SPEAKER_02 0:00

Lara?

SPEAKER_04 0:01

Yes, sir.

SPEAKER_02 0:02

I ask you a lot of random questions because I have the opportunity at different points in time to ask the doctor different questions.

SPEAKER_04 0:11

Yes.

SPEAKER_02 0:11

And so I thought this would be a really fun episode because I ask you a lot of questions that I'm sure you're like, wait, you don't know that? And so this episode is about the top ten things your doctor wish you knew, or in this case, wish I knew.

SPEAKER_04 0:32

And this is not in terms of medical problems or answers. It's more how medicine in offices its work.

SPEAKER_02 0:40

Ah, I like that. That work? I like that.

SPEAKER_04 0:43

Okay. You're ready to dive into that.

SPEAKER_02 0:45

This is a very informal, open-minded conversation of the top ten things that doctors wish their patients knew. Yes.

SPEAKER_04 0:57

Because I think many people assume that they really understand what's going on at a doctor's office, or at least that's the impression patients will give me. And people don't really know what we're doing, I think a lot of the times. So let's go through it.

SPEAKER_02 1:11

Absolutely. And so, like for context, this segment, like the whole idea is like social media, Google, information stuff out there, um, why patients arrive at the conclusion instead of asking for symptoms, all these unknowns. Uh, we're looking at the difference of what what is something that you hear versus there's always usually a pushback.

SPEAKER_04 1:34

It's the reality.

SPEAKER_02 1:35

What's the reality?

SPEAKER_04 1:36

And I asked Jana too to help. I was like, what would you put on this list? And so she helped me come up with this.

SPEAKER_02 1:42

Okay.

SPEAKER_04 1:42

We're ready. Let's do that. I'm sure this is um I'm sure we can add to this later, but let's go.

SPEAKER_02 1:46

You're gonna have to grind through all these because these are yours. I got it. I'm here to give- I got lots to say. I'm here to give constructive criticism.

SPEAKER_04 1:52

Perfect. Okay.

SPEAKER_02 1:53

From the patient's view, because I'm gonna I'm gonna challenge you. Throw it at me. Let's bring it.

SPEAKER_04 1:57

Okay. So number 10 is it and just to preface this, this is from the perspective of a primary care physician. So, uh, and I guess two primary care physicians. So um, this could be different in different specialties, but this is what we have. So, number 10, we do not know everything off the top of our heads.

SPEAKER_02 2:18

I love this because it's so funny from my point of view. I've said this multiple times in different meet and greet situations where uh people that have these very rare type of symptoms, they come into the practice and they think that especially primary care in this in particular concierge medicine, where they think that you're freaking house.

SPEAKER_04 2:47

Yeah, like we're gonna be able to figure, we're gonna have the answers to the problems that nobody else has the answers to.

SPEAKER_02 2:52

Because it's like it's because as soon as you are in concierge medicine, you're a friggin' savant.

SPEAKER_04 2:57

Yeah. And it's like I had a patient ask me the other day something about a mechanism of action of a certain medication, which is a valid question. But I'm like, um, well, let's look that up again. Because I mean, did I learn that specific mechanism of action at one point in my training? Probably. But on a day-to-day basis, does the mechanism of action of each medication really matter to me all that much? Not necessarily. And so there are, I and I not all patients seem to have this expectation, but some do seem to expect that you will just know this off the top of your head, whether it be something about a medication you've never used before, whether it be about some uh some symptom that they have, whether it be about a specific rare diagnosis, it's like, wait, you don't know that? And um people medicine is is very large. Like we have specialists for a reason.

SPEAKER_02 3:55

Well, that's where um dad and I have had this conversation, like I think it was with you, and just like the whole idea of I don't know, dad got it from somebody, which was yes, there are outliers, there are doctors that are truly just ridiculously intelligent, like truly savants from like a memorization standpoint. But in general, when you look at all medical doctors, there's width and there's depth of knowledge. Yep. Like when you're in primary care, you're a width, you have to be you have to be good at pretty much every major part of a human body. Right. You have to have a good bearing on endocrinology, you have to have a good bearing on uh just like all the cardiology, all these all this kind of stuff.

SPEAKER_04 4:41

Dermatology.

