And the fact of the matter is, if you tell your patients to do that, they’re not going to do it. And that helps them exactly, exactly. So maybe additional benefits to raise your heart rate rate past x are doing it X number of times a week for x period of time, should probably have different variables than just x but we should stop being so pretty scripted and work from their current, why, and go to y plus one. So we take what they’re currently doing. And one, allow them to recognize that they’re doing it. And that should be something that they can internalize is something positive. Oh, I thought of myself as such a lazy person. But now you’re telling me because I walk an hour a day, maybe I’m not that that lazy, maybe I’m not this lazy person, maybe I am an active person. And if they start thinking of themselves differently, and I think that even gets to like Carol Dweck, mindset research about, you know, changing, changing their mindset. I am an active person and I can be more active.
Unknown Speaker  48:50
Definitely. And I think going from not saying okay, the guidelines for weight loss are and they actually are that you should do 300 minutes of aerobic activity per That’s detail that told it to almost anybody. And it just sounds like impossible. Certainly anybody who’s got a life who’s got a job, who’s got a partner, kid. That’s a lot of time. But if you simply talk about what are you doing now? What, in what way? Could we increase it beyond what you’re doing now and just sort of progressively increase it? Again, I think we’re getting into territory where it’s a whole different podcasts about behavior change and SMART goal setting which I’m happy to talk about it another time. But I think that starting off with the language that you’re using and talking about physical activity and what activities could be done that are enjoyable or at least tolerable, rather than saying you need to exercise more people know they need to exercise more, they’re not going to thank you for telling them that and telling them that it’s not going to make them
Unknown Speaker  49:50
do it. And what I find with my patients is that is often the first thing that they say like a defensive Well, you know, I don’t have any time to exercise. And then being able to reframe that, I think is very helpful. And the other the other is, which is something that we’ve discussed before is not saying something like, Well, why aren’t you more physically active or why aren’t you exercise?
Unknown Speaker  50:23
What do you what are you doing for physical activity? Nothing, why not? That is, that is the wrong way to ask about it because it is certainly overtly sounds judgmental, why not? And it puts the patient on the defensive and they feel the need to be giving excuses. And it’s interesting because so the way I asked about this is not why not. I say what gets in the way and I Choose those words very deliberately. Because just by asking the question in that way, you’re acknowledging that are things that get in the way. And that they’re not just being ludicrously lazy. By not being active. There’s reasons why they’re not active. And so I will say what gets in the way. And very, very often, the patient will call me I’m lazy. And I’m usually very much able, by that point, to counter the patient and to point out evidence, some things I’ve already learned about them in the interview, to show that they’re not lazy. They’re working three jobs plus raising kids on their own or, you know, they, you know, they’re they have earned a bachelor’s degree going to night school or, you know, things that clearly indicate that they’re not lazy. And I say, Well, you know what, a lot of people come in here and try to tell me they’re lazy, but the fact is, here’s the evidence that you’re not lazy. And and in fact, if I just accept that you’re lazy, that really doesn’t get anywhere. That doesn’t, that doesn’t get us anywhere, because there’s not much that we can do about that. But instead, if we take a look at what the reasons are, so a lot of his patients will a patient will say, Well, I don’t really have a lot of time, but I know that’s just an excuse. And I’ll say, Listen, you know what, I don’t think about this in terms of excuses, or good reasons or bad reasons. I simply look at reasons and whatever the reasons are understanding the reasons that you aren’t doing more physical activity will point us to the right intervention to help you increase it. And, you know, like, I had one patient who initially it looks like the reason she wasn’t doing any physical activity was that she was too busy, but in fact, the real reason she wasn’t doing it is that she found it really boring. And if we were able to find something that she found engaging, that was something she felt she could make time for. So really understanding the reasons and not judging the reasons as being valid or not. But if someone said, I don’t go to my gym, because someone died in there, and now I think it’s I wouldn’t say well, that’s ridiculous. Just go to the gym I say, all right, well, let’s, could we get a priest in there to do an exorcism? Or, or a more parsimonious solution might be to find a different team or to do some stuff at home or outside walking around in your neighborhood instead of going to that gym instead of getting caught up in back a dumb reason. Okay, that’s the reason what do we do about it? You know,
Unknown Speaker  53:46
that seems a pretty good way to alienate your patient lately.
Unknown Speaker  53:49
I had a patient who had a real phobia, he had bad asthma. And so he was really convinced that if he did any physical activity, he’d have a asthma attack and die. And he walked around everywhere with for asthma inhalers on him like a backup to the backup to the backup. And this was such a such an extreme fear really was it really met the definition of a phobia. And I actually sent him for cognitive behavioral therapy to address the phobia. And I wasn’t going to say, Look, your doctor said, You’re fine, you’re pulling all this and you’re fine. Just go do it. He had a phobia. So we address that. So why doesn’t help. But if you ask, what are the barriers, what’s getting in the way that leads you and the patient together to a solution for that’s a much more productive way to be having a dialogue about it.
Unknown Speaker  54:43
Well, this was really a very comprehensive talk, and we didn’t even get into effective methods for for weight loss. As we knew we were going to it’s just the topic of how to even have that conversations. So there are many wrong ways to do it. But I think this was a great, great in depth detailed look at how to do it most effectively. So I really appreciate you taking the time to talk to us and help us have these difficult conversations more effectively. Is there anything else that you want to mention before we close the conversation? Well, I think
Unknown Speaker  55:25
that there’s dozens of other things that could be said, but I think, you know, this, this was a pretty good sampling and and thanks for for being such a good guy through these topics and being so interested. I’m always thrilled when someone cares about these things and want to learn more. So that’s
Unknown Speaker  55:42
wonderful. So thank you so much for for taking the time. Thank you. It has been a pleasure.
Unknown Speaker  55:49
Alright, have a good night. That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts or wherever you get your point. gasps and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest, send a message or post a comment.
Transcribed by https://otter.ai

