Making Sense - Sam Harris - #129 — An Insider’s View of Medicine

Dr. Nina Shapiro is a Pediatric Otolaryngologist, a pediatric ENT surgeon, and a Professor of Head and neck Surgery at UCLA. She s been featured in the New York Times, Time, the Wall Street Journal, NPR, and CNN, and she s written a new book, Hype: A Doctor s Guide to Medical Myths, Exaggerated Claims, and Bad Advice: How to Tell What's Real and What's Not. She joins me to talk about what it s like to be a patient as a doctor, and what should patients know that doctors know that they should know, and how to tell what's real and what's not. We also talk about her book, Hype, a doctor's guide to medical myths, exaggerated claims, and bad advice, which is now available for purchase on Amazon and is available for pre-order on Amazon Prime and Vimeo. She's a great friend of mine, and I wanted to have her on the podcast to give us an insider s view of medicine and what it's like being a doctor in the 21st century, so I asked her to come on the show to talk to me about her experience as a patient. She graciously agreed to come and give us her perspective on what it is like to work as a physician. a doctor and to share her knowledge and experience in the field of pediatrics. In this episode, we talk about how she got into the field, her career, her background, her path to becoming an ENT, and why she chose this field, and her advice for her new book on how to get into this field and why it s important to get a degree in this field in the first place. What are some of her favorite parts of medicine? What is it like being an ER doc? What does it mean to be an ER doctor? How do you know that you can be a good doctor in today s society? and what is the difference between a doctor and a good ER doc ? How is it s a doctor ? What do you want to know that s not a good at it? And What s the worst thing a doctor should know that a doctor can do to help you become a better doctor and what s the best thing you can do with your health care Why is it important to have a doctor s perspective on the job you can get better?

00:00:00.000 Welcome to the Making Sense Podcast.

00:00:08.820 This is Sam Harris.

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00:00:46.760 Today I'm speaking with Dr. Nina Shapiro.

00:00:50.000 Nina is a pediatric otolaryngologist.

00:00:53.340 She's a pediatric ENT surgeon, and she's also a professor of head and neck surgery at UCLA.

00:01:00.980 She's been featured in the New York Times, Time, the Wall Street Journal, NPR, CNN, and

00:01:07.420 she's written a new book, the title of which is Hype, A Doctor's Guide to Medical Myths,

00:01:12.860 Exaggerated Claims, and Bad Advice, How to Tell What's Real and What's Not.

00:01:16.960 And Nina is just a fantastic doctor, so I wanted to have her on the podcast to give us an insider's

00:01:23.500 view of medicine.

00:01:25.840 I wanted to know what it's like to be a patient as a doctor.

00:01:29.280 What should patients know that doctors know?

00:01:32.860 So we spend most of the hour talking about that, but then we touch on her book a little

00:01:36.520 bit at the end.

00:01:38.020 Anyway, it was great to talk to Nina, and I hope you find this conversation useful.

00:01:42.260 And now I bring you Nina Shapiro.

00:01:51.020 I am here with Nina Shapiro.

00:01:52.900 Nina, thanks for coming on the podcast.

00:01:54.700 Thanks for having me.

00:01:55.460 Great to be here.

00:01:56.420 Unlike many of my guests, you are someone I know personally, and as a client, you're a

00:02:01.460 fantastic doctor who has written a book that we'll be talking about, but so I just want

00:02:07.140 to give that context because I can attest to the quality of your bedside manner and

00:02:12.260 the quality of your friendship.

00:02:13.340 So I've got a better view of you than most guests.

00:02:17.000 Before we get into practical questions of health and your book, just remind me and tell

00:02:24.020 our listeners about your background because you were sort of born to be a doctor, if I'm

00:02:28.540 not mistaken.

00:02:30.100 I guess so.

00:02:31.300 Yeah, I do come from a medical family, and I don't have one of those really, really cool

00:02:38.500 backstories about how I was first on Broadway and then ended up in medical school.

00:02:43.580 I pretty much followed the track to medical school all on the East Coast, did my residency

00:02:50.060 training and medical training back in Boston, moved out to California for a year, and that

00:02:58.440 was 22 years ago.

00:03:00.360 And certainly kind of like arriving like Dorothy and Oz, I realized how nice it was out here,

00:03:05.960 so I decided to stay.