SPEAKER_02 4:42

All the ologies.

SPEAKER_04 4:44

Yeah, in ecology.

SPEAKER_02 4:45

But then when it comes to when you get into these rare outlying diseases and all this kind of stuff, this is where specialty specialists come into play. And their depth of knowledge on a specific subject is incredibly well done. Like, okay, cool. You have someone that you get an EKG come in, like you have someone that's got a heart and rhythmia problem, you put them on your EKG, and you know, yeah, that's abnormal. I don't know why it's abnormal.

SPEAKER_04 5:10

But now you gotta go see somebody else.

SPEAKER_02 5:11

And then you go to an electrophysiologist in cardiology and they go, Oh, yeah, that's abnormal for this node for this exact reason because this Purkinje fiber is doing this. And it's like, oh, gotcha.

SPEAKER_04 5:23

Well, and I think that that's very important that, yes, we a lot of times in primary care, especially, it's not always about knowing everything, but it's when it's about knowing that something, when something's abnormal and when you should be concerned about it. That's a big thing. Is like, I may not have the answer to what that skin thing is on your arm, but I can based on my training and knowledge, I can probably have a pretty good idea of if it's something concerning that you should see a dermatologist for, or if I could be like, hey, you know what? You can just watch that and it's gonna be fine. That's what training gives you.

SPEAKER_02 5:52

Absolutely.

SPEAKER_04 5:52

So great. Number 10. That's that.

SPEAKER_02 5:55

Number 10. You don't know everything off the top of your heads.

SPEAKER_04 5:58

Nope, no doctor does.

SPEAKER_02 5:59

Yep.

SPEAKER_04 6:00

Um, and I do look stuff up a lot. We have a lot of good resources to look that up. But okay, moving on. Number nine. I think this is a good one. More testing is not always better.

SPEAKER_03 6:12

Absolutely.

SPEAKER_04 6:13

Because I think um we get a lot of I think a lot of people nowadays, because of the internet and social media, they are familiar with a lot of different testing, whether it be imaging or whether it be lab work that they think that they need for a particular reason. And it's not always the right answer.

SPEAKER_03 6:31

Yep.

SPEAKER_04 6:31

And I think some people get very frustrated with that because they feel like we're just not doing what they want. But it's like, well, you're coming in for the expertise of the physician. So maybe they have a reason that they don't think that's important. And it's not to say you shouldn't have a conversation with it, because I think having a joint decision-making opportunity is really important. But it is okay to not do something.

SPEAKER_02 6:54

Yeah. Well, it's like for like the idea of false positives and all this kind of stuff. The one that I found fascinating, and I do not remember the exact numbers off the top of my head, but we were talking about it. Dad sent that article talking about different it was a multi, it was a multi-medical article email he got from somebody. And part of it was talking about how there was a population of a certain percentage of like I can't, I think it was like n in like uh Norway or something, and it had a few thousand participants, and it was like they all had shoulder MRIs done.

SPEAKER_04 7:29

Oh, yeah.

SPEAKER_02 7:29

And it was like, and at the age of like 70 years old or something, something eld leaning towards elderly population. And it was like 90% of all MRIs on shoulders of the elderly showed torn rotator cuffs and all this kind of stuff. Now, did all 90% have symptoms? No. No. But literally it was like 90% ish. I can't really exactly have it. I do remember that him showing it was like all of them have torn rotator cuffs. And so, like, here you are going, well, yeah, if you do an image, you're gonna see it, but doesn't mean they're actually symptomatic and having problems with it.

SPEAKER_04 8:07

Well, and then it's like people see it and they're like, that's a problem. And it's like, well, you weren't having any symptoms, so it's actually not a problem. So, and then I mean, for like something like that, it's probably less concerning um in this sense. But for the people like I had a patient who had with another physician, had a full body MRI done last year, and there was a finding found in her pancreas, and there was one found on her adrenal glands, and they needed follow-up. And this is causing this woman so much stress. She is so anxious about these two findings, which are probably benign, and we're just following the imaging over time, but it is causing her significant stress and anxiety. And that's that that wasn't necessary because that full body MRI was not needed. That was an elective MRI. So um, more testing, and this goes with lab work too. Um, it's I feel like so many people think that I think this might be on our list too, but that labs are like we got to do more labs to figure something out. And it's like, well, that's not always the way we find out an answer to a problem.