Bad words: why language counts when discussing weight with our patients

A few months ago, there was a HuffPost article entitled “Everything You Know About Obesity is Wrong,” by Michael Hobbes.  It discussed the struggles of people who have obesity and how the medical system has failed them.  It quoted Stephanie Sogg, PhD, a clinical psychologist at the Weight Center at MGH (notice how it isn’t called the “weight loss center”).  In it, Dr. Sogg describes her approach as “being nicer to her patients than they are to themselves.”

Given that this article lambasted physicians for not being able to effectively discuss weight issues with their patients, I contacted Dr. Sogg to find out how we can improve at this.  She provided me with an article she wrote.  This article should be read by EVERY CLINICIAN IN THE COUNTRY.  It is that powerful and important.

In the episode title, I paraphrased an article she wrote entitled, “Bad words: why language counts in our work with bariatric patients.” In it, Dr. Sogg explains how language can influence they way that we think about things.  As physicians, we are authority figures and community leaders, so thereby, the language we use can influence how our patients think about themselves and our colleagues think about their patients, for better or for worse.  This isn’t a discussion on how to lose weight.  This is a discussion on how to effectively discuss a topic that is extraordinarily sensitive and full of landmines.  This is a discussion on how to avoid those landmines and earn the trust of a patient who is struggling and could use your empathy and understanding.

The article that lambasted physicians: 

https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/

Her article “Bad Words: why language counts in our work with bariatric patients”

https://www.sciencedirect.com/science/article/pii/S1550728918300285

Dr. Sogg:

https://www.extension.harvard.edu/faculty-directory/stephanie-sogg

https://www.massgeneral.org/doctors/doctor.aspx?id=18165

Social Media Part Deux: Doctoring in the Blog-o-sphere

Dr. Dana Corriel is known to some as the godmother of doctors on social media.  This all started with her personal blog, which she created for creative catharsis and to help inform patients on a larger scale than the 1:1 office visits.  She now manages a multiple facebook communities and has a presence on almost all social media platforms.  We discuss the hows and whys of being a doctor on social media with “one of the top 10 internists to follow on Twitter.”

One of her tips: a consistent screen name.  She can be found as drcorriel on ALL PLATFORMS!  Website, Twitter, Facebook, and Instagram.

