Why is it so hard to navigate medical diagnoses ?

(00:00:01):All right, we’re live.(00:00:03):So welcome.(00:00:05):Hey, Bruce, it’s good to see you.(00:00:07):Good to see you, Debbie.(00:00:09):So you and I have been talking and I have so many questions for you because you’re a physician.(00:00:17):You’re a physician scientist.(00:00:19):You are the go-to for so many people about questions about medicine and questions(00:00:26):about what to do when people Google all the questions that they have about all(00:00:31):kinds of medical issues that they’re experiencing.(00:00:34):So I hope that you don’t mind if I ask you a few questions today.(00:00:39):Sure, because everything on the internet is completely accurate and correct.(00:00:44):Yes,(00:00:44):you know,(00:00:45):that’s my first question for you is,(00:00:47):why is it so hard to navigate medical diagnoses?(00:00:50):Because,(00:00:50):like you said,(00:00:51):we have AI,(00:00:52):we have Google,(00:00:53):and we have so much information at our fingertips.(00:00:56):So why is it so hard?(00:00:59):Well, the problem is you have to look at where the information is coming from.(00:01:03):I mean, the internet is like one big...(00:01:06):Uh, it’s like a, uh, gigantic public restroom.(00:01:10):You know,(00:01:10):you really can basically,(00:01:12):uh,(00:01:12):I say like,(00:01:13):if you see something on the internet or anywhere in internet,(00:01:16):it could be the equivalent of following what you see written on a bathroom store(00:01:21):stall in a public restroom.(00:01:22):You don’t know who wrote it.(00:01:24):You don’t know where it’s coming from.(00:01:25):It may not be.(00:01:26):verified uh there’s lots of people talking about lots of different things uh you(00:01:31):know nowadays i i watched the other day there was a video about someone talking(00:01:36):about um uh like geopolitics and that person was like a fitness person so you know(00:01:45):you you(00:01:46):Just don’t know.(00:01:47):Everyone has their fingers out there.(00:01:49):So you’ve got to be careful.(00:01:51):And then when you’re dealing with your health, there may not be do-overs, right?(00:01:56):So once you do something with your health, you may not be able to... Again, it’s not like...(00:02:03):getting uh information on i don’t know your sports team or getting information on a(00:02:12):tv show or movie you know okay if it’s wrong it’s wrong uh or fashion okay uh it(00:02:17):could be disastrous if it’s fashion but you can recover you can recover from i’m(00:02:22):living proof that you can recover from fashion disasters(00:02:26):So,(00:02:27):but,(00:02:28):but yeah,(00:02:28):health,(00:02:29):health mistakes can be very costly and costly also in terms of suffering and even(00:02:34):in your life.(00:02:36):Absolutely.(00:02:37):So, so we have all of these things at our fingertips.(00:02:41):It feels like we should be using these all the time because we use them for so many things.(00:02:46):So,(00:02:50):So it’s still hard for us, though.(00:02:51):So what is one thing that you look for when you’re navigating a new diagnosis?(00:02:57):Say you’re diagnosed with something.(00:02:59):What do you do?(00:03:00):Because I know I go to Google, or nowadays I go to AI, and I type in everything I know about it.(00:03:06):So what do you do, and what do you say we should do?(00:03:08):Well,(00:03:08):it’s interesting because we have to remember,(00:03:10):you know,(00:03:11):information is not necessarily—more information is not necessarily—(00:03:15):good right so more information is just more information and if it’s misleading(00:03:21):information it actually makes things worse uh so there is still you know a(00:03:27):significant role for people with expertise in an area that can help you digest the(00:03:32):information that’s out there um(00:03:35):One thing you have to be careful about if you do get some type of medical diagnosis.(00:03:40):Well, first of all, like where are you getting the medical diagnosis?(00:03:43):Right.(00:03:44):So there’s a difference between you are convinced that you have a problem.(00:03:51):I’ve seen this many times.(00:03:52):Right.(00:03:53):People will be like, oh, my goodness, I have such and such symptom.(00:03:58):Therefore, I must have.(00:04:01):Leprosy or something like that.(00:04:05):Well, okay, you’re self-diagnosing yourself, so you’ve got to be careful about that.(00:04:10):There can be many subtleties in diagnosis.(00:04:12):If you do have a symptom,(00:04:14):it’s better to get it checked out by a professional,(00:04:17):someone who can actually determine how best to diagnose it,(00:04:23):what kind of tests to take and those things like that,(00:04:26):or tests to get.(00:04:27):Let’s say I go.(00:04:28):Say I...(00:04:30):I Google something, right?(00:04:31):And I find out that I say, oh my gosh, all my symptoms, whatever.(00:04:35):And I go to the doctor and I decide I’m going to get an actual real diagnosis.(00:04:41):Now I get a diagnosis.(00:04:43):What do I do next?(00:04:45):Because it’s overwhelming.(00:04:47):When you get a diagnosis, then the next thing I want to do is run out and look it all up again.(00:04:53):What do you do next?(00:04:55):Well,(00:04:55):so,(00:04:56):uh,(00:04:56):so one of the first things that you want to make sure is when,(00:04:59):if you do get some type of medical diagnosis,(00:05:03):um,(00:05:03):that the person who’s giving you the diagnosis,(00:05:05):like a doctor,(00:05:07):uh,(00:05:07):for instance,(00:05:08):um,(00:05:09):Doesn’t just give you the diagnosis and say,(00:05:13):oh,(00:05:13):you’ve got,(00:05:13):you know,(00:05:15):gigantic,(00:05:17):superior,(00:05:17):such and such,(00:05:19):such and such.(00:05:20):And then just say, have a good day.(00:05:22):Walks out the door and you’re done, right?(00:05:24):I mean, that can be, first of all, you’re like, okay, what does that mean?(00:05:29):Is that bad?(00:05:30):Is that good?(00:05:30):Or et cetera.(00:05:31):So you need to get the lowdown on what this actually means.(00:05:36):So how do you do that?(00:05:39):Let me ask this.(00:05:41):I know when I go in, I’m stunned if I get something.(00:05:46):I’m going to be stunned.(00:05:47):What do I do?(00:05:49):And who carries a pad and paper around with them?(00:05:51):And I don’t write notes in my phone.(00:05:54):So what do I do when I first get a diagnosis from a doctor and I’m in there and I’m stunned?