SPEAKER_03 9:07

Absolutely.

SPEAKER_04 9:08

So, anything else in number nine?

SPEAKER_03 9:10

No, that makes total sense.

SPEAKER_04 9:11

Okay. All right, moving to number eight. Symptoms do not always have a perfect explanation. And I think, and this is another thing in our social media driven world that people don't like because there's every you can find somebody on social media that's will tell you that they have the exact answer to your problem. And they probably don't.

SPEAKER_02 9:33

Dunning Kruger effect.

SPEAKER_04 9:35

Explain that. I know you talk about it a lot.

SPEAKER_02 9:36

Yeah, Dunning Kruger is um just the whole idea of you get a little bit of knowledge, your ego, arrogance, confidence goes just massively up. Then there's the the valley of despair, which is like you keep learning, and then you're like, oh my gosh, I don't know what that is. I don't know what that is. You go down here and you're like, I feel like I'm an idiot. Like, I don't know anything. Like now you're like in a PhD research and you're at the bottom of the of the of the chasm going, I'm an idiot. There's so much we don't know. And then over time, you build it back up through crazy amounts of research and knowledge and understanding. And in particular, social media is rampant with people with Dunning Krueger, where they have no, and again, I'm not here to say that just because someone has a PhD, they have all the answers. And I'm not here to say that if you don't have a PhD, you're an idiot. But it's it is not it is very common that someone gets just a little bit of knowledge and their ego goes through the frigging roof and they speak in ultimates and confidence, they're like, this is the one thing you need to know about lectins or whatever the frick it's gonna be. And it's like uh Lane Norton's talks about it in our in our um documentary. All these people have talked about it where you can tell who your most knowledgeable, truly educated people are because they don't speak in absolutes, they speak in probabilities, they think in likeliness, but they don't sound as confident because they know we know so little.

SPEAKER_04 11:07

It's like medicine is still has so many limits, and the human body is very complex, and we do not have all the answers. And so all the people that are out there saying that they're the ones that are gonna help you because they can get to the root cause of your problem. Um, you know, that's what physicians are trying to do too. But they just know that a lot of times we don't have enough information, data, or research to give you a exact answer. Yep. Um, and so it is okay if your physician doesn't have an exact answer. I'm not saying always they should be working to find you the answer, but that can be the situation.

SPEAKER_03 11:45

Makes sense.

SPEAKER_04 11:47

All right. Number seven. And I think this ties back to our episode that we did on GLP1s, that medications are tools, but they are not magic.

SPEAKER_02 11:57

Wrong. Every doctor is paid billions and billions of dollars to prescribe medications. You can't tell me otherwise because someone on the internet said so.

SPEAKER_04 12:11

Wait till uh wait wait for on that and to a future point, and you can really go off. But it's funny because some um I think there's a lot of people that don't want meds for a variety of reasons. Um, but then there are people that think that they're the answer to everything. And so you gotta look at it as like, what?

SPEAKER_02 12:31

Great example of this that is so fascinating along those lines. I remember uh back in my EMT days um when obviously you're getting uh a basic uh scope of the uh previous hit medical history of of the person that you're dealing with. And then you're asking questions, do you have high blood pressure? Do you have are you diabetic, all this kind of stuff, and you're working through the system? And then they're like, nope, nope, nope. Like, okay, cool. And then it's like, what medications are you on? Life Center Pro. Okay, so you do have high blood pressure, but you're on a medication to super like keep it in check.

SPEAKER_04 13:05

You're like, no, then I don't have it.

SPEAKER_02 13:06

It's like, no, you still have high blood pressure. You just happen to be on a medication that keeps it in check.

SPEAKER_01 13:11

Yep.

SPEAKER_02 13:11

It's I remember how many times that happens for me back in the day with me. It was like they say they don't have any any issues, and then all of a sudden you go through their drug list and you're like, uh, you have prediabetes, this, this, and this. You just have medications to help control it.