00:03:07.920 And I've been in academic medicine at UCLA for about 21 years now.

00:03:13.180 And my specialty, which is really small and very narrow, is pediatric otolaryngology, so

00:03:19.180 pediatric ear, nose, and throat surgery.

00:03:21.720 And I'm a professor at UCLA, so I do some teaching in a lot of what we call tertiary or

00:03:26.800 coronary care medicine.

00:03:28.340 So sort of the referral cases that come from all over the country and actually all over the

00:03:33.720 world to take care of pretty sick kids.

00:03:36.540 So you did your medical degree at Harvard.

00:03:39.160 Did you work anywhere else or you went straight to UCLA?

00:03:41.900 So yeah, so I did my medical school at Harvard and I did my residency at Harvard.

00:03:45.220 And then I did a combined pediatric otolaryngology fellowship part of the year at Great Ormond Street

00:03:51.500 Hospital in London and then part of the year at Rady Children's Hospital in San Diego.

00:03:57.120 And that's how I landed in California.

00:03:58.720 Did you go straight into working with kids or did you work with adults for any significant

00:04:05.540 period of time?

00:04:06.600 So my residency was a mix of kids and adults, and that's pretty standard for all otolaryngology

00:04:13.440 residency.

00:04:14.760 And then once I did my fellowship right after residency, I've been working with kids ever

00:04:18.740 since then.

00:04:19.620 I'm always struck by how different the careers are depending on what type of doctor you decide

00:04:26.620 to be.

00:04:27.120 I mean, the overlap between being an ER doc and a dermatologist, as far as I can tell,

00:04:32.300 is almost zero in terms of just what their life experience is like.

00:04:37.320 So where would you put your specialty in terms of the high stress side of things and the technically

00:04:43.800 difficult side of things?

00:04:45.340 You're a surgeon as well as someone who just actually diagnoses problems.

00:04:50.580 Right.

00:04:50.700 So I sort of put my specialty, it's sort of like playing the piccolo in an orchestra where

00:04:57.140 you do a lot of sort of regular day-to-day stuff, mundane.

00:05:01.240 You don't really get noticed that much.

00:05:04.060 Most of the stuff is pretty healthy people.

00:05:07.080 And then every so often there's this piercing, life-threatening event that in a matter of seconds

00:05:15.680 can go from great to horrific.

00:05:19.500 So it's sort of, and I do play the piccolo, so I feel like there's some connection there

00:05:24.520 where, you know, we, for the most part, we take care of healthy people and everybody smiles

00:05:28.840 and it's pretty much, you know, an enjoyable time.

00:05:32.280 But because I take care of tiny infants and we as a specialty are the last resort when it

00:05:40.000 comes to an airway problem.

00:05:41.640 So if somebody can't breathe and if that somebody happens to weigh two or three pounds, we're

00:05:46.980 the ones that are called.

00:05:49.820 So every so often we have this excruciating, life-threatening moment and that just keeps

00:05:55.220 us on our toes and we lose a little bit of sleep because of that.

00:05:58.680 Also, you're dealing with people's kids, which has to raise the stakes.

00:06:02.640 I can tell you just from the side of being a parent that it definitely does.

00:06:06.800 I'm way more stressed out dealing with the uncertainty around my kids' health than my

00:06:11.340 own.

00:06:12.060 So I can imagine you are seeing parents at their most stressed out where the news is

00:06:18.680 seeming bad.

00:06:20.540 It is.

00:06:20.860 Yeah.

00:06:21.100 And we sort of, we joke that, you know, the kids are the easy part, the parents are the

00:06:25.540 hard part because, you know, kids are actually, for the most part, a lot more resilient than

00:06:29.920 adults and they're healthier than adults.

00:06:33.240 But rightly so, parents are very, very stressed about anything related to their kids.

00:06:40.460 And again, rightly so. 0.57

00:06:41.840 But, you know, taking care of kids, we have a little bit of a different perspective because

00:06:45.400 we know how much they can handle.

00:06:47.180 Just a lot.

00:06:48.000 A lot more than we can handle.

00:06:49.160 That's for sure.

00:06:50.220 Yeah.

00:06:50.340 Well, so say more about that because I think a lot of the parental stress is predicated on

00:06:56.160 not being in touch with that fact.