(00:06:00):What do I do?(00:06:01):What do I say?(00:06:02):Yeah, so...(00:06:05):Of course,(00:06:05):the most experienced doctors and the best doctors will understand that you won’t be(00:06:10):able to digest all the information,(00:06:12):especially if it’s a significant diagnosis,(00:06:14):unexpected or significant diagnosis.(00:06:16):So you’ll see they’ll say things like,(00:06:18):okay,(00:06:19):I understand this might be a little surprising or stunning,(00:06:23):etc.,(00:06:24):and they’ll tell you the information,(00:06:25):but they say,(00:06:26):I understand that if you have additional information,(00:06:28):you can always contact me,(00:06:30):or these are the resources.(00:06:31):They’ll give you the next possible steps.(00:06:34):Now, of course, the problem is not all health professionals, not all doctors are created equal.(00:06:40):It’s just like anything.(00:06:41):There is any profession, any role, there’s a range of people.(00:06:50):There are(00:06:51):Yeah.(00:06:52):Fabulous, very gifted athletes.(00:06:55):And then there are average athletes and then there are people who are not so great.(00:06:58):Same thing with musicians.(00:07:00):Same thing with teachers.(00:07:01):Same thing with every profession.(00:07:03):So, yes, that’s one thing.(00:07:05):You want to look for a doctor who will understand where you’re at and help you(00:07:13):understand your diagnosis.(00:07:15):Okay.(00:07:16):That being said, if in that situation...(00:07:20):the doctor doesn’t do that,(00:07:22):then you should tell the doctor,(00:07:24):you should say,(00:07:24):look,(00:07:26):all right,(00:07:26):I am just be honest.(00:07:27):I am a little surprised.(00:07:29):I’m not sure what this means.(00:07:30):I’m a little stunned, et cetera.(00:07:33):I do have some questions now or, or I’m not sure what to ask.(00:07:38):You, you be honest and also say, if more questions come up, what do I do?(00:07:43):Who do I contact?(00:07:45):Put the(00:07:46):the health professional on the spot.(00:07:48):They shouldn’t be able to kind of just leave and leave you with no,(00:07:51):no,(00:07:52):no resources with no recourse.(00:07:54):Yeah.(00:07:56):So,(00:07:56):and then if you,(00:07:58):and I’ve seen this before too,(00:07:59):like if you leave the actual office,(00:08:02):the actual room,(00:08:03):because that can be,(00:08:04):you know,(00:08:05):sometimes those rooms are confining and you’re like finally out in like a little(00:08:08):more fresh air in the waiting room,(00:08:10):you can ask the office,(00:08:12):say,(00:08:12):hey,(00:08:12):I have more questions.(00:08:13):Or if I have more questions, whom do I talk to?(00:08:17):How do I get in touch with the doctor or health professional?(00:08:20):If there’s no way of getting in touch with them, then you may have the wrong doctor.(00:08:24):You may have the wrong health professional.(00:08:26):You may have the wrong clinic setup because that’s(00:08:29):Not,(00:08:29):you know,(00:08:31):anyone who is experienced and understands this situation knows that,(00:08:36):like,(00:08:37):yeah,(00:08:37):you’re absolutely right.(00:08:38):You can’t have all the questions right then and there.(00:08:41):It’s like being put on the spot, right?(00:08:44):You must ask all the questions now or everything closes.(00:08:47):This isn’t jeopardy, right?(00:08:48):You won’t get up there and just say, tell me, you know, the question.(00:08:53):And then, no, it’s too late.(00:08:55):You know, I I’ll tell you, I don’t ever go in with questions.(00:08:58):I go in and I’m like, what?(00:08:59):And then I leave and I’m like, wait a second.(00:09:01):I have a ton of questions.(00:09:03):My husband goes in and he’s got a list like this,(00:09:05):you know,(00:09:06):like four feet long of all the questions.(00:09:08):He’s super amazing at that.(00:09:10):But I go in and it must be anxiety or something.(00:09:13):I go in and I am not able to do that.(00:09:15):So for people like me and even for my husband, who then has more questions after he leaves, I(00:09:23):What do you do next when you have more questions?(00:09:27):You leave and then you say, oh, I was too stunned.(00:09:30):I couldn’t ask any questions.(00:09:31):What do I do now?(00:09:33):And you’re sitting there.(00:09:34):The next thing you want to do is go to AI or go to Google.(00:09:38):So what do you say we should do?(00:09:40):Yeah, so I think everyone should just bring your husband to the... Bring my husband.(00:09:45):It might keep him a little busy.(00:09:47):You know, he might like go to maybe about a spouse.(00:09:50):He’s a great guy.(00:09:51):Yeah, yeah.(00:09:53):You know, so one is you have to understand how you might react.(00:09:58):So it’s helpful to have another person there if possible.(00:10:04):So if you do have a significant other,(00:10:06):a family member or something of that sort,(00:10:08):especially one that you know.(00:10:11):is like that,(00:10:11):that can basically,(00:10:13):uh,(00:10:14):quickly jump to questions and,(00:10:16):and,(00:10:16):you know,(00:10:16):listings and organize in that manner.(00:10:18):Uh,(00:10:19):you know,(00:10:19):someone who,(00:10:20):who,(00:10:21):who can cover sort of your blind spots because everyone has blind spots,(00:10:25):uh,(00:10:26):that can certainly help.(00:10:28):Um, there, you know, you,(00:10:30):Bring a pad and pencil to take notes and those things like that.(00:10:33):That’s another possibility.(00:10:35):So one, of course, is to have something or someone that can help.(00:10:40):And then also...(00:10:42):something that people may do is they’ll bring an outline.(00:10:45):They’ll bring an outline of their questions and those things like that.(00:10:47):Like you said, your husband does that.(00:10:51):I don’t.(00:10:51):But you can’t do it yourself.(00:10:53):You can try doing it.(00:10:54):And if you still can’t do it, you can get someone else to remind you or do it for you.(00:10:59):That can certainly help.(00:11:01):So, but even...(00:11:04):I have a question for you.(00:11:06):Sorry,(00:11:06):I didn’t mean to cut you off,(00:11:07):but I bet you wrote down because you bring questions everywhere,(00:11:12):right?(00:11:13):Yes, exactly.(00:11:14):What if you this allowed?(00:11:16):I don’t even know if it’s allowed,(00:11:17):but you know how you on your cell phone,(00:11:19):you have a record button and you can record conversations.