SPEAKER_04 13:25

It's the same thing. Like, if you ask a patient about their family history and they're like, no, no one has cardiovascular disease. And then they five minutes later tell you their dad had a heart attack, and you're like, uh-huh. Um, okay. Well So, anyways, but um medications I think need to be looked at in the appropriate way. And I think there are some people that are like, well, my cholesterol's high. So, you know, instead of changing my diet and exercising more, I'll just take this dad. And it's like, well, I mean, that does help lower your cholesterol, but that's not like that's not the final solution to this problem, and it's not gonna give you the best outcome.

SPEAKER_03 14:01

Yep.

SPEAKER_04 14:03

All right. Um, anything else on that one?

SPEAKER_02 14:06

No, I think I mean it's pretty straightforward. It's just like like medications are tools, and as much as uh we all value them and they save lives, if it if it was the end all be all, everyone would be healthy in America because we prescribe massive amounts of medications to people. And we're not even close to the top five health outcomes because of that fact. Yes. And so, yes, medications have their place, but there seems to be one of two camps, which is either, all right, I'm not gonna deal with my lifestyle and just give me the drug, uh-huh, or don't give me any drug. Don't give me any drug and I think that I can fix my high blood pressure with goji berries.

SPEAKER_04 14:50

Yes. It does seem like there's different groups of people, that is very true.

SPEAKER_02 14:54

Yeah.

SPEAKER_04 14:55

All right. Um, number six, um, AI and Google are both, they can be helpful or dangerous. And I bring this up because I have a lot of patients that are when they come in and talk me with me, they're like, Well, you're not gonna like this. Uh, but I Googled it. And I'm like, oh, that's fine. Like, I don't care. I actually I'm glad that you're interested in looking things up and trying to learn. So I think that's great. You just we just have to talk then about, okay, w where are you getting your information? And we have to find make and make sure we're using the right sources. But I don't have any problem with it, but we do have to be careful with it.

SPEAKER_02 15:31

Well, it's like so much, it's it's not uncommon or it's not, it's a little different, but it's the same general concept that I kind of live by because it's like constructive criticism is very important. And anyone who doesn't like to be constructively criti criticized, it's a yellow flag because that means because that means their ego is probably through the roof and or very low, one of the two. Like they have confidence issues and they don't like like but it's the idea of like anyone truly w wishing the best and wanting to to be uh correct has no problem or wanting wanting the right outcome has no problem with that whole process. From the viewpoint of like going back to dad and that stuff, it's like if someone came to him and he gave a nasty prognosis and like, hey, this isn't good and this is my findings, and all of a sudden they were like, I want a second opinion, daddy'd be like, sweet, these are the three guys I trust, have at it. Like that's it, these like that's who I'd recommend. And it is a big yellow flag, in my opinion, from if any physician hates being challenged. Now, there's there's a respectful way to go about it. And like going through when you AI or Google something and you come in just combative against a physician, like that's not gonna serve anybody.

SPEAKER_04 16:51

Or I've had people that when they read something online and then they come to talk to me, they're just skeptical about everything I say. And I mean, it's okay if they want to ask questions, but if you're gonna listen to only the thing you read on whatever website, WebMD or whatever, and and not trust anything that I say, then I don't think this is gonna be a very fruitful relationship between the two of us. Yeah. No. But yes, uh, it is okay to ask Chat JPT or Google stuff, but just make sure you are looking at the response or the answer in the right lens.

SPEAKER_02 17:26

And watch the Duddy Kruger effect and watch selection bias.

SPEAKER_04 17:29

There's that too.

SPEAKER_02 17:30

Prompt bias. Like if you're gonna use these tools, this is something that people have to learn. AI is a little different because it starts to learn prompting. Um, but Google in particular, Google is a search engine. It's not a a truth finder. If you ask why is this bad for you, why is water bad for you? It's just gonna find data that supports why water is bad for you. It's not actually putting into the whole context of everything we know about the science of water to make a logical conclusion. It just answers the question you ask. And so if you ask why do statins not work, you'll find a lot of things. You're gonna find a lot of data out there, but it's not gonna be that the actual the totality of evidence truth. It's just selection bias. And so be very careful of how you ask questions and how you prompt using Google and AI because it doesn't actually get the answer. It just gets you what you what the questions you ask.