00:06:58.740 When you've gone onto Google and read the fine print on whatever this scary diagnosis

00:07:03.740 is and you see all of the horrific possibilities, you sort of transfer that knowledge or pseudo

00:07:11.420 knowledge.

00:07:11.960 We'll talk about the problems with Google onto your kid.

00:07:15.420 And I think it just tacitly where you're just assuming that, you know, this dark cloud

00:07:20.480 hanging over your life now is casting the same amount of shade in your kid's mind, or

00:07:26.820 at least could be.

00:07:28.380 And of course, your kid, depending on the age, I mean, if your kid is in fact a kid, your

00:07:33.920 kid knows nothing of these possibilities unless you tell them.

00:07:37.760 And it's very likely that your concerns are out of proportion to the actual probabilities.

00:07:44.520 And now speaking of me and many of our listeners, you not being a doctor are not weighing these

00:07:50.500 possibilities intelligently.

00:07:52.740 And so tell me a little more about how you perceive the experience of a child dealing with

00:07:58.980 significant health adventures.

00:08:02.240 So, you know, I hear a lot of concerns from parents and some of these concerns are very,

00:08:07.080 very well-founded, you know, for instance, if they're concerned about anesthesia or concerned

00:08:12.720 about medications, you know, there's a lot of solid information about that, that they

00:08:17.560 can find.

00:08:18.200 But, you know, as you mentioned, Google, and that's what most people, doctors included,

00:08:22.580 actually use when we're looking something up or, you know, we're questioning something,

00:08:26.600 is set to find the most extreme, most exaggerated information that, you know, it's devastating.

00:08:37.080 And it's, it's, all it does for the most part is create some confusion and panic.

00:08:43.140 And we love to panic.

00:08:45.440 We love to sort of find the most extreme, whatever it is, certainly when it comes to

00:08:51.440 our health or our child's health, and it will be easily found if you do a search.

00:08:56.520 So, you know, a lot of what I do day to day is calming people down and trying to put things

00:09:04.680 into perspective.

00:09:05.940 And what often people think about is the risk of an intervention, whether it's a medicine

00:09:12.200 or a surgery, but few people are really thinking about the risk of not intervening.

00:09:18.180 And they think of that always as less invasive, when oftentimes, and certainly in my practice,

00:09:24.740 being less invasive, less invasive or less proactive can actually be higher risk and more

00:09:30.740 dangerous to a child.

00:09:32.440 But a parent obviously just thinks of it as protecting their child from something.

00:09:37.560 But that something could actually be much more beneficial than the risk of not doing something.

00:09:43.280 It is an interesting view of human health you get working only on kids, because I think

00:09:49.280 as you say, kids are, for the most part, the healthiest people on earth.

00:09:54.000 But obviously, there are the rarer cases where there's something very serious going wrong and

00:09:59.760 the stakes are that much higher.

00:10:02.600 Is there more to say about the resiliency of kids with respect to adults, I mean, in terms

00:10:06.280 of just recuperating from procedures that work out or just, you know, most conditions

00:10:13.220 being self-limiting?

00:10:14.400 I mean, how do you think about the resiliency of a kid versus the resiliency of someone

00:10:19.520 our age?

00:10:20.960 So for the vast majority of kids, they are much more resilient than most adults.

00:10:27.120 Their hearts are stronger.

00:10:28.440 Their lungs are stronger.

00:10:30.540 When they have an infection, they recover more quickly.

00:10:33.080 When they have any sort of surgery, they recover more quickly.

00:10:37.060 And, you know, it's astounding as some, you know, kids will go home the same day or

00:10:41.340 the next day after a small heart surgery.

00:10:44.020 You'd never see that in an adult.

00:10:46.760 You know, kids have these devastating illnesses or a devastating event and they bounce back.

00:10:53.620 It's really, they are almost a different, you know, obviously not a different species,

00:10:57.540 but they're really a different type of being than adults.

00:11:00.780 And because they seem so much more fragile and helpless, we rightly want to protect them

00:11:07.980 more, but their resilience is so much better, stronger, and quicker than any adult's resilience

00:11:16.000 that, you know, we who take care of kids have, you know, sort of a different view on what

00:11:20.780 they can tolerate.