(00:11:23):Is that allowed?(00:11:24):Because I wonder if I were able to play it back and even even I went one step(00:11:30):further and I played it back and I transcribed it and I could read it and even get(00:11:34):a summary.(00:11:35):That might be helpful to me.(00:11:37):Is that allowed?(00:11:39):So there are actually I’ve actually run into doctors who actually encourage that.(00:11:43):They’ll say, hey, record this, et cetera, blah, blah, blah.(00:11:46):But don’t assume that that’s going to be the case with all doctors and all health(00:11:50):professionals.(00:11:51):So you can ask.(00:11:53):There might be reasons why they don’t want things recorded.(00:11:56):You know,(00:11:58):naturally,(00:11:58):some people feel uncomfortable talking and they kind of change their tone when they(00:12:02):feel like they’re being recorded and there’s things like that.(00:12:05):But you can ask.(00:12:06):And if they say yes...(00:12:09):By all means.(00:12:10):If they say,(00:12:11):no,(00:12:11):I’d rather not,(00:12:12):et cetera,(00:12:12):then what you can do is you say,(00:12:13):well,(00:12:14):here’s the challenge.(00:12:15):I’m not going to remember this stuff.(00:12:18):Or, you know, I may not ask the right word.(00:12:21):I’m feeling anxious or, you know, just be honest about how you feel.(00:12:26):And then they may be able to, like, bring in a scribe or someone like that.(00:12:30):So that’s another possibility.(00:12:32):They might have someone else who can take notes for you in the office.(00:12:37):So ask.(00:12:38):The thing that I want to emphasize is be yourself.(00:12:42):Be honest.(00:12:43):Be honest about how you feel about things.(00:12:47):I have seen situations, and I knew people like this.(00:12:50):For instance,(00:12:51):there’s someone that I knew,(00:12:53):but basically he would just talk big and all these things like that.(00:12:57):Once he got into the doctor’s office,(00:13:00):clam shut there’s a lot of people like that and basically wouldn’t ask anything and(00:13:06):and also would like um uh you know how there’s some folks that when they will go to(00:13:13):the doctor’s office they’ll like put on all their makeup and or whatever or try to(00:13:18):dress nicely they want to impress the doctor and i’m like(00:13:23):What do you think this relationship is?(00:13:29):You’re not interviewing for a job, right?(00:13:32):The doctor might say, oh, well, your blood pressure is good.(00:13:35):Your temperature is good.(00:13:36):Why don’t we hire you?(00:13:37):Now, they’re not going to say that.(00:13:39):They’re there to actually figure out what your situation is.(00:13:42):It’s best to just kind of go in.(00:13:44):Naturally, you don’t want to come in and say...(00:13:46):I haven’t showered in six days.(00:13:48):Can you exact?(00:13:49):Don’t do that no matter what.(00:13:51):Whether you take the doctor or not.(00:13:55):General hygiene is a good idea in general.(00:13:58):But when it comes to revealing your concerns or your worries or stuff like that,(00:14:05):those can be important clues to the doctor.(00:14:07):Yeah.(00:14:08):Of your situation.(00:14:10):But also it facilitates...(00:14:13):honest exchange.(00:14:14):Now,(00:14:14):actually,(00:14:15):I wrote about this,(00:14:18):not this specifically,(00:14:19):but I wrote about relationships in general for a funny bone to pick column that I(00:14:28):have for Psychology Today.(00:14:30):And I wrote that in general,(00:14:33):with most relationships,(00:14:34):most close relationships,(00:14:37):honesty and being frank(00:14:38):It’s important, right?(00:14:39):Because then the other person can understand what you need,(00:14:42):where you’re coming from,(00:14:43):and those things like that.(00:14:44):I would throw in the doctor-patient relationship into one of those close(00:14:49):relationships because that’s what you want to establish with the doctor.(00:14:52):So if you’re not frank about something, you’re not going to get the best diagnosis.(00:14:57):You’re not going to get the best treatment, and you’re not going to get the best care.(00:15:00):Yeah.(00:15:02):Yeah, that makes total sense.(00:15:04):Oh,(00:15:04):and the one thing I should add is if you’re worried about being embarrassed or(00:15:08):anything like that or startling the doc,(00:15:13):if a doc’s been around long enough,(00:15:15):they’ve seen all kinds of stuff,(00:15:17):all right?(00:15:19):The chances of the doc or being embarrassed by something you say or do is very,(00:15:25):very low because the stories that I could tell,(00:15:29):what you see in the emergency room,(00:15:31):in the clinic,(00:15:33):Usually,(00:15:33):like,(00:15:34):you can one-up that whatever,(00:15:36):like,(00:15:36):embarrassing thing you think you have,(00:15:41):most likely the doc has seen,(00:15:44):like,(00:15:44):dozens of things a lot more embarrassing.(00:15:47):So don’t worry about that.(00:15:50):Or make that a challenge that you have the thing that’s going to one-up all the others.(00:15:53):Try to be as embarrassing as possible.(00:15:56):Exactly.(00:15:57):In general, yes.(00:15:59):So what are some tips that you’d give to friends and family to support someone who(00:16:04):has just received a diagnosis?(00:16:06):Say someone goes to the doctor,(00:16:08):they get a diagnosis,(00:16:10):they come home,(00:16:11):and they tell their family and or friends that they have a diagnosis.(00:16:14):Okay.(00:16:15):Yes.(00:16:15):So here’s what not to do first.(00:16:18):Okay.(00:16:18):Don’t offer, like, your...(00:16:22):quote-unquote expert opinion.(00:16:24):I’ve seen this happen so many times.(00:16:26):Like, someone will, let’s say, oh, they’ve been diagnosed with such and such.(00:16:29):And I’ve seen these,(00:16:30):like,(00:16:30):group dynamics where,(00:16:31):like,(00:16:32):they’re surrounded by all these friends,(00:16:34):either,(00:16:34):like,(00:16:34):in real life or in,(00:16:35):like,(00:16:35):a Zoom meeting or something of that sort.(00:16:37):Yep.(00:16:38):And suddenly everyone has an opinion and they’re offering like bits and pieces of stuff.(00:16:43):And it can be completely out of context.(00:16:47):Like it can be about themselves or, you know, Oh yeah, I know someone, uh, uh, who has that.(00:16:52):And, uh, you know, and their head fell off, you know, something like some, you know, you, you,(00:16:57):people will always like give you the most,(00:17:00):either the extremely worst situation or an extremely best situations and may not(00:17:05):relate to like your diagnosis at all.