SPEAKER_04 18:32

And yes, if you go and Google the new medication that your doctor prescribed, you probably will find a list of terrible side effects that you don't want. And your doctor is aware that those are on the internet because I think people assume like we didn't realize that these meds that you prescribed had side effects. And I'm like, no, I was aware of that. Thank you. Um, but I just wasn't concerned about that. So anyway, priorities. Yes. So I'm more worried about you dying of a heart attack. All right. Um, number five, yeah, go off.

SPEAKER_00 19:04

Here we go.

SPEAKER_04 19:05

I'm gonna like apparently this is gonna be the thing that um gets people most up in arms.

SPEAKER_03 19:10

They get that we talk about make a post on this, they go, they lose their frigging gourd.

SPEAKER_04 19:14

And I was talking to Jenna because I'm like, apparently, every time I say this, people just are gonna throw it back in my face that I am literally lying to them. Yep, that's what they're saying, because they don't agree with me, apparently. But doctors do not get paid medication or do not get paid to prescribe medications.

SPEAKER_02 19:30

It is illegal.

SPEAKER_04 19:32

And we'll say it again.

SPEAKER_02 19:33

Common assumption. Even people that genuinely still like to go to doctors still believe that they're get their doctor is getting kickbacks.

SPEAKER_04 19:44

I pulled someone yesterday when she said something about the test that I ordered and how much something about the money, and I said, No, no, no, I don't get paid any money for that. And she's like, Oh, okay. And then she moved on.

SPEAKER_02 19:53

But I literally on my bachelor party weekend, that came up. Did I really? Um I was talking to Phil and then I think it was Jordan. Uh-huh. None of the conversation was bad, so I'm not really worried about naming names. Um, but like they genuinely even I think it was even Phil. Phil was genuinely didn't know that it was truly illegal for any type of kickback. Because we were we were talking about marketing.

SPEAKER_04 20:22

Oh, yeah. Um, the marketing and healthcare is more challenging.

SPEAKER_02 20:25

Yeah, and I'm like, I love kickback deals, and I love that whole mantra because it's it's it's it's outcome-based compensation. Like, I love that. I'm like, I'm as as a marketer, if I can pay someone 10 bucks out of a $50 product, great, because then I'm like, they're getting paid for exactly what the outcome that I want. Awesome. That's illegal in in healthcare. You can't do that.

SPEAKER_04 20:49

Not paid by pharmaceutical companies to prescribe. Maybe, yes, physicians are getting money from pharmaceutical companies. We talked about this in our other episode. Amages. Well, and they can be speakers and stuff, but they're not getting paid to prescribe. It's not like, oh, you've made a prescription, here's your money. That's not how it works.

SPEAKER_02 21:05

And not to mention, of the it is a extremely small percentage of the of them of doctors that work for pharmaceuticals. I want to know of the doctors, and I have never looked this up, of the doctors who get paid to speak, how many of them are actual active clinicians? I bet you're very small.

SPEAKER_04 21:24

Well, a lot of the because I mean they bring a lot of these physicians to these dinners that they will host, and a lot of them are prescribed or are practicing. So I think they do use a lot of practicing physicians. All the ones I ever hear are. But yes, we do and you can continually to tell me, you can continue to tell me that I'm lying, but I'm not. I know.

SPEAKER_02 21:47

I've seen the books.

SPEAKER_04 21:48

Yep, thank you. All right. Um number four The boring, unsexy stuff is what saves lives.

SPEAKER_02 21:58

This is

SPEAKER_04 22:00

So I know people want to talk about hormones and longevity and I don't know all these other things, but your blood pressure, your cholesterol, your weight, your blood sugar, your sleep, your muscle mass, those are the things that are super basic, very important. And those are the things that if not well controlled are probably going to lead to the biggest problems.

SPEAKER_02 22:21

It's so this is like the whole angle of um uh not law of diminishing returns, but law of familiarity. Yeah. That's it. Where it's like people get hit over the head for 50 years on cholesterol, blood pressure, blood sugar, sleep, strength. Like, and then you just get you hear it so flippin' much.

SPEAKER_04 22:45

Like they don't want to hear it anymore?

SPEAKER_02 22:46

They don't want to hear it anymore, but it's like give me the give me the rare, the rare blood test that I'm not because that's what I'm excited about.