She is the administrator and creator of

https://doctorsonsocialmedia.com

https://www.facebook.com/groups/medicineconnect

https://www.facebook.com/groups/somedocs

EPISODE TRANSCRIPT

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  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. We’re Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned 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 and lawyers.
Unknown Speaker  0:26
On today’s episode, we have Dr. Donna Correale spelled Da na. She can be found as Dr. Corey LO on all social media platforms including Twitter, Instagram, Facebook, LinkedIn. This all started with a blog at Dr. Corey l calm and when she started blogging, it wasn’t even medical at the beginning. She’s a talented and prolific writer, and we discuss the ins and outs and advantages of blogging as a physician, the importance of having a social media presence and how she started a rapidly expanding Facebook community for him by doctors on social media called doctors on social media. Welcome back to the physicians guide to doctoring. On today’s episode we have Dr. Donna Corey L of Dr. Corey L. Calm among other social media platforms. She is the godmother of social media docs, she created a Facebook platform where physicians on social media can communicate with each other, and bounce ideas off each other, which serves to amplify our voices. But this wasn’t her first foray into social media. She’s actually a prolific blogger, and has a very active Twitter account. So Dr. Corey, l. Thank you so much for being on the show today. Sure. And thank you for having me. First, can you tell us a bit about your training?
Unknown Speaker  1:42
Yes. I was raised in I was born in Israel I was raised in in LA, right in the outskirts of LA and a place called walnut. I got my bachelor’s of science from UCLA in neuroscience and Then I went to medical school at Sackler at Tel Aviv University Sackler back in Israel where I was born, came back to New York to, to train in residency at Albert Einstein University Medical Center, Montefiore Medical Center, and finished up internal medicine there. I got my first job at Mount Sinai in New York City, I worked for the World Trade Center medical monitoring and treatment program. And shortly thereafter, at least five years later, I decided to stay home to the mother of my three children, my three boys, I became a mother during my internship year of residency, and that’s when I started to blog.
Unknown Speaker  2:46
And what were you blogging about at the time?
Unknown Speaker  2:48
That’s a great question. You know, I didn’t start out in a medical blog. Actually, I started out extremely creative. The three years that I took off four years of self discovery, there were years that I I sort of discovered things about myself that I never knew I had these talents. I started to love creating with my hands, I would entertain. I learned how to cook to bake to decorate to refinish vintage pieces and things like that. And my first blog was actually called snapshot of a lot of the day. I named it sort of out of the box just for fun. I thought it was a fun title. And I could sort of blog about everyday life. I basically had a blog when I was at home and it was called snapshot of a lot of day it was just about everyday life. And then when I went back to medicine after the three years off, I decided to start incorporating medical care. I saw I actually saw the connections that I was making behind the closed exam room door and I decided to take it out to the real world so that more patients could benefit from the exchanges that I had one on one I’m on a more virtual space and I’m in a bigger space. And that’s where I started to incorporate medicine into my blog.
Unknown Speaker  4:06
So if I’m understanding, and to me, this is also some of the idea behind why I have this podcast because I find myself saying the same things to patients over and over and over. And as a specialist, I think it would be beneficial to other people outside of my specialty to hear those things because they might learn something that they otherwise wouldn’t know where, for me, it doesn’t require me to do a lot of, you know, I don’t have to put together a PowerPoint presentation or do some research to just to be able to speak on a topic, because it’s the same, you know, sending the same thing over and over. So you’re saying, that’s what you’re doing for your patients because you end up telling them the same things over and over. Why not just make this more accessible online in a blog format so that you can resonate with more People at the same time is that which was?
Unknown Speaker  5:02
Absolutely. So that’s where it originally started that way. I said, Wow, like I was having these amazing connection as an internist with with my patients. And I said, Why don’t I have these same connections with more people like I’m spending, you know, my 1530 minutes one on one. And I’m using metaphors and things to explain concepts and people are like, Whoa, like, I never really understood because, for me, quality is very important in a patient visit. And it’s important for me to always have the patient understand and so I like to simplify concepts. I like to make concepts fun to learn. So originally, that’s where I turned to my blog is I thought I would kind of simplify concepts, but the blog definitely evolved into my writing about healthcare, for example, I think it’s the same sort of thing. It’s analogous and that I’m still simplifying healthcare like I’m taking concepts that The general public may not know about. So for example, pre authorizations right, we get on the phone, and we have to fight for our patients. And there’s a lot of little things that patients don’t know are happening in the background. And so I wrote about it, like I wrote a story about it. And I think that that’s very important as well, when you’re blogging and when you’re sort of when you’re talking about healthcare is to let patients know what’s going on behind the scenes that they may not know about, because it’s our voices that can change healthcare. And so the blog slowly evolved from first I was just basically speaking to patients about illnesses and diseases and sort of sharing work that was already published. And then at some point, I started creating my own stories and my own commentaries and op ads and things like that.
Unknown Speaker  6:56
Yeah, that’s what I found about a lot of your content is that it’s
Unknown Speaker  7:02
First, like there’s always a story, right to help to ground it. And it’s not always something technical. But you know, I find it to be personal in some ways, like it seems like these are the stories are coming from emotional places.
Unknown Speaker  7:22