(00:17:08):So it can be perilous.(00:17:10):So, uh, so the one thing that friends and family should do first is they should listen.(00:17:16):Okay.(00:17:17):Um, and they can say,(00:17:19):what can we do for you?(00:17:20):How can we help you?(00:17:21):What do you need from us?(00:17:23):Rather than immediately dive into like,(00:17:25):either let me offer you the 50,000 observations that I have about this or the(00:17:32):50,000 things I read about in the,(00:17:33):in the,(00:17:34):on the internet about this,(00:17:35):or I heard on social media about this,(00:17:38):or let me problem solve it.(00:17:41):And, uh, you know, uh, this is what I’ll, I’ll, I’ll,(00:17:47):dunk you in hot water and cover you with Vicks Vapor Rub or something like that.(00:17:50):Hey, that’s a good idea.(00:17:52):Yeah, that can be a good idea, but in all situations.(00:17:58):And so I would say basically first you want to figure out, okay, how can we help you?(00:18:04):What can we do for you?(00:18:06):Then what you can do,(00:18:07):you know,(00:18:07):one of the things that you really can do is help facilitate connections with the(00:18:12):right experts,(00:18:14):right?(00:18:14):The right place, the right, et cetera.(00:18:17):Because...(00:18:18):So doing some of the research for them to help them?(00:18:21):To get them... Other doctors, second opinions.(00:18:26):Yeah, plugging with the right professionals.(00:18:30):Now, I want to contrast this with...(00:18:33):offering your own opinions about the situation versus plugging you in with the(00:18:37):right professionals so how does somebody know it is the right professional like i(00:18:41):don’t know that i trust everyone myself included to pick the right professional you(00:18:46):know how do we know who the right one is(00:18:50):Yeah,(00:18:50):so I remember I actually wrote about this in Forbes,(00:18:55):basically about,(00:18:57):oh,(00:18:57):I don’t know,(00:18:57):six,(00:18:57):seven years ago.(00:18:59):And how do you choose it?(00:19:00):And I started off by writing about, like, how you don’t choose the right professional.(00:19:06):One is be very careful about, like, rankings or rewards and all those things like that.(00:19:12):Really?(00:19:12):I’m surprised about that.(00:19:14):Why?(00:19:14):Yeah.(00:19:15):Well,(00:19:15):because a lot of those things are very political and there’s people who are(00:19:18):actively seeking out,(00:19:20):campaigning to try to get these things,(00:19:22):like be named the best such and such or what have you.(00:19:26):They may be really good or they may be the type of people who just like are(00:19:30):self-promoting,(00:19:31):self-marketing.(00:19:32):Oh, so some of those awards like Super Doc are political?(00:19:39):Yeah, because someone’s choosing them, right?(00:19:42):Sometimes you don’t know who’s choosing them.(00:19:44):So they’ll just say, they’ll give you a list.(00:19:46):Oh, these are the best thoughts.(00:19:47):You’re like, how did they come up with this?(00:19:49):Who’s choosing them?(00:19:51):Is it one person?(00:19:52):Is it a group of people?(00:19:52):Are they qualified?(00:19:55):Can they be lobbied?(00:19:56):Can someone give them gifts?(00:19:59):Who knows?(00:20:00):I don’t know how these are actually chosen.(00:20:02):And so what I’ve seen,(00:20:05):knowing the different docs that have gotten these awards,(00:20:07):in some cases,(00:20:08):it is deserved.(00:20:09):And in other cases, it’s like,(00:20:12):I’ve been around situations where we open a magazine and we’re like,(00:20:16):that person’s listed as best doc.(00:20:20):Yeah.(00:20:20):Like that.(00:20:21):So I would say don’t really rely on those awards things.(00:20:26):Sometimes actually the best docs are the ones who never get awards because they are(00:20:32):so focused on taking care of patients that(00:20:36):They are so focused on doing the right thing that they don’t promote themselves.(00:20:40):And they’re also very humble folks, et cetera.(00:20:43):So they don’t really seek this.(00:20:44):How would you know if that’s a good doc?(00:20:46):There’s no Yelp out there for doctors.(00:20:48):So unfortunately,(00:20:49):this is an unfortunate thing,(00:20:51):but you have to rely on people who are in the know.(00:20:55):So people who actually are in the system and know the different docs, know how they act,(00:21:05):and, and know how they act when no one’s watching.(00:21:08):So,(00:21:09):so many times you can get that information from nurses,(00:21:12):from people who,(00:21:13):who trained as,(00:21:15):uh,(00:21:15):you know,(00:21:16):medical students or residents,(00:21:18):interns or residents under these different docs,(00:21:21):uh,(00:21:22):Those folks are many times are the flies on the wall because when,(00:21:26):you know,(00:21:26):people that work at the front desk or the office people,(00:21:29):are those good?(00:21:29):You get a sense.(00:21:31):Now,(00:21:32):so you can get a sense from them on how kind the doc is,(00:21:36):how responsive the doc is,(00:21:38):et cetera.(00:21:39):You may not be able to get(00:21:41):information from them about the clinical knowledge or the skill when it comes to(00:21:49):procedures or surgeries or those things like that because they may not have the(00:21:53):background to judge that.(00:21:55):Uh, but it is similar in the sense that these are folks that are, have worked with the person.(00:22:00):Now,(00:22:00):of course,(00:22:01):sometimes if there’s someone who’s actively still working for a doc,(00:22:05):they may not want to say,(00:22:07):tell you the truth because,(00:22:08):you know,(00:22:09):so the best situation is,(00:22:11):are people who have seen many different docs,(00:22:14):aren’t necessarily beholden to those docs,(00:22:16):uh,(00:22:17):and can,(00:22:17):and can give you the sort of the,(00:22:19):the lowdown,(00:22:20):um,(00:22:21):So one of the things that I suggest is think about who you know that’s in the(00:22:28):profession and see if you can ask them.(00:22:31):And they might either be able to give you a direct answer or they might say,(00:22:36):hey,(00:22:36):I don’t know,(00:22:37):but here’s some folks that may know.(00:22:42):And then you basically see this in every profession.