00:11:21.820 And it's a lot more than what most adults can tolerate.

00:11:24.880 Yeah, I once saw my daughter fall down the stairs from a distance.

00:11:31.220 I mean, this is still, I'm still horrified by this sight.

00:11:34.940 I can't get, I still have PTSD, I think, from seeing this.

00:11:37.860 And this was a fall that would have absolutely paralyzed a stuntman.

00:11:43.840 I mean, this was just, everything was wrong about this fall.

00:11:46.720 It looked like her attempt to break her own neck and she was completely fine.

00:11:51.860 Right.

00:11:52.080 So you sort of lose sight of that when you're being dragged through this labyrinth of medical

00:11:58.320 uncertainty with your child.

00:12:00.440 And yeah, some of the, you know, kids, if you, if you look at a little child and, you know,

00:12:04.720 we always say, oh, children are not just small adults.

00:12:06.860 They're built to withstand stuff like that.

00:12:09.960 Their, their necks are smaller, their heads are kind of puffier and more, you know, kind of

00:12:15.180 cushioned than ours are.

00:12:16.980 So, you know, a lot of just physiologically and physically kids are physically built to

00:12:23.680 tolerate falls.

00:12:25.040 Their babies, they're even like something as simple as a baby's vocal cords.

00:12:29.620 What do babies do when they're not sleeping?

00:12:31.420 They're crying, but they don't develop hoarseness or nodules or, you know, vocal issues from crying

00:12:37.960 for 10 hours per day because they're built to withstand that.

00:12:42.040 So, you know, it's some sort of evolutionary ability for kids to withstand a lot of the

00:12:48.980 trauma that we as adults, you know, if we fell down the stairs, we'd crack our necks or break

00:12:52.760 our skulls.

00:12:53.820 But kids, you know, literally we say they bounce and, and it's great.

00:12:58.200 You know, that's, that's why they can go on to adulthood and then get hurt.

00:13:01.760 Yeah.

00:13:03.440 Yeah.

00:13:03.940 Well, I want your doctor's eye view of being a patient essentially, or, or, or the parent

00:13:10.700 of a child who's a patient.

00:13:12.780 And I want to know how you go through these experiences of getting sick or having people

00:13:18.060 in your life get sick and just, you know, how it is you would navigate a hospital and,

00:13:23.180 you know, how you think about second opinions and all of that.

00:13:26.720 We've touched a couple of these issues already.

00:13:29.300 You get a diagnosis that sounds scary from one doctor.

00:13:34.400 You go home and Google it and get properly terrified by the, what is in many cases, a

00:13:39.480 very low probability risk.

00:13:42.060 And then it's certainly standard procedure to get a second opinion.

00:13:48.460 Certainly if there's any significant intervention on the menu, like a surgery.

00:13:53.080 At this point, I have gone down this path enough that all this is anecdotal, obviously, but

00:13:58.040 if you're judging from my experience, both when I'm the patient and when my kids have

00:14:03.780 been, it's fairly alarming how often I've gotten a false diagnosis, you know, that is

00:14:10.700 overturned by a second opinion.

00:14:13.080 And in some cases, the first diagnosis came with a very strong recommendation for treatment

00:14:20.100 that was a significant intervention.

00:14:22.760 I once left a doctor's office where, I forget, this is now 10, 15 years ago, I was having

00:14:28.220 some problem.

00:14:29.780 I think I had pain in my hands or something.

00:14:31.720 I mean, I was a martial artist.

00:14:33.320 There were plausible reasons why I might have pain in my hands.

00:14:37.040 But I wound up in the care of a rheumatologist who diagnosed me with, I think it was psoriatic

00:14:43.440 arthritis and sent me out of the office with a month's supply of methotrexate and Humira,

00:14:48.480 which are significant medications, and basically it was, you know, putting me on these drugs

00:14:52.560 for the rest of my life.

00:14:54.140 And, you know, it seemed quite crazy at the time.

00:14:57.320 And I went and got a second opinion and another rheumatologist said, well, you don't have psoriatic

00:15:01.320 arthritis.

00:15:02.140 You probably just did something to your hands.

00:15:03.740 But that kind of thing has happened with my daughters.

00:15:07.620 It's fairly startling.