Absolutely. I think that that’s what appeals to readers is when you write from a personal place, and it’s almost like a vulnerable place, we had discussed this offline. The the topic of vulnerability. I definitely open up a lot on the blog about certain issues. I mean, I definitely still, it’s important for me to still stay private. Even though I blog and I am present on all the social platforms. It is important to still hold on to things that you consider private but at the same time, I do like to dissect life events and things that are That bother me and health care and even happy moments in healthcare. But like for example, I’m a very emotional person. So I wrote about emotions I call it my story. Emotions aren’t just baggage there Louis Vuitton carry on, right? Because, first of all it appeal to the reader to read that to see that title. But secondly, to open up and tell people why being emotional is either good or bad is just very interesting. And when you’re sort of comparing it to things that are day to day like a Louis Vuitton carry on, it just makes it more interesting. And again, I write about sometimes I do write about illnesses and diseases and patient physician relationships, but I always relate it to other things. So like another example is a recent story that I wrote called embracing rejection, the beetle said Go go go when my counselor said no, no, no, and it was about a personal story of my counselor in high school, telling me not to apply to university that I really wanted to Go to because he said I wouldn’t get in. And I don’t really know why he said that. But I didn’t listen to him and I applied and I made it in. And the story kind of goes into like, why why would somebody tell you not to do something? First of all, because I got it. But secondly, because what is wrong with trying even if you’re going to be rejected, rejection is such a beautiful thing that you need to embrace because it makes us appreciate it when we actually do earn something we can always be told Yes, right. We need to appreciate being told Yes. When we are also told no. So these are sort of the kind of stories that I write about that makes people it makes it interesting to readers.
Unknown Speaker  9:40
And what about making it interesting to yourself? I mean, obviously, if you’re writing about it, something you find interesting, but what I mean more is like, how have you found this helps you to be a more fulfilled person?
Unknown Speaker  9:53
Oh, I knew exactly what you meant. And I agree. I think this helps me tremendously. fact, I first took it up because it was so it was so therapeutic for me that I really didn’t care if people were going to read and I think that’s part of what makes me succeed. I always tell my readers and I tell people in the group and everything that if tomorrow, everything worked to be taken away from me, I would still be a happy person. I really would I just I love. I love life. I’m an optimist. I love looking at the glass half full I love appreciating the other half of the glass. I don’t need people to read it and to like it, I need to like it. I need to feel good about myself. So when I create a story, I mean I’m also happen to be a perfectionist psyche, I always think that there’s a, you know, that I can make it better. And so I go back and redo it and redo it and redo it until I finally I’m like, Okay, now I’m going to publish it. And even then I go back sometimes and change it around, but I’ll put a story out there and it’ll just make me feel good because I’ve said what I wanted to say. And it’s just, it’s therapeutic. Um, I do really love the feedback though I love when people share and people comments and people sort of tell me that my stories have helped them to stay strong, but, but I don’t necessarily write for that I write because I really enjoy doing it. And because it’s therapeutic for me.
Unknown Speaker  11:23
Well, one thing that we were also talking about before the show is the saying every time you say yes to one thing, you’re saying no to something else. And so, you know, clearly writing this, you enjoy it. It’s a creative outlet. It makes you It sounds like it’s bubbling inside of you and just getting it down on paper is, is an enjoyable experience and helps you to be a more well rounded person. But there is a downside to it. Because you’re a mother of three. You’re a physician. You have this active social media presence so that when you decided to start doing it, what did you decide? Or what turned into the sacrifice that you made in order to find the time to do the crew? Sorry, not find the time. Create the time to do this?
Unknown Speaker  12:17
Yeah, absolutely. It takes up a lot of time and eats up your time. And so that’s the sacrifice that I make. I mean, I personally work a part time schedule. I definitely work more than the hours that I commit because I’m an internist and I have charting and all that but I worked. When I went back into medicine from my time off, I went back to a part time position in internal medicine because I wanted to allow myself the time to still do these kinds of things. I have this like artistic pull that I needed to satisfy, but but it’s still a sacrifice. So I try not to let it get in the way of mothering. But when push comes to shove this tape My time. That being said, it happens to truly be. And I know it sounds cliche, but this happens to be my passion. So I love to do it. I wake up and I think like, what am I going to write, I take showers and I come out of the shower and I have to go grab my phone and write in my notes section in the like three ideas I had while showering. It just really helps me to be a better person. And I honestly and I’ve written about this. I feel like it makes us better physicians. I feel like it helps us connect with patients better. It helps us think outside the box. It helps us be creative. It helps to innovate, it helps to lead others to be role models for others. And so while I’m sacrificing a lot with with my writing, and all the time that I spend on the social media platforms, it also helps to, to better myself. So it’s almost like um, it’s like giving me time. It’s like me, too. time when I write these things
Unknown Speaker  14:02
so it’s a way for you to for you to sequester time for yourself okay, I’ve decided to dedicate this much time to the blog, which then also translates to Donna time. This is time for Donna. This is this is not for my patients this is I mean it has benefits to your patients. But this is this is this and I think it’s very easy for us to let that go with all of our other obligations. Oh, I shouldn’t it’s selfish. I should be spending this time with my family Oh, I shouldn’t should be spending this time with my patients. Oh, I shouldn’t die. You know, and then you you you sacrifice everything and there’s nothing less yourself and then you end up not being as much of a person or a complete person as you can be for them when you are with.
