Lucy McBride, MD with Elise Loehnen BEYOND THE PRESCRIPTION Live at Zibby's Bookshop!

2026-08-07 · 65:06 · Lucy McBride · Bookshop Event

[0:00]We've done some talking so it's going to be fun over the years. I met you. Let's talk about sort of like you as the primary care position now slash media person

[0:12]What was the draw like why what moved you out of just patient care into sub stock podcast but one word COVID

[0:21]So during the pandemic I

[0:24]I started writing a newsletter to my patients and my family

[0:29]Because everyone was texting me like what is going on. I have a cough. Is it allergies? Is it COVID?

[0:36]You know, do I get a vaccine? Do I not so I started writing a newsletter?

[0:40]Just I just downloaded like a email list of my patients and it took off and

[0:46]because of that newsletter I

[0:48]I started doing I started I was a regular contributor at the Atlantic. I was on MSNBC

[0:53]I got to testify in front of congressional committees trying to make sense of the crazy landscape

[0:58]We were all listening. We were all living through and my argument was

[1:02]not that

[1:04]kind of I didn't think it was that radical, but that this was a parallel pandemic of mental health and crisis

[1:11]that

[1:12]COVID was indeed a massive threat. I had a patient die from COVID. I had patients in the ICU from COVID

[1:18]so was

[1:20]the experience of living through like

[1:23]sustained stress, sustained vulnerability,

[1:27]isolation, loneliness, the toll on people's emotional and social health. Not to mention like missed mammograms colonoscopy

[1:36]So I was arguing that health was more than the absence of COVID

[1:41]and that got me in some trouble

[1:44]Interesting. Oh, big trouble. Who from so as you recall, the pandemic became a politicized

[1:53]I don't know what you're talking about

[1:56]I mean, it's not like we just put Fauci on trial, right?

[2:01]So I was accused. I mean, we could talk basically the whole book talk. I was accused of being like a right when we're not

[2:06]operative

[2:08]Right for arguing that schools in 2022 post vaccine should be open because a lot of the blue states and the 2021

[2:14]So I was like health is about more than

[2:18]preventing COVID. It's about

[2:20]Being at school. It was and I was arguing for kids who

[2:24]Not unlike my kids didn't have access to iPads and zoom school

[2:28]Right, or meals or social connection, you know, domestic abuse went up like yeah, I mean, so

[2:36]I had my eyes wide open to two things one that science plus politics equals politics

[2:45]Like

[2:46]That's how the sausage is made and two people are starved

[2:52]for basic

[2:54]information and guidance about

[2:57]Monday and things like should I get a vaccine? Should my kid get a vaccine?

[3:02]I'm so coughing. Can I leave my house

[3:05]And it I realized what I already knew it'll actually but that people don't have a medical home

[3:10]They don't have a guy they don't have a primary care doctor to answer these basic question that I thought

[3:16]This is so tragic. This is so tragic people don't know who to trust and trust is at an all-time low and health

[3:22]Institutions through no fault of doctors

[3:25]So I said I thought to myself

[3:27]I'm gonna write this newsletter and I started writing and writing and now it reaches 41,000 people a week and I got that this book

[3:33]Offer from Simon Schuster my dream to reach people beyond the walls of my office

[3:38]with straight talking

[3:41]Evidence-based advice isn't that's stripped of jargon and ideology like I'm not I have a political

[3:47]Viewpoints, but this you know health is not about politics. Yeah

[3:51]Well, and I think that the absence of jargon or translating because you see it you see jargon weapon

[3:57]on both sides and people's basic lack of understanding about what these terms mean

[4:03]sort of roll out and

[4:05]In parallel

[4:06]I my dad's a physician my mom's a nurse. I used to type his medical dictation

[4:10]Because that's why I was like sit in his waiting room waiting to be driven home

[4:16]Because we lived out of town and I would like eat sugar cubes and read highlights magazine and then I was like

[4:22]I'm gonna become a really fast type this

[4:23]But I remember saying to him like what's a pneumothorax like why can't you just say punctured long or collapsed long like why is it a pneumothorax and

[4:33]You know

[4:35]Immediately I just had a doctor's appointment with a brilliant neuro geneticist, but I left I was like

[4:42]I don't know what just happened. I know I just was like a ha ha polymorphism. Totally. I

[4:49]And I'm pretty educated. Well people feel very very

[4:53]You know when doctors don't have time. They don't we don't learn necessarily how to communicate right or read studies and nor should we

[5:00]Well, we don't we we don't we do a lot of studying. We do a lot of time in a library a lot of

[5:08]Right learning to be how to be doctor. We don't necessarily learn how to communicate how to connect with people how to meet them where they are and

[5:16]to translate complex

[5:20]Things like a new with our ex into like okay, you have a punctured lung. What do I do?

[5:25]Can I walk up the stairs right like yeah, just basic information. So that's what this book is. It's really to help you make sense of

[5:33]You know all the information coming at you and

[5:37]To make sense of your health, you know in your own living room because it turns out you need to be your own

[5:43]Sort of detective and self advocate more than ever

[5:48]Well, that's an interesting question because I feel like our culture there's so much fear

[5:52]We all hear it every day about everyone and everything, right and there's this sort of

[5:57]dueling

[6:00]There's this like you need to do your own research and you need to be more prepared when you go into your doctor's office then

[6:07]of first-year resident, right and the onus that people feel to sort of understand what is beyond them potentially

[6:15]And then simultaneously it's like can you you also need to trust right you need to sort of relax into the care

[6:22]Ideally your primary care physician who's quarterbacking

[6:26]There's this this like you need to be hypervigilant

[6:29]Because nobody else is going to catch anything or care and they're probably going to be wrong

[6:34]And then the simultaneous like your best way through is actually to relax, right two two things about that

[6:41]It's such a good is such a good question at a point

[6:43]One is that the people that you and I trust that all of us in the room trust in your life

[6:49]Are people who are interested in you as a whole person who don't interrupt you

[6:56]When you're talking doctors in studies have been shown to interrupt patients in the first 11 seconds

[7:02]Again through no fault of doctors. They just don't have time

[7:06]Who are willing to say I don't know but let's figure this out together

[7:11]And who have the credentials in

[7:15]The area with which they are advising you

[7:17]But they're they're real they're human and they want to help you in the way that you want to be helped so at the end of the day being an empowered patient

[7:28]requires

[7:30]You making sure that that relationship is part like the relationship is the glue

[7:35]And it doesn't have to be this like nurturing relationship where you guys

[7:38]You know crying to their shoulders and I want that but yes

[7:41]I do too. I do too. I do too. When you cry in my office

[7:44]People apologize always for crying and I'm like look I am

[7:47]You know singing for myself when you cry that means that I'm doing my job like I am like poking I'm poking it bruises right on purpose like emotional

[7:55]bruises

[7:57]So I think I think trust is the glue and you know

[8:02]You want to you deserve to have a physician who you trust

[8:07]and it doesn't have to be the person with the

[8:10]Best resume or the person who has done the most

[8:15]You know xyz. It's just somebody who you feel has an interest in you and is willing to problem solve

[8:21]And not just shoot you at the door. Yeah, the other thing about the vigilance part

[8:25]I think you know, I think there is this sense that you have to be vigilant

[8:29]You have to be paying attention. Almost like you have to be your own doctor like like and that sort of touches the crowd

[8:34]That's like I'm gonna do my own research

[8:37]So patients are doing their own research, right? Like they just are like I do my own research on things

[8:44]I don't know about right?