00:15:08.920 And in fact, I met you in this context, or at least I've met you professionally in this

00:15:14.040 context, where I think my daughter had been diagnosed with a cholesteatoma by a pediatrician.

00:15:20.580 And this is very much in your wheelhouse.

00:15:23.420 I had never even heard of a cholesteatoma.

00:15:25.320 And I brought her into you and you took one look in her ear and said, well, she doesn't 0.97

00:15:28.420 have a cholesteatoma.

00:15:29.640 But, you know, I had spent 24 hours previously having Googled a cholesteatoma and realized how

00:15:36.500 much I didn't want her to have one.

00:15:38.400 And, you know, it was a fairly stressful day.

00:15:41.500 So how do you think about second opinions and what advice do you have for people?

00:15:46.300 Because doctors obviously can quite confidently represent some state of affairs that isn't

00:15:51.300 true.

00:15:52.240 Yeah, second opinions are, you know, surprisingly a luxury.

00:15:55.840 A lot of people don't have the wherewithal or the means to obtain second opinions, unfortunately.

00:16:02.120 So a lot of people, you know, just are lucky and feel lucky that they can just get in to

00:16:07.220 see a doctor.

00:16:07.860 And unfortunately, a lot of people are misdiagnosed or, you know, receiving overly aggressive or

00:16:14.500 underly aggressive treatment.

00:16:16.060 And this is a big problem.

00:16:18.020 You know, I, as you, you know, you've had the experience with your daughter, you know,

00:16:21.440 I, I see patients and I, you know, sometimes they're a bit disappointed when I say, nope, there's

00:16:26.660 not the problem.

00:16:27.460 And your child doesn't need surgery and the family actually leaves a little bit frustrated

00:16:32.460 because they, they almost wanted there to be something.

00:16:35.780 And I, I tell them, you will find a surgeon who will operate on your child, you know, guaranteed.

00:16:42.360 So it is, it is a problem.

00:16:45.960 And it, there isn't really the, why this is happening, why people in different medical centers

00:16:53.300 recommend different treatments, unless it's something that's, you know, has several pathways.

00:16:58.680 For instance, if, if you have a cancer patient, there are several different ways to approach

00:17:03.560 it, whether it's surgery, chemotherapy, surgery, chemo radiation, you know, there are some variations

00:17:09.460 to those sorts of paths.

00:17:11.360 And a lot of that depends on the medical status of the patient, how healthy they are, their age,

00:17:17.560 what they can tolerate.

00:17:18.380 But, you know, this sort of stuff where somebody doesn't have something and then they end up

00:17:23.340 getting a surgery, that is not good medical care, unfortunately.

00:17:29.760 I think, you know, if you have a new problem and you have the wherewithal to obtain two or

00:17:35.540 even three opinions and it's not something urgent, I think I do encourage people to do that.

00:17:41.680 And for the most part, you will find, you know, for instance, if it's a surgical issue and you

00:17:48.280 see two surgeons, you're, you may find some minor variations in how they do the surgery or exactly

00:17:55.400 what type of surgery.

00:17:56.580 But if one surgeon says operate and the other surgeon says absolutely don't operate, then

00:18:02.260 you need a third opinion to sort of break the tie.

00:18:05.420 But, you know, it's a problem.

00:18:07.720 What about bias built into the discipline?

00:18:10.380 So, you know, surgeons have the tool of surgery and I think it's a common concern and maybe

00:18:18.240 a valid one that if you go to a surgeon for advice, really his or her choice will always

00:18:25.700 be, well, to operate or not.

00:18:28.260 And that could bias you in the direction of getting surgery that perhaps you don't need.

00:18:34.760 I mean, I guess this is somewhat linked to the question of whether or not to get certain

00:18:39.200 kinds of tests.

00:18:40.060 I remember once, again, this is back to my own personal martial arts generated problems,

00:18:45.180 but I was having some back pain and I asked my doctor whether he thought I should get an

00:18:50.620 MRI of my back.

00:18:52.060 And he said, well, you know, you're whatever it was at the time, 40 years old.

00:18:56.220 I can guarantee you, you have at least one bulging disc.

00:19:00.600 You'd be a miracle not to have something that we can image there.

00:19:05.580 And seeing it in your scan is not going to tell you whether it really is the source of

00:19:10.620 your symptoms.