(00:22:45):Whatever profession you might be in, you tend to know(00:22:50):who the good and not so good people are.(00:22:55):You tend to know the quote-unquote dirt on folks, right?(00:22:59):Whatever profession you’re in,(00:23:00):like if you are in construction,(00:23:04):you probably know who are the good and the bad folks in construction.(00:23:11):If you play a certain sport, you happen to know more details of people who play that sport.(00:23:17):It’s the same situation.(00:23:19):So what if you also ask, I’ve asked this of my doctor.(00:23:24):I’ve had pretty good relationships with my physicians in the past just because,(00:23:28):you know,(00:23:28):you go year after year and you get to know them and you get more comfortable.(00:23:32):And I’ve asked in the past, who do you go to for these things?(00:23:37):And then I can find out because I’m thinking to myself, I know you’re a good doctor.(00:23:42):You must like to go to good doctors.(00:23:44):And that has been able to give me a sense.(00:23:46):I don’t know if all doctors give that information out, but(00:23:51):finding out who the doctors go to could be useful, too.(00:23:55):Yeah, it can’t hurt.(00:23:56):Like,(00:23:56):you know,(00:23:57):the worst that could happen is the doctor will say none of your business or(00:24:01):something like that.(00:24:03):But, you know...(00:24:06):I would say if you’re asking, hey...(00:24:08):Who would you go to?(00:24:10):And do you go to somebody for this?(00:24:12):You know, you don’t just put them on the stand, ask them a question.(00:24:15):But if you have a relationship with your primary care doctor,(00:24:19):you could ask that of them,(00:24:21):I think.(00:24:22):I would suggest not like grabbing a spotlight and saying, who do you go to?(00:24:26):For your last visit.(00:24:28):Yeah.(00:24:31):Answer me in 10 seconds.(00:24:34):Yeah.(00:24:34):But yeah, certainly.(00:24:35):Well,(00:24:36):you know,(00:24:37):that’s another reason why it’s important to have a good relationship with your(00:24:43):doctor.(00:24:44):Yeah.(00:24:44):You feel like you can have an honest conversation about almost anything.(00:24:49):And so that’s something that’s actually been de-emphasized in recent years,(00:24:56):in big part because you have these health systems that(00:25:01):that like are are treating um clinical care like assembly lines and say oh you know(00:25:10):you can just you know they’re all the same all the docs are the same all the health(00:25:13):care professionals are the same all the therapists are the same all the uh(00:25:18):psychologists are all the same etc and we all know that that’s just not the case(00:25:22):there is a huge difference in terms of people’s(00:25:26):experience, competence, interest, personality, capabilities, all those things.(00:25:34):Every single profession is like that.(00:25:38):You wouldn’t say, oh, okay, I’m constructing, I’m putting together the Olympic team.(00:25:45):We can use just any swimmer.(00:25:46):Right.(00:25:47):Just pick a swimmer, a bunch of swimmers and a bunch of, hey, you over there, you’re running.(00:25:52):Why don’t you join our Olympic track and field team?(00:25:56):Like, you’re very serious about that.(00:25:57):Or you’re talking about, you know, your favorite baseball team, favorite football team.(00:26:01):You know.(00:26:01):You know all the players and you know their strengths and weaknesses.(00:26:04):It’s the same situation.(00:26:06):There’s a big difference between if you get someone who’s really good and then(00:26:09):someone who is not so good or doesn’t care.(00:26:12):So you’ve got to choose these things wisely.(00:26:15):The problem also is many times people don’t choose until they really actually need(00:26:19):someone,(00:26:19):until an emergency happens.(00:26:20):And then it’s like you have less time to choose.(00:26:23):I mean, that makes sense.(00:26:24):You know, you don’t think, let me find all the people who I could possibly need.(00:26:31):if you don’t need something,(00:26:32):it usually is when it’s an emergency,(00:26:36):you know,(00:26:36):that you need somebody.(00:26:38):If you get a diagnosis of cancer,(00:26:39):if you get a diagnosis of,(00:26:41):you know,(00:26:42):some kind of an issue,(00:26:44):you know,(00:26:45):maybe with your bones or whatever it is,(00:26:47):you usually don’t plan for that.(00:26:50):It’s a hard thing to plan for.(00:26:52):That’s why it’s so hard, I think, for most of us because(00:26:57):We go to the doctor, get news, get a diagnosis.(00:27:00):Then we’re like, what?(00:27:01):What did I just hear?(00:27:02):And then we’re lost.(00:27:04):But there’s some good tools to use so that we can move forward if we do get diagnoses.(00:27:13):Well, I think that’s one of the reasons why you want to build relationships with a doctor.(00:27:19):Yeah.(00:27:20):in general uh that’s one of the reasons why why you know it’s encouraged that kind(00:27:24):of regular checkups at least you get to know one doctor like okay naturally you are(00:27:28):gonna say oh you know i really need to like get to know like all these 50 different(00:27:35):doctors you know just say you know you you don’t show up to like the proctologist(00:27:40):and say i don’t have a problem there right now but i want to get to know a(00:27:44):proctologist and just hang out with you that would be a little weird but um(00:27:49):But it’s good to know at least one doctor well in the healthcare system and that(00:27:53):doctor can then help you navigate.(00:27:56):So you want to say the similar things with like friends, right?(00:28:00):You don’t want to make,(00:28:01):you don’t want to wait until like a disaster happens and say,(00:28:04):oh,(00:28:05):like,(00:28:05):hmm,(00:28:06):I think I,(00:28:06):maybe I need some friends,(00:28:07):right?(00:28:08):So you don’t want to do that.(00:28:10):You know, that’s why we cultivate, well, I mean, it’s also fun to have friends and(00:28:15):You cultivate,(00:28:15):but it’s,(00:28:16):that’s another reason why you cultivate friendships throughout all the time.(00:28:21):So why not do this with a physician?(00:28:26):a relationship so that you know who to turn to just in case something happens.(00:28:31):You know, the other thing to keep in mind is it’s, you know, medical diagnoses aren’t scheduled.(00:28:37):They don’t, they don’t say, okay, I, you know, you can’t see this.(00:28:40):I’m going to have a medical diagnosis or crisis at this time.