[8:45]So and who can blame them when your doctor has 15 minutes and health care in this era has

[8:51]become transactional and impersonal and

[8:54]You know not about the whole person really about the symptoms and the diagnosis codes

[8:58]But I want to stress to people and this is really what the book is about is

[9:03]You have more control and more agency and more information about yourself than you think if you take the time to excavate

[9:12]Your interiority your biography

[9:16]Your vulnerabilities your fears your past experiences with doctors and how you show up in that exam room

[9:24]Your biases like are you the kind of person who's like

[9:29]I'm not the kind I'm not the kind of person who takes a pill for that or

[9:33]You know, I can't or I should or I won't

[9:36]You know knowing yourself and then

[9:39]Helping your doctor know you in a way that is authentic

[9:45]is part of the act of care delivery

[9:49]And it works both ways. So I think I think you in this book is really it's like a library of questions to ask yourself health

[9:56]Isn't I will argue until I die health isn't about having

[10:00]the answers. It's about asking smarter questions of yourself first, like radical honesty

[10:08]with self, and then asking better questions of the people responsible for your care, right?

[10:15]And the, you know, in this era of AI, we have these like master solution generators,

[10:21]right? Like answers, answers, answers, answers, answers, answer, solution solution,

[10:25]and patients come in to see me all the time with a solution already.

[10:29]Let's tee it up for me, like, I want to take a GLP one. I want to be on testosterone.

[10:34]I want to do this. I'm like, whoa, whoa, whoa, whoa, whoa. That is that maybe what you need,

[10:38]and we may get there. But let's figure out what's your question first, like what's your pain point?

[10:43]Like, what is the actual issue? You may not need a GLP one. You may need to start eating lunch,

[10:48]because you're not satiated, because you're not eating enough. You may not need testosterone.

[10:56]You may need relationship therapy. You want to use spouse for your libido. I'm not trying to

[11:03]send anyone to the divorce court right now. I'm just saying like, let's solve the problem you actually

[11:07]have. And then we can talk about testosterone for libido. But let's first talk about what the actual

[11:13]issue, is it a relationship issue? Is it a libido issue? Is it a gender issue? What are we talking

[11:18]about? Is it just vague marketing and exposure where I'm like, I guess I need to take

[11:22]creatine. Maybe I need protein. But all right, we're going to talk about optimizing. We're going

[11:26]to talk about testing. We're going to talk about GLP ones. But I love that you sort of at the,

[11:35]this is an important question. Like, what does health mean to you? And what are your values,

[11:39]right? Which is essential. So I want you to talk a bit about that, which is like, what are you

[11:46]optimized? I hate that word. What are you even optimizing for? But then second, let's talk

[11:52]about patient personalities, because that's like the beginning of the path. I want to be the best

[12:00]patient. I'm on your best behavior. I don't know a little book about it. I wrote a whole book about

[12:04]being good. And I will do anything to make sure that I am my therapist slash doctors favorite

[12:12]patient. I want them to see my name on the schedule and be like, oh my god, I'm so excited.

[12:19]She could teach the class. Yeah. And I'm very compliant. I mean, there's like, I catch myself

[12:23]doing all sorts of things. Yeah. So I talk about the, so I talk about in the book five steps.

[12:32]They don't have to go in order. But five items you want to consider to become your best

[12:38]advocate in the power of patient. Step one is understand why you're alive. What are your goals

[12:46]on a mundane level? Like, how do you want to feel next week or next year compared to how you feel

[12:52]now? Do you want to be in less pain? Do you want to have lost weight? Do you want to feel like you

[12:57]understand your body, your digestive system better? Do you want to be less stressed, less anxious,

[13:04]feel more in control of your mental health? Do you want to have more support? So know what your goals

[13:10]are. It turns out if you don't know your goals, the medical system will tell you what they are.

[13:15]And it will treat you like a check like a like boxes to check. And the wellness industry will

[13:21]tell you it's this protocol. It's this set of peptides. It's this, you know, someone else's goals.

[13:27]We've conflated health in the medical system as, you know, a cholesterol level, a normal mammogram,

[13:34]and those are important. But health is actually about a sense of inhabiting your body in mind and

[13:40]a sense of agency knowing who to go to, how to ask the question, what is your pain point,

[13:44]self-awareness in action? So that's step one. And then to answer your question about patient

[13:50]personalities, I have that too. So there's a great New Yorker cartoon. I put it on my sub stack

[13:56]where the person is, the patient is lying on the doctor's exam table. And the thought bubble says,

[14:03]if I can just get my doctor to like me, everything will be okay. And that's exactly what

[14:07]we were talking about. Yeah. I'm obsessed with this. And I see patients like this all the time. And

[14:11]I see right through it. And I know my patients will not somebody, somebody or my patient. So you know,

[14:17]I will be like, dude, like stop trying to win this appointment. Stop trying to dazzle me. Like,

[14:24]this is not a competition. Like I already like you like what's actually going on. And then

[14:29]like the tears come down. I was like, Oh, my husband, I think you're getting a divorce and I'm

[14:33]drinking too much. I'm like, that's what we need to talk about. Right. Right. Because behind

[14:39]that facade of people pleasing, you know, there may not be anything that, you know, dramatic,

[14:45]but there's something there. And you have to remember, you're not here to please the doctor.

[14:51]You're here to get the support you need, the advice you need. And if you find yourself

[14:55]people pleasing and then your doctor is kind of laughing that up, that may not be the relationship.

[15:00]You want?

[15:01]No.

[15:02]Yeah.

[15:03]Do you?

[15:04]Okay.

[15:05]See, I know you outlined some of them.

[15:06]Patient personalities.

[15:07]Patient personalities.

[15:08]Optimizers.

[15:09]So all of us are sort of a bend diagram of these different personalities.

[15:13]And this is something I kind of made up after seeing patients for 25 years.

[15:17]The patient personality is the version of yourself who shows up in the doctor's office when

[15:21]you're vulnerable.

[15:22]Are you the people pleaser like we talked about?

[15:25]Who may minimize symptoms to sort of not bother the patient, but not bother the doctor?

[15:30]Are you the optimizer who believes that will power and discipline guarantee outcomes such

[15:37]that you're likely to ignore like genetic predisposition disease and sort of think you can

[15:43]sort of exercise or eat your way out of like just health issues?

[15:49]Are you the outsourceer who is you know, trust doctors, but maybe too much like just want

[15:55]the prescription, the recommendation, like doesn't want to understand the mechanism.

[15:59]Like those are actually really easy patients to take care of because they don't want to understand

[16:04]the why and I'm like a big why person.

[16:07]So it's and it's not that they're not curious people.

[16:11]It's not that they're not smart.

[16:12]It's that they don't they there's there's some sort of block to wanting to want to

[16:16]understand deeper.

[16:17]And that's okay.

[16:18]Sometimes sometimes we don't want to know why sometimes we just need the prescription.

[16:22]And then there's the internet warrior who's on chat TV or Claude and being like, you

[16:28]know, every rash like what is that, you know, and, and, and you know, all of us are some

[16:34]kind of version of, you know, pieces of these.

[16:38]But I think the point isn't to indict yourself or to pigeonhole yourself.

[16:44]That would not be productive, but rather to identify your attitudes towards your own health,

[16:50]or attitudes towards an authority figure, like a position who in that attitude you

[16:57]may have earned rightly so a lot of people have been shamed by doctors have been dismissed

[17:02]by doctors have been talked over by doctors.