SPEAKER_04 22:52

But they're not worried about their blood pressure being elevated when that is causing way more people to have massive health problems.

SPEAKER_02 22:58

It's like, it's like, for example, um I like knowing the difference between what people say they want versus what they actually want are not always the same thing. And from the standpoint of the medical practice, for a free give, I know for a fact to get more pe patient more potential meet and greets for patients, us doing an LPA test. Like I know it for a fact. If we give a free LP little A test, which is a lower tier, clinically proven blood marker that that has merit on uh cardiovascular risk.

SPEAKER_04 23:36

What do you mean lower tier?

SPEAKER_02 23:37

It's not lower tier. Well, it it's it's less important, is what I'm saying. Like LP, it matters, but not compared to total cholesterol, not compared to blood pressure, not compared to just the basics, but it does. But the fact that here's a blood test that most people have never heard of that has merit. Ooh, give it to me, give it to me, give it to me. Yes. But it's like, hey, is your blood pressure, blood sugar, uh, A1C, are those all in check? And it's like, well, I don't really care. But it's like, actually, that stuff matters way more. But what hooks people is the new blood test that no one has ever had before.

SPEAKER_04 24:10

I feel like blood pressure is the biggest thing that at least this is what I see, that people just do not care about their blood pressure a lot of the times. And it's a thing that honestly worries me the most for a lot of people. And they just don't care.

SPEAKER_02 24:22

Well, here's the classic one. Didn't you have what's your what's your horrible one on that?

SPEAKER_04 24:26

Oh, I had a patient, this was what years ago, but he came in with a blood pressure of like 190 over 110. He was probably in his early 60s, and he refused to treat it. He was like, I'm not taking anything, not gonna do it. And I was like, Well, I can't force anybody, but I I was pretty str I was pretty strong. I'm like, this is you are going to have a stroke or a heart attack or something if you do not manage this. And um, several months later, he ended up in the hospital with a massive stroke, like probably one of the worst strokes I've seen, because there's people that have strokes all the time that have very little side effects uh or um deficits from it. This man is now in a wheelchair, he can can't speak, he can't go to the bathroom on his own, he has to have his wife feed him. Like he is so incapacitated from this stroke. And I guarantee if he had treated that blood pressure, it would have made a difference.

SPEAKER_03 25:22

But it's not sexy, it is not.

SPEAKER_04 25:24

All right. Um, number three, many chronic conditions have a significant lifestyle component. And I think people are like somewhat familiar.

SPEAKER_02 25:32

People get offended by this too.

SPEAKER_04 25:34

They do. And it's not the only thing. I'm not saying that.

SPEAKER_02 25:37

Yeah, like as somebody, and yes, my survivorship bias plays into this. I know that, I'm aware of it. As somebody who was pre-diabetic at 15 and had massive high blood pressure at 15, who was 400 pounds by the time I was 18 years old, I, and being now down 200 pounds-ish of body fat for freaking 13 years, my last A1C was 4.2. I like my blood pressure can get a little high. I'll admit. We're just talking about it.

SPEAKER_01 26:07

You're just talking about this.

SPEAKER_02 26:08

It's it's it's on the edge of if I should be on a drug or not. It's on the edge. Um, but in general, like, what what what changed? Was it medication? No. Was it what socioeconomic standard? No. It was my lifestyle. Losing 200 pounds reversed every single chronic disease I had in ones on the border. Um, and so it's like, what do you like until we have a really hard conversation about how your lifestyle affects chronic con chronic diseases, we're not gonna make a major shift in the American healthcare system. We're not going to.

SPEAKER_04 26:46

And I think, I mean, I think people are very aware that, say, diabetes is lifestyle driven to some degree. Um, but there are things that I think people don't even realize. Like this is a very common problem in older men that uh we treat all the time. But uh, and I don't know how many people know how it's connected to lifestyle, but erectile dysfunction, so common. Do you know how many men are on Viagra or Cialis? That is a highly, highly, highly lifestyle-driven condition. Really?

SPEAKER_02 27:14

Yep. All right, walk me through that because I was completely unaware of that.