(00:28:45):They always come at times when you don’t expect it.(00:28:47):So you have to remember.(00:28:49):Yeah.(00:28:49):Yeah.(00:28:50):That’s so true.(00:28:52):What would you tell physicians?(00:28:56):You know,(00:28:57):anybody who’s seeing people,(00:29:00):if you could tell them anything about how to treat people who have just been given(00:29:05):a diagnosis,(00:29:07):what would you tell physicians?(00:29:11):Well, I would say one thing, you know, you have to have a relationship with the patient.(00:29:18):So it’s not one size fits all.(00:29:21):It’s not like,(00:29:22):okay,(00:29:22):here’s the template on how you talk to the patient and have that applied to(00:29:29):everyone.(00:29:30):I’ve seen that in some, like, you know, I’ve actually...(00:29:35):I saw this once in a course that was taught in medical school where they’re saying,(00:29:41):oh,(00:29:41):here’s a phrase that you should use.(00:29:44):That must be hard for you.(00:29:46):They basically said, you should say.(00:29:50):Empathy was manualized?(00:29:52):Exactly.(00:29:53):And then I remember.(00:29:54):That’s funny.(00:29:56):Someone who’s not, like empathy was not his strength.(00:30:00):And he goes, that must be hard for you.(00:30:05):Like the Terminator saying that.(00:30:09):And so, so that’s what you don’t want to do.(00:30:12):You don’t want to like,(00:30:14):uh,(00:30:15):pick up a manual and,(00:30:17):and have these cats phrases and those things like that because people aren’t(00:30:21):stupid,(00:30:22):right?(00:30:22):They can feel authenticity.(00:30:25):I, I, you know, I, I, I was, uh, seeing where, um,(00:30:30):And I think I’ve actually written about this where,(00:30:33):you know,(00:30:33):these days there’s a real craving or hunger for authenticity,(00:30:36):like on social media.(00:30:37):Like there’s so many people on social media who are like everything’s carefully(00:30:41):manicured and all that stuff like that.(00:30:42):So people can recognize that.(00:30:44):Well, they can recognize that with a doctor.(00:30:46):They can recognize when you’re being inauthentic.(00:30:50):Yeah.(00:30:52):first and foremost,(00:30:53):I would encourage health professionals,(00:30:54):you’ve got to get to know the patient,(00:30:56):right?(00:30:56):You’ve got to know what that patient’s personality is like,(00:31:01):what that patient’s strengths and blind spots,(00:31:06):worries,(00:31:07):and those things like that.(00:31:08):And that will allow you to be a little more equipped in terms of what to say or how to say.(00:31:15):Now, in absence of that,(00:31:17):In absence of that,(00:31:18):if you don’t know the patient that well,(00:31:20):or you may even know the patient well,(00:31:23):but the reactions can be surprising,(00:31:27):be honest.(00:31:28):Just say something like, okay, and just say, well, I know that...(00:31:39):many people might react in many different ways and it can be very unpredictable.(00:31:42):How are you feeling about this?(00:31:45):What can I do to help?(00:31:46):How can I support you in this?(00:31:49):You know, this, this, this must be challenging.(00:31:51):Um,(00:31:52):you know,(00:31:53):but say in an authentic way,(00:31:54):don’t say this must be challenging page two,(00:31:57):you know,(00:31:58):don’t,(00:31:58):don’t do that.(00:31:59):So, um,(00:32:01):So, yeah, nothing can replace, I think, authenticity.(00:32:06):Nothing can replace just being frank and open about how you’re actually feeling.(00:32:13):And then see what the patient says and see what the patient needs and be available.(00:32:20):I think that’s great advice.(00:32:22):You know,(00:32:22):there was some advice I got from a boss that I had,(00:32:25):and I don’t know if this would apply,(00:32:26):but(00:32:27):But I was working in United Cerebral Palsy in a classroom with severely disabled(00:32:36):children with lots of different disabilities.(00:32:38):And I was new and I was unsure about how to interact because I could be as(00:32:44):authentic as I wanted,(00:32:45):but I wanted to make sure I came across.(00:32:47):And she said, you have to find something in everybody that can connect you.(00:32:53):And what you were saying about be authentic and how you answer,(00:32:56):you can’t be authentic until you can find something in somebody to connect with.(00:33:01):And I wonder if doctors were able to take just a step back.(00:33:05):I know they have such busy, busy schedules.(00:33:09):to take a breath and connect, you know, because then it’s easy to be authentic.(00:33:14):Then it’s easy because you’ve just found out a little bit about that person.(00:33:17):I don’t know if that’s something that could be useful to physicians,(00:33:21):but I think that was the best advice I got my whole life.(00:33:24):I use that all the time because then I’m actually connected to the person.(00:33:28):I’m not trying to authentically connect in a way that I’m like, you know, it’s about me.(00:33:35):It makes it about them.(00:33:37):Yeah,(00:33:37):I mean,(00:33:37):I think if you have a curiosity about people in general,(00:33:41):you want to learn more about people,(00:33:43):that really helps.(00:33:45):And I think there’s a lot of incentive to do that.(00:33:48):I mean, the biggest learning that you have as a person going through life is from other people.(00:33:56):You learn about what other people’s lives are like.(00:33:58):And that’s why it can be very enjoyable to be in professions where you have(00:34:05):to their clients or patients or what have you because you end up connecting with a(00:34:10):lot of people.(00:34:11):Now,(00:34:11):that being said,(00:34:12):I think one of the challenges that a lot of doctors and health professionals face(00:34:16):these days is these healthcare systems that basically limit the amount of time that(00:34:21):they can spend with each patient.(00:34:23):Like they’re put on these assembly lines and these treadmills.(00:34:28):15 minutes is not enough time(00:34:32):to really talk about anything.(00:34:34):I wrote an article in Forbes a while ago that basically said, what can you do in 15 minutes?(00:34:40):And I was talking about this ridiculous 15-minute limit to visits.(00:34:45):And I found a fact that an uncomplicated bathroom visit takes about six minutes.(00:34:56):That means if you want to go to the bathroom and think of the most uncomplicated(00:35:01):thing you can do in the bathroom,(00:35:04):that already takes six minutes.