[17:04]So like it's not that you don't earn the right to have those biases, but it it helps

[17:09]if you can articulate them to your doctor.

[17:12]For example, a people pleaser might say in their most self aware state, I tend to be

[17:19]a people pleaser for whatever reason.

[17:22]And so I tend to minimize my symptoms.

[17:24]So when I come in with abdominal pain, like I probably need an appendectomy to me, like

[17:30]something seriously, or I might not mention something.

[17:34]So just know that about me or an optimizer.

[17:38]I mean, this this takes a lot of fortitude to be able to do this.

[17:40]This is a sophisticated patient to be able to say, look, I tend to think and sort of black

[17:46]or white, I need help thinking through the gray.

[17:50]So can you help me think through the things that I may not have brought up and I kind

[17:54]of think I have more control over my health than I then I really do.

[17:58]So like help me understand what I don't have control over.

[18:01]I love that.

[18:02]That's a great thing.

[18:03]Those kind of patients, I'm like, get it up because that is someone you it's also like

[18:07]if you want to please your doctor do that, help them help you like we're we're it helps

[18:14]us understand you.

[18:16]I'm I'm a massive minimize I come from a family of minimizers because I'm over medicated

[18:21]and under seen and my brother just spent, I don't think it might be saying this a week

[18:25]in the hospital because he doesn't have a spleen because he was stabbed.

[18:29]I know it's a crazy story, but doesn't have a spleen to be as no like his immune system.

[18:34]Yeah, he needs to not appropriate defense.

[18:36]He had a fever for three weeks and didn't go in and he ended up having line three tick-borne

[18:42]diseases including lines.

[18:44]Anyway, and I'm I have I was just telling you that I have an aneurysm I just went

[18:49]through breast cancer, but I really felt bad going it's taking an appointment from I'm

[18:54]at UCLA.

[18:55]They've been amazing going to see the neurosurgeon because I'm like mine's very small and

[18:59]it's not a minute rupture and I'm kind of wasting his time and he's going to look

[19:04]at me and be like, go home, that's my psychology, but I think it's very common.

[19:11]It's no surprise when when you've been hurried through an appointment and you know your

[19:17]doctor's busy and you understand that the rates of burnout are you know sky high and medicine,

[19:23]but you still need to take care of yourself and you don't need to take care of your doctor.

[19:28]Hopefully your doctor is taking care of themselves.

[19:31]Yeah, like the whole we know now that doctors are really bad at self care and we are now

[19:40]trying to like practice what you preach.

[19:41]I don't think we're great at it.

[19:43]There's so much in your book that's about sort of our psychology and I kind of feel like

[19:47]maybe you missed your calling and you would like to be like a medical therapist.

[19:52]So the therapist that I said tons of patients and Jacob Smith PhD is like my body double

[19:57]and she's a therapist in DC.

[19:59]She said.

[20:00]that I'm a psychiatrist or like I'm a therapist and a doctor's outfit and she's a doctor

[20:04]and a psychiatrist and a therapist outfit. So I mean I see everything up through the lens of

[20:13]mental health, cognitive health, like consciousness, my daughter who's here in the audience,

[20:19]she is a student, a pre-med and studying consciousness, which is to me like the frontier in medicine

[20:26]and I could talk forever about how we use like 10% of our brains, sort of like you use 10% of

[20:37]your closet, right? 90% of our brain activity is the unconscious mind, the untapped universe

[20:47]that really drives so much of our thinking and our feeling and our behaviors and guess what

[20:54]behaviors and form health. So you know doctors love to tell people exercise more, eat less,

[21:01]lose weight, get your mammogram. Those are easy words to say. What's harder and more interesting

[21:08]is to help people understand why they're stuck, why they aren't getting that mammogram.

[21:12]The avoidance of pain because of some you know family history of breast cancer,

[21:19]some deep-seated fear of taking care of themselves or like sexual assault history. I mean

[21:27]why isn't someone able to execute on their best intentions starting exercise program eating

[21:32]better for high cholesterol reasons? Sometimes as they don't have time, they don't have the financial

[21:37]support that they need, they don't have or help resources. Sometimes it's fear of failure,

[21:42]sometimes it's perfectionism, like those things matter so much and your doctor doesn't have time

[21:48]to ask you about those things. So this is a way of mining that whole interior space so you can

[21:55]sort of paint a more authentic rendering of your health, which includes a lot of the stuff

[22:01]that's under the surface. You write about and I think this is not news to anyone in this room that

[22:06]we have sort of never before access to a wealth of like battery of testing, right? Whether it's

[22:14]like Pranovo full-body scans or blood tests by mail or like early cancer detection etc. But

[22:21]we've never been less well, right? As a people and what do you what are your thoughts on I've sort

[22:28]of besides what my doctor orders abandoned all of that. But what do you think? What do you

[22:35]recommend for people who are sort of curious full-body scan curious? Yeah I think you have

[22:42]to ask yourself what are you looking for? I think that those like the Pranovo scans and the

[22:48]the tests that you can order you know online for yourself speak to the absence of primary care

[22:54]medical homes in this country. A hundred million Americans don't have access to primary care

[23:01]and it's actually it's not and and then so many people in general just don't have a primary

[23:08]it's not an insurance problem. Only 11% of people who don't have go to primary care don't

[23:16]have insurance. So the majority of people who don't have primary care have insurance. They just

[23:19]don't go. They don't know what to ask. They don't know what to expect. They don't use it or they

[23:24]can't get in because of time. So it's no surprise that there are these sort of for-profit

[23:32]and you know wellness kind of adjacent clinics or products people order. And I think it speaks to

[23:42]this idea of you know getting to the solution before we have the question and this idea that you

[23:48]can sort of be your own doctor. And Lord knows like credentials aren't everything but you do need

[23:53]training experience to be able to contextualize data. Lab tests without context are just lab tests.

[24:01]So you can have two people with the same LDL cholesterol for example. And they have completely

[24:07]completely different mechanisms by which they got there completely different lives and completely

[24:12]different needs. One needs laboratory. Another one needs you know the divorce we were talking about

[24:17]earlier because they're stressing and at night because they hate their husband. Why does that

[24:20]keep coming up? I love my husband anyway. Right or they have I have they're so genetically high

[24:28]cholesterol I can't cure it which I need to stop. Right exactly. So so I think and then the

[24:33]prenubos cans I mean I was just on a podcast and he said is there anyone who should get a

[24:37]prenubos? I said get it if you want it. If you have like a couple thousand bucks lying around

[24:42]the only person I would say to get it is someone who's like Dr. Phobic has not seen a doctor in

[24:47]30 years and likes to go into it MRI. Five thousand dollars on the ground and like we'll see it

[24:53]but like this it's just like something but that's just that's not a good answer. Yeah no. I think it

[24:59]again it gets into

[25:00]to this hyper-bit, I'm going to find something,

[25:02]I'm going to see something that would otherwise be

[25:04]undetected and that generalized anxiety,

[25:07]which is not good necessarily for any of this.

[25:09]You also have to remember that MRIs show you structure,

[25:14]but the majority of health is about function.

[25:16]So you can have a thyroid disturbance or an infection

[25:19]or depression or even breast cancer

[25:24]and have a normal MRI.

[25:26]So it's just a point in time.

[25:27]Anyway, so save your money.

[25:29]Should we all be on GLP once to combat inflammation, et cetera?