00:19:11.620 And then you are going to want to have a conversation with a surgeon and you will find one who will

00:19:15.400 say, yeah, we could shave that off for you or this is something that we can talk about.

00:19:19.720 And, you know, why start that process at all when what I'm going to recommend you do,

00:19:24.380 whatever we see on that film is, you know, do physical therapy, back off the martial arts

00:19:28.700 and avoid surgery at, you know, at almost any cost for a problem of this scale.

00:19:34.140 There's this problem of too much information and maybe there's this problem of talking to

00:19:39.660 the wrong specialty too early.

00:19:42.520 Well, hopefully not.

00:19:44.680 I like to tell people that they don't need, that their child doesn't need surgery.

00:19:49.260 And I think, you know, we have to sort of wonder, you know, where, if it's that much of a concern,

00:19:55.160 if you, if people are feeling that you, you can't go to a surgeon for an evaluation because

00:19:59.920 they are a hammer and they're just looking for a nail, you know, that, that says, that's

00:20:06.300 a pretty negative feeling or, you know, concern about medicine in general that, you know, if

00:20:13.820 you go to a certain specialty, they will find a problem related to their specialty.

00:20:18.820 And I, you know, and I think that's, what's created a lot of, you know, sort of mistrust

00:20:23.460 of, of medicine and rightly so, because people are, you know, known to overoperate.

00:20:29.460 As you said, you know, you have a small disc problem that could probably be remedied just

00:20:34.140 by taking, you know, some physical therapy or resting or doing different exercises as

00:20:38.780 opposed to, oh, you know, you have a disc bulge, we need to operate on it.

00:20:42.720 And, you know, unfortunately there are a lot of doctors out there, a lot of surgeons out

00:20:46.840 there who are sort of cutting, you know, recklessly or unnecessarily and, you know, with the same

00:20:53.400 result as not doing surgery, but, you know, it's, it's unfortunate that that's, that's

00:20:58.960 how it's become, that people feel that if they go to a rheumatologist, you're going to

00:21:04.520 leave the office with a rheumatologic disease, or if you go to a spine surgeon, you're going

00:21:09.140 to leave, you know, scheduled for spine surgery.

00:21:11.340 And, you know, I think that's, I don't know how to sort of purify medicine or how we can

00:21:18.640 sort of get back to, well, if you go to a surgeon and the surgeon tells you, you don't

00:21:23.460 need surgery.

00:21:24.440 Actually, some people are disappointed with that recommendation and they'll go find someone

00:21:28.600 else who will recommend surgery.

00:21:31.180 But I think if there is something so drastic that's recommended, then you do need to get

00:21:36.960 a second or a third opinion.

00:21:39.080 Does this all just fall into the bin of there being a normal distribution in the talent and

00:21:45.840 knowledge and ethics and any other relevant variable among doctors as there is in almost

00:21:52.500 anything else?

00:21:53.240 And I think this is something that people don't realize or don't want to realize because there's

00:21:58.760 not really a good or obvious remedy for it.

00:22:01.420 But I mean, we recognize that there's a normal distribution of ability in any domain.

00:22:07.040 I mean, baseball players aren't all the same skill level and you could extend this to every

00:22:12.140 profession.

00:22:13.320 But I think we all want to assume that doctors are all at the same level or that the differences

00:22:20.020 between them don't matter.

00:22:22.600 How do you as a doctor think about that?

00:22:24.860 I mean, when a friend of yours has to get a surgery and is asking you, you know, how to find

00:22:30.380 a good surgeon, is there a kind of insider knowledge of there being good surgeons and bad surgeons

00:22:36.540 in medicine or do the bad surgeons magically disappear?

00:22:41.760 Bad surgeons never disappear, unfortunately.

00:22:45.600 You know, I think there is a little bit of an insider track that we in medicine are privy

00:22:53.860 to.

00:22:54.340 You know, certainly if you work in a large medical center, you know, we sort of know certainly

00:22:58.840 how to navigate this very complex system internally and then even around the country.