(00:35:07):There are a lot of complicated things that can happen in the bathroom.(00:35:11):I’m not going to list all of them right now, but you can imagine.(00:35:16):And that can immediately push things above 15 minutes.(00:35:21):So you’re talking about you’re giving less time.(00:35:26):To really figure something out to a doctor,(00:35:30):then you would a moderately typical bathroom visit,(00:35:37):right?(00:35:37):Because a typical bathroom visit can get a little more complicated than a(00:35:43):completely uncomplicated bathroom visit.(00:35:46):So that makes absolutely no sense.(00:35:48):That completely makes no sense.(00:35:50):15 minutes.(00:35:51):Think about it.(00:35:52):15 minutes.(00:35:53):It probably takes a minute or two minutes alone to say,(00:35:56):hey,(00:35:57):good to see you or introduce yourself,(00:35:59):et cetera.(00:36:00):Then you’ve got 13 minutes.(00:36:02):Okay.(00:36:02):Oh, I can’t log on this computer.(00:36:05):Oh, no, you’ve got 12 minutes.(00:36:07):Oh, okay.(00:36:08):Oh, excuse me.(00:36:09):I’m, you know.(00:36:10):I have to burp.(00:36:12):All that can take up time.(00:36:14):That’s just not enough time.(00:36:17):What do we do in those cases?(00:36:20):Because I feel for the physician who is thinking of you as a ticking clock.(00:36:27):You are my 15 minutes.(00:36:30):And every second that is taken away from direct work,(00:36:35):is a minute gone by.(00:36:36):That’s how it can feel.(00:36:39):So what could be done in that case for both the physician and the patient?(00:36:45):Well,(00:36:45):that’s one of the reasons why some docs have sought out other kind of practice(00:36:52):situations where they have more control of their time.(00:36:54):That’s also another reason why(00:36:57):um, patients have, have sought out those types of docs that have more time.(00:37:01):And also you will see situations where there is some variability,(00:37:06):like with,(00:37:07):especially with certain specialists,(00:37:08):they,(00:37:08):they have managed to insist that they need more time.(00:37:12):Um, uh, if you’re in a situation, uh, you could, you could,(00:37:18):uh, bring that up to the health system.(00:37:20):You know, they all have like feedback and you can say that.(00:37:25):And then,(00:37:25):so rather than say,(00:37:27):oh,(00:37:27):you know,(00:37:28):uh,(00:37:29):critique the doc,(00:37:30):you might want to critique the health system and say,(00:37:32):say,(00:37:33):look,(00:37:34):I didn’t more time with the doc.(00:37:36):And I think the doc was willing to give me more time,(00:37:39):but you know,(00:37:40):it’s on a,(00:37:41):a kind of a 15 minute slot.(00:37:43):That’s just not enough time.(00:37:45):And so if patients start doing that more often, they actually may start seeing changes.(00:37:52):There can be potential workarounds where you can insist on getting two slots or(00:37:57):stuff like that,(00:37:58):but not be charged two slots.(00:37:59):You never know.(00:38:01):Again,(00:38:02):it’s a situation where you shouldn’t feel like whatever the healthcare system is(00:38:06):dishing you,(00:38:07):you have to accept.(00:38:08):Right.(00:38:10):So if you’re back to the diagnosis,(00:38:12):right,(00:38:13):because you’re probably not thinking,(00:38:14):oh,(00:38:14):I’m going to fix the health care system now.(00:38:17):You’re like, oh, I have a diagnosis.(00:38:19):What about the portals?(00:38:20):Do doctors really look at those?(00:38:22):Do they read those?(00:38:23):Are those useful?(00:38:24):If you go into,(00:38:25):I don’t know that every place or every hospital system uses those portals where(00:38:31):you’re given your information and you can look at things.(00:38:35):Is that a good place to go, to ask questions, to get additional information?(00:38:43):Potentially.(00:38:43):That’s another thing to ask your doc.(00:38:45):How often does your doc check the portal?(00:38:49):Is the doc the actual person answering the portal questions?(00:38:56):I know one doc who says, oh, we love the portal.(00:39:02):If there’s any questions, go there.(00:39:04):So again,(00:39:04):part of it depends on the style of the position,(00:39:07):but you have to get to know what that style is.(00:39:10):So ask those types of questions.(00:39:13):It’s a lot of the principles that apply to relationships in general also apply to a(00:39:23):physician-patient relationship.(00:39:26):Not all of them, obviously.(00:39:27):But,(00:39:28):like,(00:39:29):for instance,(00:39:30):you wouldn’t,(00:39:31):like,(00:39:31):if you’re getting to know someone,(00:39:33):like a friend or something like that,(00:39:36):you wouldn’t just leave...(00:39:39):And then later, send a carrier patient message to the friend.(00:39:44):Well, you typically would say, hey, let’s exchange contact information.(00:39:49):What’s the best way to contact you?(00:39:50):And they might tell you, oh, don’t text me.(00:39:53):This is why I check most often.(00:39:55):Or, oh, if you need to reach me, this is how you reach me, right?(00:39:58):You will typically do that with someone that you want to maintain some kind of(00:40:03):continuity with after that,(00:40:04):right?(00:40:05):So...(00:40:06):Again,(00:40:06):any type of relationship,(00:40:08):even if it’s like,(00:40:09):you know,(00:40:09):professional,(00:40:10):you’re networking with someone,(00:40:11):you exchange information and say,(00:40:12):hey,(00:40:13):how do we follow up?(00:40:15):Do the same thing.(00:40:17):So would you suggest if a person,(00:40:19):you know,(00:40:20):not everybody has a primary care physician that they see.(00:40:22):A lot of people use walk-in clinics.(00:40:25):Would you say that people should maybe use the same walk-in clinic over and over(00:40:29):again so they can develop a relationship with the people in that walk-in clinic?(00:40:33):Or what would you say?(00:40:35):Now,(00:40:35):that’s very difficult because walk-in clinics can be staffed by all kinds of(00:40:39):people,(00:40:40):and it all depends.(00:40:41):Some people there can be full-time staff.(00:40:44):Some people there can be moonlighting.(00:40:47):You can get people who are residents or fellows because they’re in training,(00:40:52):so they’re not going to be there too long,(00:40:53):and then they move on to somewhere else.