[25:33]Like, are we all, is that the future?

[25:35]We're all going to be on some maybe micro

[25:39]to high dose of GLP1?

[25:41]I like the directness of that question.

[25:42]I think I think, what are we funny if I was like, yes.

[25:46]Talk is over.

[25:48]No, no.

[25:50]I think GLP1's are the most sophisticated technology

[25:52]that's arrived on the scene in my lifetime.

[25:55]They are not a panacea.

[25:56]They are brilliant for the patients who need it,

[25:59]who have type 2 diabetes, who have obesity,

[26:02]or even who don't meet criteria,

[26:04]and are for people who want to lose 10 or 15 pounds.

[26:09]And they've done all the things.

[26:11]The exercise, the eating healthy,

[26:14]and they just can't lose weight.

[26:17]The most interesting thing about the GLP1's

[26:20]isn't their ability to help people lose weight

[26:23]and improve their metabolism, all that.

[26:25]That's amazing.

[26:26]It's the people's agency over the relationship with food.

[26:30]For people who have really struggled

[26:31]with what's now being called food noise,

[26:34]I would call it sort of ruminations about food

[26:36]and sort of a wonky relationship with food.

[26:38]It can be very empowering.

[26:41]On the flip side, it can enable restrictive eating,

[26:44]and it can enable this notion that it can enable

[26:51]restrictive eating disorder.

[26:52]I mean, that's just what's happening.

[26:53]And I think only you and with in conjunction

[26:59]with your doctor can sort of understand

[27:00]if it's right for you, the applications for GLP1's

[27:05]beyond obesity and diabetes are vast.

[27:08]Unsurprisingly though, for those of us who

[27:10]know that metabolic disease, metabolic dysfunction,

[27:13]are at the core of so many other problems,

[27:16]like vascular dementia.

[27:20]Vascular dementia is basically the consequence

[27:23]of the three problems that are metabolic problems,

[27:28]blood sugar, cholesterol, blood pressure.

[27:31]So to the extent that GLP1's hit those three things,

[27:34]they help with vascular disease, heart attack, stroke,

[27:38]and vascular dementia.

[27:40]And then of course, weight loss helps with sleep apnea.

[27:43]It helps one of my patients lost 75 or 100 pounds.

[27:48]So her arthritis and her knees, much, much better.

[27:50]She was Dr. Fobick, didn't want to go get her knees replaced.

[27:53]Now she doesn't even need a replacement.

[27:54]She will in like 10 years, but so they're pretty remarkable.

[27:58]But I don't think everyone should be on a GLP1.

[28:00]Yeah, I mean, it just feels like every day

[28:02]there's some new, generally pegged to inflammation

[28:06]where people are.

[28:08]So inflammation, that's mysterious.

[28:10]I mean, the inflammation from like, you know,

[28:12]I have strep throat or inflammation from, you know,

[28:15]I had surgery is not mysterious,

[28:17]but chronic inflammation can be from cancer,

[28:24]rheumatologic disease.

[28:25]But for a lot of people in the US,

[28:27]it's metabolic dysfunction.

[28:29]It's the three things, the blood pressure, the cholesterol,

[28:32]blood sugar.

[28:34]And so they can help with inflammation,

[28:35]which is generally good for the body.

[28:37]Yeah.

[28:39]All right, I'm conscious of time.

[28:40]Yes. Having time for questions.

[28:42]So what time do we, or is we've gone for 30 minutes?

[28:48]So we have like 15 minutes.

[28:49]15 minutes?

[28:50]What are you saying?

[28:51]Yeah. Well, we started a little late.

[28:54]We can chat.

[28:55]We can go for a few more minutes

[28:57]before we just hear about everyone's health complaining.

[28:59]Yeah.

[29:00]Are you guys ready?

[29:05]About the book?

[29:06]Yeah. So all right.

[29:07]That's a, I mean, let's talk about this.

[29:09]It has everything in it, essentially.

[29:11]If you want her deep thoughts in very

[29:15]passable succinct, you're like,

[29:17]I want to understand stroke.

[29:19]She's got you.

[29:20]Yeah. But it's in a framework.

[29:21]Do you want to describe the framework?

[29:23]Sure. The framework.

[29:25]So as my editor said, you really like making

[29:30]things more complicated than they are.

[29:31]I'm like, that is so true.

[29:32]That is way more like she nailed it.

[29:35]So so what I'm trying to do is talk about.

[29:40]So bear with me for a second.

[29:43]So the four eyes, informatics, inputs, infrastructure,

[29:53]insight, those are the four parts of your health ecosystem.

[29:59]The medical system.

[30:00]system likes to index on that informatics eye.

[30:04]So like the informatics, like your lab tests, your blood pressure,

[30:08]your BMI, your life of protein delay, your mammogram,

[30:12]all the things you can see and measure in a test tube

[30:15]or on a scan, informatics.

[30:17]But informatics is only one part.

[30:20]Your lab, the data is only one part of your health.

[30:24]And what I'm trying to help people do

[30:25]is flesh out the entire health ecosystem,

[30:28]not just for the components,

[30:29]but for how they talk to each other.

[30:32]Inputs is everything you put in your body

[30:35]from supplements and vitamins to medicines to food, alcohol,

[30:40]marijuana, whatever you're putting in your body.

[30:44]It affects your inputs.

[30:46]Infrastructure is the container you drive through life.

[30:49]This vehicle, I literally mean like the structure,

[30:51]the bones, the muscles, the joints.

[30:54]Because we take care of our cars better

[30:56]than we take care of our skeletons.

[30:59]Doctors love to say, eat better, exercise,

[31:02]and your labs will be better, right?

[31:07]But this requires care and maintenance

[31:10]and awareness of your body, awareness of your injury

[31:14]as a high school athlete that now makes your hips out

[31:17]of line and causes low back pain.

[31:21]It means understanding that your 70 in postmenopausal

[31:25]and you have a weak pelvic floor.

[31:27]And that's why your hip hurts you.

[31:28]It's not a hip arthritis that you can see on an MRI.

[31:30]It's actually postmenopausal estrogen depletion.

[31:33]So, sorry, informatics, inputs, infrastructure.

[31:39]And where does it all kind of end of landing is insight?

[31:43]Insight is, who are you?

[31:45]What are the internal narratives you adhere to?

[31:48]About the shoulds and the I can'ts

[31:50]and I'm not the kind of person who,

[31:53]where are you on the continuum of anxiety?

[31:56]We're all anxious.

[31:57]It's not that you're anxious or not.

[31:59]You are anxious because you're alive.

[32:01]Where do you travel up the continuum

[32:03]when you're triggered by vulnerability or stress

[32:06]or illness or someone in your life?

[32:08]Where are you with regard to mood?

[32:11]What brings you joy?

[32:13]What makes you sad?

[32:14]And what levers do you have to bring you back

[32:17]to your baseline?

[32:18]And it's your baseline comfortable.

[32:19]What's your relationship with food?

[32:21]Your relationship with alcohol?

[32:22]Your relationship with other people?

[32:23]Your relationship with yourself?

[32:25]Because those things inform how you eat,

[32:27]how you move, and your labs.

[32:29]So, my job is to look at the data,

[32:31]but to think about the interception

[32:33]of all these different components.

[32:34]And the book helps you frame out your health ecosystem.

[32:38]It's basically a library of questions to ask yourself

[32:41]to basically map your health ecosystem.