Unknown Speaker  14:51
So it’s my pastime so like it’s literally like because I love it. Like I’m not forcing myself to write and it’s annoying to me like all I have to write You know, I never think that because I love it. And I also don’t, I don’t put the pressures that maybe others. I don’t know if others do this, but I don’t put the pressures of, well, I have to write a blog post now. I really don’t because I don’t feel that way. I feel like when it becomes that, I won’t appreciate it anymore. So I don’t have any of those pressures on it. I know that I have the time to do it. And honestly, because I love it so much. It doesn’t feel like work to me, it just feels completely like a natural thing to do. And it gives me pleasure. I love to do it.
Unknown Speaker  15:35
But to be clear, it is a financial sacrifice because this is time that because we because you’re working part time, this is time that you could be seeing more patients, and there are always more patients that but at the same time, like you said you feel like it makes you a better doctor, to the patients when you are seeing all so it’s a financial sacrifice. Yeah,
Unknown Speaker  15:58
it’s it’s a very, very much of a financial sacrifice that’s 100% of you know, it sucks my time it actually like takes time. That being said, it’s a great point to touch on because I think something that I teach the so many docs community I know we’re going to talk about this so many docs community, but something that I really say is just how many doors have opened. Thanks to everything that I’m doing. It’s just incredible. So while I sort of did this because I loved it and did this because it was my pastime and my hobby and my passion. It has also led to such incredible things and that’s why I sort of decided at one point to open it up and to like, push other doctors to do this. The doctors that are interested so so like the so many docs community before we get to that,
Unknown Speaker  16:48
what about the advantages to your practice? They go their patients that find you through the blog, or they’re referring physicians that find you through the blog. Have you had other and again, this is not We’re going to talk about your other social media platforms. Blogging is not your only social media platform. You’re very prolific in other areas as well. But of all of your different social media platforms. Can you talk about concrete advantages that have come like speaking engagement or increased patient volume? Or
Unknown Speaker  17:19
if this were a multiple choice? test, a question, I would say all of the above. So literally, everything I mean, from being quoted in big media, you know, journal articles and journals. I mean, the big gastroenterology publication reached out to me to talk about again, this is more of the so many docs and we’ll talk about that in a second. But, I mean, I’ve been asked to be guest faculty at one of one of the Harvard conferences that took place last April and loved it. I’ve been invited back in 2019. I’m conducting a roundtable next month at Harvard at one of the conferences for women leaders. I’ve been asked to speak at a Grand Cayman conference for female physician wellness. And, and you know, and and some of these are paid positions. I’ve been, you know bestowed some some honors from for example, medical economics named me the top 10, one of the top 10 internists to follow on Twitter. I’ve had tons of things open up I’ve also made incredible connections I had a health care in my county we have I created this healthcare professional organization and group with some of the other female health care providers in the area. And we had a meeting the other day in my house and we were like going around just kind of talking and it was amazing how I got to know some of these people based on my platform. So like each person who’s got any became a joke going around the circle that people got to know me because of my platform. One person saw my blog and she was super curious. And she was she thought to herself, like I should write to another person said that she, you know, had seen my tweets. So it also really connects and it helps to network and I can’t even begin to tell you how many physicians I’ve connected with across the United States and even the world. And it’s just, it’s just incredible. So this has this is multi level this, this has benefits on many levels.
Unknown Speaker  19:29
So let’s talk about so many docs, then this is I have to say I am very grateful for the Sony Doc’s Facebook group because I have found people to be on this podcast and I have found listeners for this podcast on this group. So my podcast would probably at this point, just consist of my friends and family who is that being said, Our experts, right my first my first guest was my brother who’s a PhD in health. See from Harvard and worked on Obamacare. So he’s definitely he’s now he’s a professor of health policy at a medical school. So they’re definitely experts, but it was able to rapidly expand beyond my circle, because because of your group, so again, I am very, very grateful for so many docs Facebook group. So let’s just talk about that. What inspired you to start it and what has it been doing and why why should more physicians be joining? Yeah,
Unknown Speaker  20:29
so I mean, I saw the amazing benefits of my own efforts. And it was a very lonely effort because nobody was doing it. When I was doing it. I was definitely looked at as doing something that wasn’t traditional. I had interesting comments come to me, even from family and friends. What are you doing? physicians don’t do this, this and it really bothered me because I be part of all these like Facebook groups, for example, and none of them had visited in them, and if anything, I think people found it odd that I was a physician and I was in groups, like why I mean, it was just not an accepted thing. And I felt like there was something lacking there. And I also felt like, there were so many benefits to what I was doing. I mean, I was feeling great. I was fulfilling a passion. I was seeing so many the open the doors opening that I described earlier, that I said, Why don’t other doctors do it? Right. I mean, I’m doing it and I’m an internist. But there’s people that are experts on everything. I mean, people that know a lot about headaches, and there’s people that know a lot about I mean, Botox, right. There’s people that know a lot about orthopedic surgery. And at some point, I can talk
Unknown Speaker  21:45
a lot about postnatal,
Unknown Speaker  21:46