(00:40:55):So the walk-in types of clinics, many times,(00:40:59):They just don’t offer that continuity.(00:41:01):That’s why I think it’s better,(00:41:03):if possible,(00:41:04):to get an established physician so you can develop that relationship.(00:41:10):Again, yeah, I know people who will get all of their care from urgent care.(00:41:17):I know people that do that too.(00:41:21):So,(00:41:22):you know,(00:41:22):if a person is in that case where they use urgent care and they get a diagnosis,(00:41:27):they’re going to be assigned a doctor or they’re going to be,(00:41:30):you know,(00:41:31):they’re going to have to go to a regular doc,(00:41:33):not a regular,(00:41:33):but a doctor for whatever the diagnosis is that they get seen for.(00:41:40):I would then say,(00:41:42):assume that you would say, hey, maybe that person should go get an internist at that point.(00:41:48):Yeah, you mean a regular doctor as opposed to an irregular doctor.(00:41:52):I know, I shouldn’t have said that.(00:41:53):Yeah, the irregular doctor is like irregular clothes, you know.(00:41:58):Yeah, exactly.(00:42:01):Thethoscopes wrapped around their head.(00:42:03):Yeah.(00:42:06):Their white coat is inside out.(00:42:09):Long size.(00:42:11):So, yeah.(00:42:11):So my takeaways from this are that really,(00:42:15):you know,(00:42:16):dialogue,(00:42:17):relationship,(00:42:20):you know,(00:42:21):getting friends and family involved and don’t rely on walk-in clinics and Google(00:42:28):and AI to be your doctor.(00:42:30):Is that about right?(00:42:31):Yeah,(00:42:32):look at,(00:42:32):like,(00:42:32):you know,(00:42:33):and Google is,(00:42:35):you know,(00:42:35):you can try this experiment with Google.(00:42:38):Put in anything that you know really well in Google,(00:42:41):and you’ll find you’ll get a mixture of right information and just information(00:42:47):that’s completely off.(00:42:48):Yeah, so true.(00:42:50):Say you really, okay, take this example.(00:42:54):Say you follow a sports team very closely, or you say you follow a TV show very closely, right?(00:43:01):Try Googling that.(00:43:04):See how many opinions come up and how many things you actually disagree with.(00:43:09):Like, again, this is a sports team or TV show or movie that you know really well.(00:43:15):See how many things you actually agree with.(00:43:18):It’s going to be all over the map, right?(00:43:20):Yeah.(00:43:21):So imagine that when it comes to health or medical stuff, it’s going to be all over the map.(00:43:27):But on top of that,(00:43:30):That’s, you know, health advice is supposed to be personalized.(00:43:34):So,(00:43:35):you know,(00:43:35):opinions about a sports team or a TV show,(00:43:39):it’s applying to that sports team or TV show.(00:43:42):Not necessarily different for every person.(00:43:44):But when it comes to you,(00:43:47):a diagnosis and how it’s treated and how it’s taken care of is really personalized.(00:43:52):It all depends on your personal situation.(00:43:54):Yeah.(00:43:54):The heck are you going to find that on Google?(00:43:57):Yeah.(00:43:58):That’s Google.(00:43:59):AI is filled with inaccuracies.(00:44:03):It can tell you some,(00:44:05):it can be helpful with certain things,(00:44:06):but like think about how many times,(00:44:09):if you haven’t done this yet,(00:44:11):try to get it to do something for you(00:44:14):you know whatever ai platform and then see how many mistakes it makes right so tell(00:44:19):it to like do uh like a picture or something that you know or something yeah i(00:44:24):catch it all the time mistakes it makes it’s going to make a lot of mistakes so do(00:44:29):you really want to play around with their health in that manner um so yeah i(00:44:35):remember uh i so i teach a course on uh(00:44:40):introduction to AI and health and public health.(00:44:43):And I got the students to basically use an AI platform to produce some kind of(00:44:48):health or public health material,(00:44:50):like a campaign,(00:44:52):a commercial or something like that.(00:44:55):And then some of it looked(00:44:56):pretty good i told him also work with ai to like um you know go back and forth as(00:45:01):you know just tell to adjust these things etc and some of it look very snazzy and(00:45:05):kind of smooth but like when you dug in deeper you found many mistakes like there’s(00:45:10):this one campaign where it said you should get vaccinated against against this(00:45:16):against this virus otherwise you may get pneumo ridiculosis pneumo ridiculosis it’s(00:45:25):like what is that(00:45:28):That does not exist.(00:45:31):Folks out there, that is not a condition.(00:45:33):If someone tells you you have pneumoidiculosis, that’s not a condition.(00:45:39):So that’s a mistake, but everything looked great, right?(00:45:42):Everything, et cetera.(00:45:43):So that tells you that you can get deceptive information through AI.(00:45:49):Yeah.(00:45:50):Make it look good.(00:45:51):It can sound very authoritative and all this like that.(00:45:54):So, yeah.(00:45:56):And it’s also, you know, it will try to please you.(00:46:00):It could seem like,(00:46:03):you know,(00:46:04):if you want someone to compliment you,(00:46:05):go to one of those AI platforms.(00:46:07):They’ll compliment you very quickly.(00:46:09):I’m going up right now.(00:46:10):It may not be warranted.(00:46:12):You may not deserve that compliment, but you can get complimented.(00:46:16):Thanks for coming on tonight, Bruce.(00:46:19):I just want to let everybody know a little bit more about you.(00:46:22):This is Dr. Bruce Y. Lee.(00:46:24):He is a physician.(00:46:25):He has an MBA.(00:46:27):He’s a researcher.(00:46:28):He runs a consortium at CUNY.(00:46:30):He writes Minded by Science for Substack.(00:46:35):He writes for Forbes.(00:46:37):How many reads do you have in Forbes now?(00:46:40):Since January 2019, it’s about 92 million.(00:46:45):92 million reads.(00:46:47):And he writes for Psychology Today, too.(00:46:49):So a lot of what we talked about, he’s probably written about already.(00:46:54):But you can check him out there and look for the posts that we do together on YouTube as well.(00:47:02):So thanks for coming on.(00:47:04):I really appreciate it.(00:47:05):And I can’t wait for our next conversation.(00:47:07):Looking forward to it.(00:47:09):Take care.(00:47:10):Right.(00:47:10):Bye, Debbie. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit deborahheiserphd.substack.com/subscribe