[32:44]And then figure out the intersections.

[32:46]Because I have patients all the time who are like,

[32:48]oh, I never thought that my,

[32:51]the fact that I was bullied on the school bus,

[32:52]someone told me 10 years ago,

[32:54]I was bullied on the school bus.

[32:55]My mom called me fat when she wasn't at age 10.

[33:02]And I developed a wonky relationship with food in college.

[33:05]And now I have type two diabetes

[33:07]and I can't get under control.

[33:09]And I need insulin, but I also need self-compassion

[33:12]for that kid.

[33:14]And permission to be human.

[33:16]Because I have adhered to this narrative

[33:17]that I'm not enough.

[33:18]And I've been like starving myself.

[33:22]So like that's health, right?

[33:24]Understanding the levers that you have.

[33:26]Your doctor won't have time to ask you those questions.

[33:28]So you can ask them of yourself.

[33:30]And then practice self-compassion.

[33:32]The most important prescription I can give people

[33:34]isn't limited or if you want it's compassion for self.

[33:38]Beautiful.

[33:40]I know, can we all be your doctor?

[33:44]You write a bit, it's not sort of core to the book,

[33:48]some of the promise of AI in terms of,

[33:51]and I loved, I don't know if you guys watched the pit.

[33:54]I love that.

[33:55]It's a great picture.

[33:56]And I loved the second season and sort of like the AI tool

[33:59]that's being forced down their throats

[34:00]and like the havoc it wreaks.

[34:02]I mean, I have, we all have feel,

[34:04]I'm sure quite ambivalent about this new arrival.

[34:08]But it does feel like in people have talked to you about this,

[34:12]that there is potential unlocks just in terms

[34:16]of administrative times that you can ask,

[34:18]you can be a therapist more than a doctor.

[34:20]Or more than a...

[34:21]Talk about this actually in the end of the book

[34:23]is that AI is here for healthcare.

[34:25]Like it's already here, right?

[34:27]And I use it for administrative tasks.

[34:30]If AI alone and Silicon Valley alone tries to reinvent

[34:33]healthcare, what's it's trying to do,

[34:35]then we run the risk of healthcare being basically

[34:37]like just more answers on steroids

[34:40]and no one asking questions.

[34:41]We take the human element of care away from medicine.

[34:45]But if we use the, if we deploy AI and point it

[34:48]to the areas where it does a great job,

[34:50]like drafting letters to insurance companies

[34:54]to tell them to buzz off or cover my patients medications.

[35:00]or writing a summary letter to my patient in English,

[35:03]so they can understand what I'm saying

[35:05]after our 45 minute appointment with a hard diagnosis.

[35:09]And then pointed to all the admin junk

[35:13]that doesn't require an MD that doctors have to do.

[35:16]And then that could elevate the relationship

[35:20]between patient and doctor.

[35:21]That's what all of us who went into medicine,

[35:25]went into medicine to do is to care for humans.

[35:29]So I think there's a real hope out there.

[35:33]There are a lot of interesting companies

[35:34]that are trying to leverage AI

[35:38]and help it rebuild primary care.

[35:40]So that primary care is the crown jewel of healthcare,

[35:43]the hub for problem solving,

[35:46]the place where people are seen and know not just their names,

[35:51]but they're diagnosed, not just their diagnosis

[35:52]but their names.

[35:54]And you don't have to refer and prescribe

[35:57]when you understand someone's whole health.

[36:01]I mean, that is a little bit idealistic,

[36:03]but if we don't dream about that,

[36:05]and we don't leverage AI,

[36:06]which is incredibly powerful to point it at healthcare.

[36:11]Yeah, it's not, it's not going to be good.

[36:13]I don't know, have you ever been in conversation

[36:15]with Alexandra Cipherland?

[36:17]She's a New York Times writer who did the diagnosis process

[36:20]or diagnosis, I can't remember, but it's a great book.

[36:23]And it's about essentially what you're describing

[36:28]is that you are an excellent diagnostician, right?

[36:32]Through being able to talk to interview,

[36:36]have curiosity about your patients,

[36:38]connect disparate pieces of information and whatnot.

[36:41]Anyway, the book is about sort of this diagnosis crisis

[36:44]and we fill in these gaps by looking for answers amongst

[36:49]all of these tests that we run on ourselves, right?

[36:51]Which often is just like, why do I feel like shit?

[36:54]Cause it's kind of shitty to be alive right now, right?

[36:57]Well, that's true.

[36:58]That's true, but and wonderful.

[37:00]But it feels, and that her point,

[37:04]the larger argument of the book is that we just get off track

[37:06]because we're whackamalling and that there's this failure

[37:10]and her point is that AI and who she talks to.

[37:12]And I guess get on open evidence if you're going to go

[37:15]and look great, it's really great.

[37:17]You get stopped if you don't have a medical license,

[37:19]you get like four searches a month or something.

[37:22]It's free for, I like that, it's free for you.

[37:25]But it is AI is actually not a good diagnostician.

[37:32]It's great for differential diagnoses.

[37:34]So what is interesting is the studies done on AI.

[37:37]Yeah, and so there are a lot of studies that show

[37:41]that AI does better than doctors at diagnosis.

[37:46]And then it's more empathetic.

[37:47]And I believe that.

[37:50]But when you do the study on any and you strip away

[37:55]the if you take away, if you control for the fact

[37:58]that those studies showed the brilliance of AI,

[38:02]but only because the the LLM was shown a cohesive story

[38:09]to begin with.

[38:10]In other words, it was asked the right question going back

[38:13]to my point, health isn't about having all the answers,

[38:14]it's about asking better questions.

[38:16]You have to be trained to ask,

[38:20]to surface the right questions of yourself

[38:24]and the person you're caring for,

[38:26]to be able to get to the answer.

[38:28]So I have patients actually just wrote this op-ed.

[38:31]I just submitted it.

[38:32]Let's just hope I should reach out to Alexandra.

[38:34]So several different ones, everyone.

[38:36]Because it hasn't been, it hasn't landed yet.

[38:38]About a patient who came in and she said to me,

[38:42]I want to be on a GLP1 because I know it's going to help

[38:44]my risk for Alzheimer's.

[38:46]And she had found on ChatDBT, but this was like a month ago

[38:50]that it can reduce her risk for Alzheimer's.

[38:53]Well, and it went on this whole thing about it.

[38:56]It didn't say be on a GLP1, but it gave her enough confidence

[38:59]to come in and say, this is what I want.

[39:00]Like I'm like in an outburger, like here.

[39:02]Yeah.

[39:03]It's like, you know, fries on the side.

[39:05]Yeah.

[39:06]And so I was like, whoa, whoa, first of all,

[39:08]there's the randomized control trial just came out showing it,

[39:11]GLP1s don't help with Alzheimer's risk.

[39:13]So there's that, right?

[39:15]I'm her.

[39:15]Yeah.

[39:18]Secondly, what is your actual concern?

[39:21]And tears come down.

[39:22]She's caring for her mom with Alzheimer's,

[39:24]watching her mom die in front of her.

[39:26]I mean, not die die, but the mother she knew

[39:29]is she's grieving the loss of her mother.

[39:32]And she's terrified.

[39:34]She's not sleeping enough.

[39:35]She's drinking too much alcohol for her body.

[39:38]She's not on home on therapy, what she needs to be on.

[39:41]So I'm like, OK, we've got to work on this stuff first.

[39:45]And empower you with more things that you actually

[39:47]can do their evidence-based.