right? Yeah, and I’m sure there would be an audience for that. But I said, that lonely process, that lonely road that I felt on my journey, other doctors are probably feeling it too and They’re probably not even realizing how amazing it is to actually blog and they maybe they think it’s not okay. So I said, I’m going to create a group so that we can all do this together. And we can almost mimic these other Facebook groups of all of these bloggers and Pinterest groups and this and that, and there isn’t really one for physicians, I’m going to make it okay for physicians to do this. And that’s where I decided let me do doctors on social media. And then I started like, kind of asked the group like, what hashtags should we use and, you know, I kind of use the rules that I use for myself with branding, which we could talk about, you know, spend a whole podcast talking about but keeping that hashtag, really short and kind of catchy and fun, and that’s where so many docs was created. So, so me being short for social media, so many docs, social media doctor, so for anyone who’s looking to use social media to expand either their business to make changes to healthcare to beat burnout like I did. You can really use social media for so many different reasons. And so many docs was born.
Unknown Speaker  23:10
And you can just join the group and lurk and learn. Right? You join the group, and you just reading the other posts to see what’s out there. Because if you haven’t figured out what you want your outlet to be on social media, or, you know, or whether you’ve disturbed you’re wavering on having a social media presence, or you’ve just started a page, you don’t know how to get it started. You want a blog, but you don’t know the nuts and bolts of it. You have a community of physicians and human beings are tribal. We’re, we’re genetically tribal by nature. So you find your tribe, and you help your tribe and you protect your tribe and physicians are a tribe, right? And so we have a tendency to help each other, expecting nothing in return. So if you go on there, and you asked For a piece of advice, how do I get started? You know, what do people think about this topic, you are going to get a lot of feedback. And and you know, a lot of it is going to be very helpful in terms of getting you started and getting you motivated. Because when you see what other people are doing out there, that’s also very motivating, like look at what all this great content that all these people have put out there. And it can also help you find your niche. So there’s so many reasons to to join that community so
Unknown Speaker  24:29
that I agree and I think it’s been an extremely supportive community. And so, you know, I really haven’t seen any fights break out obviously, you know, it’s Facebook people are faceless there and so it’s sometimes easy in other you know, in other Facebook groups, I’ve noticed people will easily you know, start name calling and be want to get in a fight because it’s not face to face. It’s not like that on so many docs. We’re all respectful. We’re all physicians. There is so much there’s are so many productive posts that are shared. I personally do try and stay active there as the admin of the group. I try and stimulate conversation I try and post interest not only interesting posts, but but posts that get involvement. So even just sharing URLs like sharing the, the handles right, the Twitter handles of the group members. That helps because it gets connections, it gets people to like each other’s or follow each other’s Twitter, Twitter accounts, and it helps us grow
Unknown Speaker  25:36
and it makes our voices louder. I think it’s so important because you see celebrities making recommendations for people’s health, like when it’s Paltrow and goobers they’re talking about the healing power of crystals, and they have millions of followers and they’re spreading misinformation and that’s a dangerous expert.
Unknown Speaker  25:56
That’s that’s we’re worried right.
Unknown Speaker  25:58
And I think people are worried about getting sued. Right, they’re worried about getting sued. And so you know what people have thrown that comment out in social media, what do I do? What do I put on my blog or my Twitter account to make a disclaimer to me, we’re not lawyers, some of us are actually there. There are a couple of lawyer physicians out there. Um, I mean, you don’t have them on retainer, but you know what I mean, like, just bouncing friendly advice around so that we can be and then you see other people are doing it. So you can be less afraid to do it, because you’re not the one doctor who’s putting medical. I mean, you can’t make a HIPAA violations. You can put information out there. And that’s your thing. You put it in a way that your patients can consume it. And then we become part of the conversation again, rather than just, you know, complaining to each other in the lunchroom about you know, the healing power of crystals. Most of my patients brought in their crystals again, and they wanted to know what the dose should be. Oh, gosh,
Unknown Speaker  26:50
yeah, that’s, that’s also part of what what why I initially started this is because I, I saw the pseudoscience out there and it was really bothered me not only the pseudoscience actually but even things like physician reviews, I saw someone that I knew a colleague of mine reviewed poorly not even reviewed, it was just a, an ugly post that was written about him on a Facebook group. And it was a general, like community Facebook group. And I was appalled because I said to myself, he doesn’t even know that the post is there, that he’s now been bad mouth to like thousands of community members. And it’s not true. And he can’t defend himself, even if he knew was there. He can’t really break hip but to like, give his side of the story and it was just all in all a bad situation. And that was actually the first healthcare article that I wrote. It was I submitted it to Kevin MD, and I had it published on his site and this was years ago and I loved it. I just felt really good to put my thoughts into words. So yeah, it’s changing healthcare by writing about it so that people know a little bit more what is happening from our point of view from the physician point of view, and it’s also drowning out, drowning out pseudoscience. But I think legalities are important. I think that it’s sad that physicians have to be careful, but we do because we are. You know, we’re the leaders in healthcare. And so what we say really matters. And so we have to really be careful about not giving out any specific information and sort of keep the generalities and, and that’s really important, I think,
Unknown Speaker  28:33
right, not giving specific medical advice to someone over you’re not their Twitter doctor. So if someone texts you a picture of a rash you shouldn’t respond on on social media, but at the same time, personally, I think it’s ridiculous that I have to start each episode when I interview a physician who’s actually giving some medical information. We just had one recently about about back pain, that you know what, I’m not your doctor, and I’m not giving you medical advice right now the fact that I have to say that is a little ridiculous they do. I’m not their doctor. But still, I have to say that in order to