SPEAKER_04 27:16

Well, so I mean, when when men have this problem, they probably have endothelial dysfunction, they probably have high cholesterol. Those things all kind of work together, like smoking, physical inactivity, obesity. It's a very um, if you're not metabolically healthy, it leads to this endothelial dys dysfunction. You have um uh problems with nitric oxide availability, and that contributes, and it's just very connected.

SPEAKER_02 27:39

So funny enough, I used to actually make this as a joke because I got it from a comedian. Okay. Kind of knew some of those points as you started, it started it waved back into me. It was a comedian talking about how he went to his doctor and he was like 340 pounds or something, like 150 pounds overweight. And talk about leverage. Like you gotta just gotta find what is valuable to the individual, position the pain point of whatever they find valuable, and you can get someone to change. So this guy was seeing his primary and he was like a hundred, 110, 120 pounds overweight. And his primary goes, just so you know, if you're this heavy for too long, you can get ED and you can't get hard anymore. And all of a sudden he's like, wait, wait, wait, wait, that's a thing? He's like, Yeah, it's a hundred percent thing. The guy lost a hundred pounds. Whatever it takes. He's like, Wait, my weeder won't work if I weigh this much? Like, all right, uh now that's enough motivation for me. And the guy lost a hundred pounds.

SPEAKER_04 28:38

Yeah, I think guys just like oh my, I feel like it's like a lot of men are just like, oh, I have it. Can I have the med? And I'm like, well, okay, if you have that problem, you should probably be making sure that your uh heart is okay, that you don't have any significant cholesterol issues, atherosclerotic plaque buildup. Like you should be having these things figured out because it's not it's not this thing that just happens because you're old. It's really not.

SPEAKER_02 29:03

Noted.

SPEAKER_04 29:03

So all right. Um number two. So we as your physicians, we want partnerships with you. We do not need or expect or want perfection. And we say this because I think a lot of people will sometimes people will cancel their appointments or they come in with their head, um, their head down and their tail between their legs, that they haven't accomplished the thing that you talked about at your last visit. And that's okay. We do not expect you to be perfect about all these things that we talk about. And so I'd rather you come in and we have that conversation about okay, what were the challenges and what uh what were the limitations that didn't that you weren't able to make these changes from this visit to that visit? Like let's talk about it.

SPEAKER_02 29:42

So I think that's so true. Like being being on the outside of the practice now and seeing the scheduling and seeing all that kind of stuff, I've witnessed it.

SPEAKER_04 29:50

Oh, really?

SPEAKER_02 29:50

Like, oh, you you have these certain patients that tend to miss appointments and oftentimes the same people that tend to need the most help. And it's so funny because like they're paying a yearly membership. Whether you whether they come in or not, you're getting paid. And like here you are trying to say, hey, let's stay on top of this. We're that's why we're doing this. I we want to help you. Let's do collaborative effort. Like, we'll adjust the approach. This is a team. And like some people just struggle with knowing that they think they think you have to be perfect and they hide.

SPEAKER_04 30:23

Yep. Um, but we're we as your physicians, if your physician is making you feel bad, they didn't do something or kind of yelling at you about it, I wouldn't go to that person. That's just me.

SPEAKER_02 30:33

I don't like being yelled at. See, that's always a fascinating one because some people I I was actually I was on social media some.

SPEAKER_04 30:38

Okay, fine. If you like that kind of Yeah, there is a population that just wants to be just But if you do not like that, like there are people that aren't gonna do that to you. That is not how I practice. All right, number one. I think this is big.

SPEAKER_00 30:53

Yep.

SPEAKER_04 30:54

Healthcare is uncertain, and it's uncertain, more uncertain than people realize. And I think this kind of connects back to one of our earlier points, but we do not have that much certainty in medicine. We can be certain that if you have an infection that is causing a problem, that if we give you this antibiotic, it will fix it. That is quite certain.

SPEAKER_02 31:13

Like we have or or it even in separate part is you can't even like it will help.

SPEAKER_04 31:18

Yeah.

SPEAKER_02 31:18

Like there's still a a fluke. Like we know this drug kills this bacteria.

SPEAKER_04 31:23

But the bacteria is resistant. Yes, I there are caveats to this.

SPEAKER_02 31:26

But that's that's what's always so tough because here's one so, so direct. It's one of the most direct. Oh my gosh. It's like it's still got it, it still has its gray. Yep.