[39:49]GLP1s aren't going to help you.

[39:50]Let's do the basics.

[39:52]So I think to the point that AI can give you

[39:55]a lot of solutions and ideas and take you down

[39:57]like rabbit holes in information.

[39:58]But generally ask yourself.

[40:00]question for us. What is your actual complaint? Is it psychosocial? Is it biological? Is it genetic?

[40:07]Or maybe you don't know what it is yet. If I was going to use AI as a patient,

[40:13]as a non-medically trained patient, here's what I would do. And I'm not suggesting

[40:17]everybody use AI. Ask it to ask you questions. Ask it to ask you questions.

[40:25]Meaning, you can put in your complaints. I can't believe I'm advertising this.

[40:29]But put your complaints in there and just like, what am I not thinking? What am I not asking?

[40:35]What are the psychosocial, like the biological, psychological, social things

[40:41]that I'm not thinking of, that I should be asking myself?

[40:45]This is only if you don't have a primary care doctor. Ideally, you have someone you can

[40:49]but again, you have to do the prep work. You got to do the advanced work. You got to be an

[40:53]empowered educated patient about yourself. First, I'll just do a PSA and then I'm going to turn

[40:59]it to questions, which is I didn't have a primary care physician because I have a dad who

[41:03]prescribes me my statins. Terrible, terrible, terrible. And then he was like, I am in a flip

[41:08]table if you don't figure this out and we live in LA. And I was like, everyone's a concierge MD.

[41:14]He's like, I doubt that's true. And I went on UCLA's website and I found a young,

[41:18]there's tons of young primary care physicians who have shits tons of availability and I was like,

[41:26]this is great. And I've been on a health journey, but she has been wonderful and it's really

[41:32]not that hard. And my dad is smug. Well, and it's just to have that partnership and to have that

[41:39]person to call. And one one organize my chart because you read about this too, like all of your

[41:45]disparate health information being all over the place. And that's right. You have a digital avatar

[41:50]that looks one way at CBS. They think you're just a tetanus shot and a and a and a and happy and

[41:56]you know, and then you take these prescriptions, which maybe some of them were 10 years old.

[42:01]And then the ER has this digital avatar of you and then your primary care thinks you're this person.

[42:05]And then when you want on vacation and you know, slice your finger. So, you know, you unfortunately

[42:13]have to bring all that data together. And one of the things I recommend is keeping a living document

[42:18]of all the different medicines you're on, your medical history. And you got to read the book to

[42:25]the whole inventory, but you get a book bag and you get a book bag. Yes, yes. Most importantly,

[42:32]okay, questions. Yes, peptides, peptides. I'm calling them nephobabes. The peptide industry is

[42:42]enjoying this sort of gold rush because they're parent, ozemphic and zet bound, which are FDA

[42:48]approved have gone through rigorous clinical trials, abundant data showing their safety and

[42:54]efficacy are now being applied to these experimental doodads that have been tested on mice.

[43:02]I may be here in a year and tell you that the Wolverine stack and BC, I can't remember at BC 100,

[43:13]is actually improving your tendon repair. But right now, all we know is that it's helping mice

[43:20]recover less from injury. A lot of people report anecdotally that they feel better

[43:27]on a peptides, experimental peptides that they are burning fat faster. But I wouldn't

[43:35]personally want to take something that was experimental. And I think it's a, I would say,

[43:42]for money. And there are sometimes often from dubious origins. Yeah, that's true.

[43:49]Yeah. I think you have to meet the people. You have to meet them. And I give you some guiding questions

[44:00]because your doctors don't love. I mean, nobody really loves to be challenged. I've been working

[44:07]in too. So you want to come and be like, are you going to just ignore me and interrupt me in

[44:14]a second? Like everybody is like, that's probably not the best way to start a relationship.

[44:19]But if you were someone who came in and said, you know, I'm really interested in having a

[44:23]partnership or like you understand me and I understand you. I understand the limitations of your

[44:27]time. I also understand, you know, I need to participate in my care and understand myself and

[44:33]my limitations and my vulnerabilities, I'd be honest with you. So like, has that sound.

[44:39]If a new patient said that to me, I'd be like, oh, my God, like cancel my afternoon.

[44:44]That's for my favorite patient.

[44:46]Someone else wants to do the work. You're like, I want to do the work. I want to, I want to trust

[44:53]you. I also like, just be honest. Yeah, that's what, that's what, that's

[45:00]So, that's what helps us help you.

[45:03]And then if you don't get that,

[45:04]make another appointment.

[45:06]Try it again.

[45:06]Sometimes you'll have a bad day.

[45:09]And it really doesn't work.

[45:10]Just find something else.

[45:13]Hello.

[45:13]Hi.

[45:14]Okay, so Dr. Jessica.

[45:16]I want you to.

[45:17]A few attrition, extraordinary.

[45:18]So excited for you.

[45:20]It's been a long time coming.

[45:21]Yes.

[45:22]So first in the question of comment,

[45:24]they don't have the answer, but then I have a question.

[45:27]The first thing is,

[45:28]do you think we can leverage AI to make like another

[45:32]million of this in France?

[45:34]Oh, my gosh.

[45:35]You're so cute.

[45:36]You know, they're trying to.

[45:37]I don't mean me.

[45:40]So it's funny.

[45:42]Like, I got approached by this AI company

[45:43]called Onyx, O-N-I-X.

[45:45]Have you were you?

[45:48]Yeah.

[45:48]Okay.

[45:49]Where they like, they like,

[45:52]my biggest question to him was like,

[45:53]why don't I just do that myself?

[45:54]Right?

[45:55]Where you like, they take all the,

[45:58]all the public pacing work you've done,

[45:59]you're writing and then they like make a little chat

[46:01]about it.

[46:02]I'm like, I'll just do that myself.

[46:03]But I don't think that's what you want.

[46:05]I think you actually need like a real human in the room.

[46:07]There's so, as you're so cute.

[46:10]As you know, there's so much nonverbal communication

[46:13]between patient and doctor.

[46:14]So much was lost in the pandemic when we were on Zoom.

[46:17]Like, I couldn't tell that one of my patients

[46:19]was developing an eating disorder.

[46:21]I couldn't tell another person when my older patients

[46:24]was losing weight and becoming more frail,

[46:26]because they just couldn't see her body.

[46:28]Yeah.

[46:28]Right?

[46:29]I couldn't tell.

[46:30]A trimmer or something like that.

[46:31]Yeah.

[46:32]Yeah.

[46:33]I'm worried nodules.

[46:34]Like, I mean, all the things you find on physical exam.

[46:36]So I don't think that that's possible,

[46:37]but thank you for the idea.

[46:39]I think it's so, you're so lovely.

[46:41]Wonderful.

[46:42]I think it's going to be one of my patients.

[46:43]Theality is so hard to find the quality.

[46:48]The full time is clear in your body.

[46:50]I mean, we have so much work today.

[46:51]We need to incentivize medical students

[46:53]and residents coming out of school

[46:56]to go into primary care.

[46:58]We need to point funds.

[47:01]Like, the class of 2025, graduating class of 2025,

[47:04]medical school was had between $200,000, $250,000 of debt.

[47:09]So if you're deciding what field to go into,

[47:12]and you look at primary care where you're underpaid,

[47:14]overworked, burned out, 50% of people are leaving,

[47:17]we're going to have 87,000.

[47:21]We're going to be short, 87,000 primary care doctors

[47:23]are 20, 37 because of this.