Unknown Speaker  29:08
die, that’s absolutely ridiculous. And honestly, I could talk about this for hours because that’s something that really irks me is just the like, the legal issues in medicine and the fact that we, you know, just just the need for tort reform and the fact that we have to not constantly watch our back and not be able and I think it’s actually hurting healthcare tremendously. It’s one of the biggest problems in healthcare today. But anyway, that’s for another episode.
Unknown Speaker  29:36
It’s actually Episode Two. If you want to get involved in advocacy, I interviewed someone about some of the easy ways without devoting much time that you can be an effective advocate for yourself because you know what, the trial the trial lawyers have a huge lobby. And so their interest is, they say protecting their patients, but they do they make a lot of money quote, protecting the patients from from us. I mean, I think there’s definitely conflict. I
Unknown Speaker  30:03
think patients do absolutely need protection. I mean, but like it’s gone the other way there. Yeah, there’s just way too much legalities to the point where we’re all sort of just watching our backs non stop. And that’s not where you want your doctor to be. Right? You want your doctor to just straight out, like, tell you how it is and treat you and you don’t want him to have to even like, you don’t have to want him to spend five minutes out of the 10 minutes. He’s with you, right, talking about all the possibilities just to you know, CYA to cover your ass. Excuse my language. So, you know, those are important things. And I think that, again, that’s something that is that is important to blog about to tweet about is health care and health issues like legalities and healthcare. I think we can definitely make a difference in the world if we take to blogging and to all the social media platforms and we We can certainly make a difference in the world in that way.
Unknown Speaker  31:03
So let’s, let’s. That’s an excellent segue. So now one of our listeners has been inspired to start a blog. How do they do it? Give us a basic intro some of the nuts and bolts, which was web hosting and WordPress and what are the some of those words mean? How do you you’ve got your laptop sitting in front of you. You’ve written something on word, right? How do you start a blog?
Unknown Speaker  31:27
Okay, so this is off the top of my head. Um, so first and foremost, you gotta pick a niche. If you want. I did not pick a niche I wanted to just write so I write about my family and medicine all in the same blog. But you if you really have a niche, it’s easier if you know that you are a neurologist and you want to talk about headaches, then that’s your niche. Then you would want to find a name you would want to brand yourself and you’d want to brand yourself with a name that you would keep consistent in your blog name and in all of your social media platforms. So doing that requires some investigating and some research because you want you want the website to first of all be available right? So you have to always go to the internet and look up the different names that you’re interested in. And the name that you would want to pick has to be relatively easy to say it has to roll off the tongue it has to sound good. It has to be easy to pronounce. I usually tell people don’t
Unknown Speaker  32:33
don’t choose words that are difficult to spell.
Unknown Speaker  32:38
There may be specifics that are specific to you I always use my own example I’m Dr. Corey yell. And I’m not Dr. Donna coil for example, because I spell my name DNA and it looks like Dana so I didn’t want people calling me Dana or hell non stop. So, those are specific considerations that could be like particular to you. So you know, you also have to consider your Media handles so if you’re going to pick a blog blog name, you’re probably going to eventually start different social media handles start different accounts on the social media platforms that are in existence so I’m Dr. Corey gal. I have a Facebook Twitter Pinterest and Instagram account. They’re all Dr. Corey l to it’s easier for your followers to find you across the different platforms. You wouldn’t want to be Dr. Donna Corey all on one platform and then Dr. Corey Allen, another one and then dr. D. Korea and another one. You want consistency. So that’s another thing I would do and then you’re ready to start your blog once you find your name. And so you I mean, I do it on WordPress. Some people ask Should I do WordPress, com or wordpress.org. I long time ago learned that wordpress.org was smarter right off the bat. It’s not easier to use it. It’s actually harder to use because you’re basically controlling everything and building Everything from scratch, but, but it gives you the freedom to then do with it what you want you own it, as opposed to WordPress com. Um, and you need a host hosting like a hosting company. So I use Host Gator but you know there’s others out there like GoDaddy and things like that. And then you basically you start you just right you have to get all kinds of apps installed into your the back end of your blog, which can be extremely complicated. I did it on my own for the most parts, and most people can do it on their own but I as we’re very busy physician, sometimes it may work out financially to get somebody to, you know, to do it for you. It literally it just depends on time, and finances. Those are the two rate limiting factors with actually running the blog
Unknown Speaker  34:55
and the economics seem pretty straightforward because you know about how much you make per hour seeing Patience and if it takes you a bunch of time to sort out some of this stuff, then your time is probably better spent seeing patients and then outsourcing rather than struggling and struggling and struggling doing a lot of it
Unknown Speaker  35:13
yeah I agree completely I agree completely and by the way yet another thing we didn’t mention when you blog cuz I’m thinking of the back end is you can also you can make money by blogging because we were talking about all the time that you spend doing all of this blogging can actually give bring you money, you know, whether it’s advertisements that you insert inside which, you know, there are ethical considerations to consider as a physician. I’m not saying to like endorse a medication but like so you know, little ads that pop up on AdSense and such things. You can make money that way you can make money with sponsors that want to be affiliated and you can make money many different ways. And have you been approached by pharmaceutical companies to put ads for drugs on our