SPEAKER_04 31:35

Um, so again, uh, you can have, you know, you can have somebody tell you uh that your friend that's like, I did this, I took this, it fixed this problem. That doesn't mean it's gonna fix yours necessarily because you are a different person, you're a different age or a different genetics or something. Um so it's not that simple. There's always uncertainty. And again, if um somebody is telling you very definitively and certainly that something's gonna work, they may not be the right person to talk to.

SPEAKER_03 32:05

Agreed.

SPEAKER_04 32:06

So medicine lives in the gray. And that's okay.

SPEAKER_03 32:10

That was a good top 10. Why thank you? I think I think I think I added some value. It was definitely it was definitely a doctor focused.

SPEAKER_02 32:17

But I think I can pick some good.

SPEAKER_04 32:19

Um we gotta do a few of these. Yep. We can't have you talking all the time.

SPEAKER_02 32:24

It's hard for me not to.

SPEAKER_04 32:25

No, I think that was good. I think um those are all really important points that I hope people find helpful and uh I hope open some people's eyes to what their doctors are thinking behind the scenes.

SPEAKER_02 32:38

And it's also super important to know because uh this whole process comes about from this idea that this practice values a collaborative relationship education-driven outcome and patient care. Uh so, and it's fun to know that we've been really starting to grow the local West Michigan uh viewership base, and we've been consistently growing for six months now. And so in the podcast? In the podcast.

SPEAKER_04 33:06

Remember, Jana told me that we were talking about starting the podcast a year ago.

SPEAKER_02 33:10

I know. And then we're six months in now. Seven, seven months. I think we're more than six months.

SPEAKER_04 33:14

Six months was six months was December. We've been doing this since last summer. It's been like a year almost.

SPEAKER_02 33:19

Like July. Uh but it's super important to know if if you're in West Michigan, I'm gonna do my shameless, this is one of the first shameless plugs here. If you're in West Michigan and you value the opportunity to have a collaborative effort with your doctor, and insurance-based medicine just they can't do it. It's not the doctor's fault. Some doctors are bad. Some doctors are bad. But majority of time, doctors are tied to insurance. And this practice is about building a relationship over time to actually make long-term health benefits. So if you've been listening to this podcast and you value what this podcast is about, come in for me and greet. Please do. And just and even if it's if it doesn't work out and you don't find the value at the end of the day, that's fine. But at least come in, say hi, and uh say what you value most about the podcast.

SPEAKER_04 34:05

Yeah.

SPEAKER_02 34:05

And uh we're looking forward to seeing you.

SPEAKER_04 34:07

We want it to be a fit for both sides for both parties. So but come talk to us. We're happy to sit down. No pressure at all.

SPEAKER_02 34:14

And now we have San Pellegrino.

SPEAKER_04 34:17

We do. We have beverages for our patients. You can get a coffee, there's chocolate.

SPEAKER_02 34:22

It's not as good as Diet Coke. I'm sorry. It's it's good. It's not it's not a Diet Coke.

SPEAKER_04 34:28

It's just different. It's just not quite as fake sweet.

SPEAKER_02 34:31

It's sweet, sweet.

SPEAKER_04 34:32

There's not sugar in that. Well, there might be a smidge. I don't actually know.

SPEAKER_02 34:36

What is? We are not sponsored by Sam Pellegrino. Concentrate. But we do like it. No, there's no sugar in here at all.

SPEAKER_04 34:43

Great, perfect. Cool. Well, uh, if you're out there and found this valuable, we would love, please give us a five-star review on whatever platform that you use. Uh send us a DM or a comment or we're gonna start doing more top tens.

SPEAKER_02 34:56

So if you have a top ten you'd like us to do, tell us what you want to hear. DM down below.

SPEAKER_04 35:00

Absolutely. And we will uh David and I are nine days from our wedding. We so we're gonna we're gonna try to get these podcasts ready.

SPEAKER_02 35:11

We're supposed to keep it through going through the wet through the honeymoon. So we're cranking out some top tens over the next week and a half.

SPEAKER_04 35:16

So let us know what you think, and uh we'll talk to you soon.

SPEAKER_02 35:20

Totals.

SPEAKER_04 35:20

Bye.