[47:26]So we need, like, it's going to take generations

[47:29]to make primary care placed people want to work.

[47:33]And that's going to require leveraging AI

[47:35]to do the crack work we do,

[47:37]and then having primary care doctors have fewer patients

[47:39]on their panel, and then telling students

[47:42]coming out of medical schools,

[47:43]here's what it could be like,

[47:46]500 patients instead of 5,000.

[47:49]You have 30 minutes with your 80-year-old patient

[47:52]who just left the hospital

[47:53]who was grieving the loss of his wife,

[47:56]and just broke his head.

[47:58]And then primary care becomes cool again.

[48:04]But I mean, that's what I want to do.

[48:05]That's what I hope this book does,

[48:06]but, you know, the girl's got a dream.

[48:09]Yeah, no, you're doing it.

[48:10]Yeah.

[48:11]I just want to take you back on everything else.

[48:14]In the last 14 years, I've had four different primary care

[48:17]and all of them with love.

[48:18]Yes.

[48:19]All of them who went on the air.

[48:20]So I don't know if it's like this to be me,

[48:22]but in Santa Monica.

[48:23]Yes.

[48:24]Everybody, all of the good ones go on air.

[48:26]Some of them, I have friends who were doctors.

[48:28]You are also from here.

[48:29]So my dermatologist just went off the air.

[48:32]And I have really good PPO insurance.

[48:34]You know, like, I should, for me, I'm like,

[48:36]but I'm just curious.

[48:38]So I'm in deep.

[48:39]So I started my own pet.

[48:40]I'm not a person that we can see

[48:42]in a painting doctors that they deserve,

[48:43]but like that's not happening.

[48:44]So it's an unfort.

[48:45]So I also started my own direct primary care practice

[48:48]in 2024 for the, and I don't call it concierge,

[48:52]because that implies that I went to medical school

[48:54]and abandoned like my social life for 10 years to like,

[48:58]sort of people platter on, right.

[48:59]No, but people do.

[49:01]I call it doctors empowering themselves

[49:04]by having fewer patients to do what we set out to do.

[49:08]But we are part of the problem.

[49:10]I also think we're part of the solution.

[49:12]I'm starting to think that because we're showing,

[49:15]I mean, there's more and more doctors are doing it

[49:18]because they want to provide the care they were trained to do.

[49:21]But I understand it, it separates the people

[49:24]who want to pay for it or can't pay for it for people who can't.

[49:27]So it is a terrible, terrible, sort of like societal solution,

[49:33]except that the more and more doctors who do this,

[49:37]the more and more we signal what healthcare

[49:39]really should look like for more than just people

[49:42]who can't afford it.

[49:44]So I think you understand why people do it.

[49:46]It's just, it's fraught.

[49:49]It really is.

[49:50]I mean, what, again, I hope that doctors are able

[49:55]to provide the care they, they were trained to and.

[50:00]everyone has access to a primary care medical home and that you pay according to how you can, right?

[50:07]Yeah. Oh, okay, go for it and then I'll come to you.

[50:12]I wish my husband would be here. He's a retired primary care physician for Kaiser. Yeah.

[50:18]And he always, even would be here. I would say, you people please go. We need to change the system.

[50:24]The entire country should be on the system. The country is debating. I can say you're also going to

[50:30]become a primary care physician. That it's very stable, very good. They're just becoming very young.

[50:38]And I want to know if I'll use, there's a bit of simple primary care in your work coming from you.

[50:43]Right. And she's the first year already, they're offering a job because they are a piece of luck with that.

[50:48]And she's really, she wants a special thing, but she's realizing that they lack all of primary care anyway.

[50:56]And she said it won't let me go. The country, the government should take primary, the medical school for primary care

[51:03]physician because we need them. 100% before we go to the special system, right? 100% could not agree anymore.

[51:10]I don't think it's going to happen in the federal government. Whether I don't, I love that. I think

[51:14]yes, we need to reward primary care doctors the way we pay specialists because, you know,

[51:22]preventative health maintenance and pay for medical school. 100% I don't know if the federal government's

[51:33]going to do it. There's just so much involved that I don't know if it's going to happen.

[51:38]I think that's a problem. Okay. Yeah. Right. I have a question. Yes.

[51:47]Okay. I love your whole question. Can you speak to something that we see a lot in what

[51:58]this community is saying and playing on your diagnosis that. Yes. You think you're thinking,

[52:06]oh, you're nice. Then you don't have to be there. There's a, it just feels so

[52:13]like this is not helping anything. It would be for some of that you as your fault. And I feel like

[52:21]we're going to fire. You know, possibly enough, you're not doing all the things. And I'm trying

[52:28]to do all the things, but you don't see any difference in your journey. And I just have to be

[52:34]like, I could go out and out. Yeah. I think a lot of people with chronic illness and chronic

[52:44]disease are the ones who feel the most abandoned by the healthcare system.

[52:50]Because, you know, we can't measure illness always in lab tests or in scans. There's a lot of

[52:59]suffering that isn't visible with the eye. There's a lot of suffering that is visible with the eye.

[53:06]And so I think, you know, empathy for the suffering patient is its own art. And it takes time,

[53:16]and it takes wisdom and it takes patience, which unfortunately doctors right now don't have a

[53:23]ton of, I'm not saying they're not empathetic. I'm just saying it's not made for somebody who has

[53:30]chronic illness that isn't always measurable in the blood test. Like mental illness, for example,

[53:39]or patients with long COVID or chronic Lyme or diseases that the medical industry has kind of

[53:46]shamed and blamed patients for. And then, you know, we're not always the most self-aware bunch

[53:52]either doctors. We are just because we went to medical school, it doesn't mean we're the most

[53:57]sort of self-aware or like, right? So I think, you know, grace for doctors, grace for self,

[54:06]can go a long way. And like I said, the most important prescription I write in my office sometimes

[54:10]isn't for lipaturates for a self-compassion. But, you know, that can, that can, that can be healing

[54:19]for some people. It can feel dismissive for other people. So. I feel like it's in general not directly

[54:26]from doctors necessarily. It's just like culturally. It just feels like this. Yeah. Yeah. I mean,

[54:33]there's it's part of the like the it's the shadow side of autonomy and being empowered and

[54:40]being responsible. And then the flip side is that like you create your entire world and your

[54:47]responsible for your cancer, your responsible for your diabetes, whatever it is, it's the

[54:51]shadow side. And so I can all things. It's finding this balance of taking care of yourself.

[55:00]being proactive, sure, of course,

[55:02]and recognizing like we're not that powerful, right?

[55:06]So it's finding somewhere in the middle,

[55:09]and yes, like the culture of wellness,

[55:12]which tends to be very appealing to up to my person,

[55:16]perfectionists, and all of us who think we can like

[55:19]behave our way into the desired outcomes of life.

[55:23]It's a very dark underbelly that generates a lot of shame

[55:28]and a lot of we're taking responsibility and blaming

[55:31]ourselves for things that are just shitty luck.

[55:34]Yep.

[55:34]That's right.

[55:36]And like this idea that willpower is sort of inoculates you

[55:41]against discipline, all of these things.

[55:43]Yeah.

[55:45]I promised I would come back to that.

[55:46]Oh, yes, yes, yes, yes.

[55:49]It's one of the older times when I claim that older doctors

[55:54]are so happy with the system and all of their requirements

[56:00]in between computers and AI.