Unknown Speaker  35:57
blog, no
Unknown Speaker  35:59
wonder if that’s Right. Oh,
Unknown Speaker  36:01
I’m sure. I’m sure. No, I have not. And again, I am extremely careful with legalities and with you know, I want to still say stay true to who I really am and what I believe in. And so I’ll put disclaimers if I need to. Yeah, I mean, I really pay particular attention to like the statements that I make, and I want to make sure that nobody can misinterpret although again, nowadays. Anyone can say that you said anything. And it’s just unfortunate.
Unknown Speaker  36:36
This This episode of physicians guide to doctoring brought to you by liberty.
Unknown Speaker  36:42
Really not? Completely
Unknown Speaker  36:44
generic, right, the cheap
Unknown Speaker  36:50
Yeah, so. So that’s what you do. And then you start blogging. What’s really cool about blogging is that you can blog at your own pace. So you Have to blow. I mean, some people say like, makeup, sort of make a schedule and stick to it. But you don’t have to. I mean, there’s there’s weeks where I’m tired, there’s weeks where, you know, I really value traveling, there’s weeks where I’m, you know, a few days where I’ll take off the road traveling, it’s okay to be gone. Um, it’s, it’s up to you again, it just depends on your endpoint and what you’re trying to achieve. If, if you’re looking to be, you know, tomorrow’s mega star, you’re probably not going to make it by blogging unless you have something like spectacular to share with the world that like nobody knows about. But most of us are just regular people that are, you know, going to work in and out of work and we’re all parenting or we’re all kind of living with our own issues. And, you know, blogging is just a really cool therapeutic way to put yourself out there and to talk about issues that are interesting to you. Have you marketed your blog at all, no meaning have I paid to like to have it advertised.
Unknown Speaker  38:02
Yeah, I mean aside from mean I’d say yes you created this amazing Facebook group which in and of itself is marketing on top of just creating this what became a self sustaining community. But but something that you would have done just to put more eyeballs on your nose so
Unknown Speaker  38:22
I have not if you Okay, that’s a great question great question. Marketing is so huge now. No, I have not put money into marketing my blog and I’m actually proud of that now that you asked me that no, not a single penny as far as I can remember. No, I do not put financial marketing into place with my blog or my social media platforms. I love to talk about them and to to engage on social media and that is marketing but it’s not for money. So and that and that kind of limits you right because Facebook I have a Facebook page which is limited. I have At this point, I don’t know how many 18 1900 followers and yet my followers don’t see my work because Facebook wants my money they want Yeah,
Unknown Speaker  39:08
right. They want to change their algorithm looking for people totally, to spend more wisely.
Unknown Speaker  39:14
And by the way, that’s what we talked about in so many docs is how do we beat this algorithm? Right? Because you’ve got like this group of 1900 plus physicians that are gathered in this like secret Facebook groups, physician only. And we’re trying to beat these like algorithms. So we’re putting all our brains together and saying, how do we, you know, what kind of ways can we find to get our work scene? So I do market not financially, I market by just sharing, you know, tweeting. If I tweet about an article that I just wrote, then I get it retweeted by people that really liked it, or I have ways of like, embedding the tweet icon into my blog, and people can sort of tweet cool saying that I have from my stories. Um, there’s little things like that, that I’ve learned along the way that can help to market myself by not paying.
Unknown Speaker  40:10
You create connections.
Unknown Speaker  40:11
Exactly. And network.
Unknown Speaker  40:12
So what platforms let’s let’s do some of that now. What platforms are you on? And where can people find you?
Unknown Speaker  40:19
So I am Dr. Corey l everywhere Dr. CORR. So Dr. GLORIA And I’m on. I’m on Instagram. I love taking iPhone photos. I call myself I it’s half of a joke, but it’s not. I’m an iPhone photographer. So I love taking really cool photos I just wrote on my blog 13 tips on taking fabulous iPhone photos. So my wife just got a new phone and it’s got the portrait mode. Love the portrait mode.
Unknown Speaker  40:47
Oh my god, the picture she takes of our two boys. Amazing. Hey,
Unknown Speaker  40:52
exactly. So portraits amazing, but there’s also just really cool ways of I give some tips about angles and different things you can do. I love to edit. So Instagram, Twitter, I’m close. I’m somewhere around the 2800 followers, which is amazing to some people but to other people have hundreds of thousands of followers. It’s it’s not that great. But the bottom line is I love to tweet, I love to engage with people on Twitter. Like I said medical economics gave me that honor, which was so nice. In three months, I was able to garner so many followers and it wasn’t hard. And on my blog, you can find Twitter tips, 14 Twitter tips to how to tweet and how to engage with other physicians and other and patients. So I’m on Twitter, Instagram, Pinterest. LinkedIn is a huge one lately that I’ve been extremely active on Facebook. Ah, yeah. And they’re all different. Like you could literally do a podcast on each and every one of those platforms, how to use it and what kind of benefits do they provide for your whatever it is that you’ve seen? Seek to gain. Well, I think you’ve just obligated yourself to do another episode. I’d be happy to come on another time in the future.
Unknown Speaker  42:06
Well, is there anything else that you want to discuss today that you think that we may have missed?
Unknown Speaker  42:12
I think we’ve said plenty. I think I’ve said plenty,
Unknown Speaker  42:14
very comprehensive episode. I really appreciate you creating the group which has allowed me to proliferate and, and making a stand for physicians and our patients and really putting yourself out there. So I appreciate everything that you’re doing. Your patients, appreciate it. You’re the other doctors appreciate it. And thank you again for taking the time
Unknown Speaker  42:37
to talk to me today.
Unknown Speaker  42:38
You’re welcome. And thank you so much for
Unknown Speaker  42:40
all the compliments. I appreciate it. It’s been a pleasure.
Unknown Speaker  42:44
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to die During if you are interested in being a guest or have a question for a prior guest, send a message or post a comment.
Transcribed by https://otter.ai