00:23:05.840 You know, for instance, if I get a call from a friend across the country and their child

00:23:10.900 or they need a surgery or have a specific medical problem, you know, it's one of those almost

00:23:16.340 like a six degrees of separation, but it's usually only two or three degrees within a phone

00:23:20.920 call or two. I could find them the right person that is trustworthy, has a good background, has it,

00:23:27.300 you know, has good ethics, as you said, and is not just operating because they feel everybody

00:23:32.200 needs a certain type of surgery. So, you know, there is just as with most fields, there is a little bit

00:23:38.840 of an insider track. And one of the benefits of being in medicine is that we have pretty good

00:23:45.420 access to other specialists pretty quickly.

00:23:49.680 All right. So we'll give your phone number at the end of this podcast and you'll just get a few

00:23:53.460 calls a day for medical referrals.

00:23:56.700 Just my home address would be good. Yeah.

00:23:59.580 So this just brings me to my wanting your doctor's eye view of getting pushed or dragged into the

00:24:08.120 machine of medical attention. And so you are sick or someone close to you is sick and you now have to

00:24:14.360 go to the hospital. What do you as a physician know about checking into a hospital that the average

00:24:21.820 patient might not? What are your concerns? What do you want to avoid at all costs? What kind of

00:24:28.740 questions do you ask that might not occur to the average person to ask? How do you navigate a hospital?

00:24:34.760 So, you know, that really depends on whether it's something that's planned, you know, a scheduled

00:24:40.520 procedure or scheduled admission or surgery versus an emergency situation. Obviously, if there's an

00:24:47.280 emergency situation and it's something in my home hospital, whether it's as when I was a resident

00:24:54.320 in, you know, across the across the country or now here in Los Angeles, you know, we do have there is a

00:25:01.640 little bit of professional courtesy, just as with if you're in any other line of work, you will get a

00:25:07.380 little bit of professional courtesy and perhaps get in the door a little more quickly, get seen by who

00:25:12.620 you want to get seen a little more quickly. But what I've found and, you know, certainly living and

00:25:17.980 working in Los Angeles where we have a very substantial VIP population, you know, as we say,

00:25:25.720 everybody's a VIP, but we have VIPs. They often try to create and navigate their own treatment plan.

00:25:35.680 And it ends up being creating the worst possible medical care. They may ask for somebody who they

00:25:43.680 think is the best anesthesiologist, for instance, but because the person has a high administrative

00:25:49.880 title, but they have no experience with their medical, their family member's medical condition,

00:25:56.360 it may be the absolute wrong person. People also have this notion that they want to be

00:26:01.900 the first procedure of the day, you know, for a surgeon's busy schedule. Well, that's not always

00:26:08.520 necessarily the best time to have surgery. Or I don't want any, you know, if you're in a teaching

00:26:14.720 hospital, I don't want any residents or medical students around. Well, if we're used to a certain

00:26:20.140 way of practicing and then somebody tries to change that routine because they think they'll get better

00:26:28.900 care, it actually just makes for more anxiety on the part of the caregivers and can create actually

00:26:35.960 a worse care situation. So oftentimes, you know, it's best to just go with the flow of a hospital

00:26:44.680 because they know what they do best. They know their routines, how they do them best. And sometimes

00:26:50.760 trying to alter that, even if doctors, we as doctors try to alter the routine of the caregivers,

00:26:58.300 it can actually backfire and get in the way. So, you know, a lot of hospitals, especially the big

00:27:05.360 ones are very frustrating. They feel very inefficient, but a lot of that is just the nature of how they

00:27:12.220 work and the care ends up being better sometimes by not making a big stink about who you are and who

00:27:18.480 you know and, you know, trying to sort of cut corners. Has this been quantified in any way? It's hard

00:27:24.700 to see how it would be quantified, but I'm sure there are some famous cases where some, you know,

00:27:30.680 Hollywood celebrity got what was obviously substandard care because the whole machine of

00:27:36.860 the hospital was thrown into disequilibrium by all of his or her demands and all of the 0.96

00:27:42.480 star fuckery going on. Is that what you're thinking of when you, when you talk about this? 0.92

00:27:46.560 Yeah. I mean, certainly there've been some extreme cases. It was, uh, you know, there was,

00:27:51.180 you know, one of the babies in one of the hospitals in Los Angeles, you know.

00:27:55.020 If you'd like to continue listening to this conversation, you'll need to subscribe at

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Making Sense - Sam Harris

#129 — An Insider’s View of Medicine

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