[56:03]There's a lot of them are retiring, and young the doctors

[56:09]go on these times that the way the systems

[56:12]can be felt in the validation of either,

[56:16]that it is about the bottom line,

[56:19]about the times of the term.

[56:21]It's the older doctors, I think, or you know,

[56:26]move up with the kind of practice you're talking about,

[56:29]and even the emotional kind of information.

[56:32]So is it in the freeze that the doctors are getting

[56:38]out of your doctors and getting in medical school,

[56:42]you know, you suggested to move just that more focused

[56:47]on compassion and empathy spending time,

[56:51]and not just putting your hand in the computer,

[56:55]is there talking to a patient?

[56:57]Yeah.

[56:58]Just seems like a lot of forces that are in conflict right now.

[57:03]I totally hear you.

[57:05]Yeah, I hear you loud and clear.

[57:08]I'm not sure it's the training.

[57:09]I mean, I think, you know, humanism in medicine

[57:13]is really emphasized quite a lot.

[57:16]I think that it's not realistic in fact

[57:19]this with the current payment model in health care.

[57:24]So the payment model incentivizes doctors

[57:28]just treating volume with the patients.

[57:31]So volume, not outcomes.

[57:34]So you, I mean, I mean, this is why doctors are burning out.

[57:39]is because they go into medicine with idealistic desire

[57:46]to help other people, to heal, who not all doctors,

[57:51]some of them just want to, I don't know,

[57:53]they go for different reasons.

[57:55]But, and then they go into the field of medicine.

[57:58]And this was me too.

[58:00]And you see what the system is requiring of you.

[58:05]I mean, that was why I went into primary care

[58:08]is because I wanted to be that person that people went to.

[58:12]I remember I was at Hopkins where I did my residency training.

[58:16]And I was an ICU and a patient, a young patient

[58:19]died from ovarian cancer in the hospital

[58:22]with like chest compressions and tubes.

[58:24]And I learned later.

[58:27]And this was, I was like young.

[58:28]And so I hadn't had experience with this kind of thing.

[58:31]Of course, I realized after she died that her family hadn't

[58:35]been given the option of hospice.

[58:38]They hadn't talked about like end of life, quality of life.

[58:41]I mean, she was young, but still,

[58:44]the prognosis was really grand.

[58:45]So I remember thinking to myself,

[58:48]I want to be the doctor who has a conversation

[58:50]with that person, like an honest conversation.

[58:52]Maybe she wants to be in the hospital full court press

[58:55]to the end.

[58:57]My point is, this is why doctors burn out.

[59:00]It's because they were trained to do the humanism,

[59:03]the understanding of the whole person,

[59:05]and then the system, the payment model,

[59:07]means they have got 10 people in the waiting room

[59:09]who are pissed off, because they're being seen late.

[59:13]And they've got 10 minutes, and they've

[59:15]got an 80-year-old patient who's got 15 medicines, five

[59:18]questions, and has a mole that needs to be looked at.

[59:23]Do you know what I mean?

[59:24]So it's the pain that's gone off, and it's a 100%.

[59:29]But it means that then the system's

[59:33]representing and focused on finding the pain

[59:37]that it's going in the wrong direction.

[59:41]It is.

[59:42]It's the kind of care that you're talking about.

[59:43]It is.

[59:44]That's why doctors are leaving, and doing concierge medicine,

[59:48]as much as I don't like the word, that's what it is.

[59:50]I mean, that's what, right?

[59:53]That's why doctors are leaving the field of medicine,

[59:56]and why doctors are being replaced by nurse practitioners

[59:58]and PA's to arm.

[60:00]Wonderful, by the way, I love the PAs and NPs that I work with,

[60:03]the ones who understand health in a nuanced way.

[60:06]And it's why people are on chat, TBT.

[60:10]And why we run the risk of health care in 10 years being chat bots

[60:14]with a physician assistant for their license.

[60:17]And I will be on a shelf, like a relic of the past, like I'm in a museum.

[60:21]I mean, I won't be in a museum, I'll be just like, you know?

[60:24]Oh, that's great.

[60:26]Great grandmother Lucy, who used to talk to patients.

[60:29]One more.

[60:30]Okay.

[60:31]Okay.

[60:32]Sorry.

[60:33]The topic of training.

[60:35]I work for now, it's 32 years at Taylor School Medicine on the same presentation.

[60:41]Oh, oh my gosh, you're the person who would, that's amazing.

[60:45]And all of us are actors.

[60:49]And they train us extensively for each individual case.

[60:55]of people that you're talking about.

[60:58]That's hilarious.

[60:59]That's amazing.

[61:00]It makes sense of that story of our family and our work and all of that.

[61:05]And we work with the students.

[61:08]And every time you get to talk to them, they go, yeah,

[61:12]I was in clinic, doing, you know, actual rounds.

[61:16]It was the way I could do that.

[61:18]Right.

[61:19]And it's sort of disheartening.

[61:22]So they are trained a lot.

[61:25]Every year of months, who will age the way on.

[61:29]They call it doc.

[61:30]They used to call it bits like that.

[61:32]It's doc training caller or.

[61:35]And they all have to do it.

[61:37]And they most of them really could tell how much they love it.

[61:40]And she used to only think about how they're communicating and interacting.

[61:46]Not about the medicine part.

[61:48]They love doing this.

[61:49]And then they feel like they can't really replicate that time and care.

[61:56]And watching us,

[61:58]help you react.

[61:59]Like watching our face fall at an answer.

[62:03]They're changing their blood water expressions and.

[62:06]Ask questions in an open ended way.

[62:09]And all these kind of stuff things that.

[62:12]When they get in the world, they're like,

[62:14]they get stripped away.

[62:17]I've taken.

[62:18]I've held you over time because you still have to sign books.

[62:21]Thank you guys so much for coming.

[62:23]At least thank you for.

[62:24]Oh, my daughter.

[62:25]Yes.

[62:26]Thanks.

[62:27]Oh, thank you.

[62:28]Just in the first book.

[62:31]I just want to ask what was your favorite for writing.

[62:34]Oh, thanks, Sally.

[62:36]My favorite part of writing it.

[62:40]There are a lot of course I didn't like about writing it.

[62:43]Including what my editor told me that the first three chapters

[62:46]was not going to not going to work.

[62:49]I think.

[62:51]I think sort of living the process that I talk about in the book,

[62:55]which is like accepting the things you can't control.

[62:58]I think of health as like a.

[63:01]Version a secular version of the serenity prayer.

[63:04]Where wisdom comes from realizing what you can't control and

[63:08]realizing where you have agency and knowing the difference.

[63:11]So I think I realize like I don't really enjoy the process of

[63:17]solitary writing and but I also enjoy the process of like

[63:21]exploring my own interior landscape.

[63:25]And then letting go of the fact that my editor had a lot of criticisms

[63:29]and just like the whole process of putting the book out there.

[63:32]Like this is amazing.

[63:33]But like behind the scenes and like.

[63:35]I don't know.

[63:38]And so it's so I think I just learned a lot.

[63:42]As you and I are talking about driving over here.

[63:45]The best part of this is like meeting new people,

[63:48]connecting people with ideas, having a light bulb moment go off

[63:53]and somebody in the audience and just meeting cool people,

[63:56]like a lease.

[63:57]And so it's a long way of answering your question.

[64:02]Thank you.

[64:03]All right.

[64:06]Thanks everyone.

[64:33]Thank you.

[65:00]You