#129 — An Insider’s View of Medicine
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Summary
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?
Transcript
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She's a pediatric ENT surgeon, and she's also a professor of head and neck surgery at UCLA.
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She's been featured in the New York Times, Time, the Wall Street Journal, NPR, CNN, and
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she's written a new book, the title of which is Hype, A Doctor's Guide to Medical Myths,
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Exaggerated Claims, and Bad Advice, How to Tell What's Real and What's Not.
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And Nina is just a fantastic doctor, so I wanted to have her on the podcast to give us an insider's
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I wanted to know what it's like to be a patient as a doctor.
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So we spend most of the hour talking about that, but then we touch on her book a little
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Anyway, it was great to talk to Nina, and I hope you find this conversation useful.
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Unlike many of my guests, you are someone I know personally, and as a client, you're a
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fantastic doctor who has written a book that we'll be talking about, but so I just want
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to give that context because I can attest to the quality of your bedside manner and
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So I've got a better view of you than most guests.
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Before we get into practical questions of health and your book, just remind me and tell
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our listeners about your background because you were sort of born to be a doctor, if I'm
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Yeah, I do come from a medical family, and I don't have one of those really, really cool
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backstories about how I was first on Broadway and then ended up in medical school.
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I pretty much followed the track to medical school all on the East Coast, did my residency
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training and medical training back in Boston, moved out to California for a year, and that
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And certainly kind of like arriving like Dorothy and Oz, I realized how nice it was out here,
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And I've been in academic medicine at UCLA for about 21 years now.
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And my specialty, which is really small and very narrow, is pediatric otolaryngology, so
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And I'm a professor at UCLA, so I do some teaching in a lot of what we call tertiary or
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So sort of the referral cases that come from all over the country and actually all over the
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Did you work anywhere else or you went straight to UCLA?
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So yeah, so I did my medical school at Harvard and I did my residency at Harvard.
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And then I did a combined pediatric otolaryngology fellowship part of the year at Great Ormond Street
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Hospital in London and then part of the year at Rady Children's Hospital in San Diego.
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Did you go straight into working with kids or did you work with adults for any significant
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So my residency was a mix of kids and adults, and that's pretty standard for all otolaryngology
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And then once I did my fellowship right after residency, I've been working with kids ever
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I'm always struck by how different the careers are depending on what type of doctor you decide
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I mean, the overlap between being an ER doc and a dermatologist, as far as I can tell,
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is almost zero in terms of just what their life experience is like.
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So where would you put your specialty in terms of the high stress side of things and the technically
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You're a surgeon as well as someone who just actually diagnoses problems.
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So I sort of put my specialty, it's sort of like playing the piccolo in an orchestra where
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you do a lot of sort of regular day-to-day stuff, mundane.
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And then every so often there's this piercing, life-threatening event that in a matter of seconds
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So it's sort of, and I do play the piccolo, so I feel like there's some connection there
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where, you know, we, for the most part, we take care of healthy people and everybody smiles
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and it's pretty much, you know, an enjoyable time.
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But because I take care of tiny infants and we as a specialty are the last resort when it
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So if somebody can't breathe and if that somebody happens to weigh two or three pounds, we're
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So every so often we have this excruciating, life-threatening moment and that just keeps
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us on our toes and we lose a little bit of sleep because of that.
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Also, you're dealing with people's kids, which has to raise the stakes.
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I can tell you just from the side of being a parent that it definitely does.
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I'm way more stressed out dealing with the uncertainty around my kids' health than my
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So I can imagine you are seeing parents at their most stressed out where the news is
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And we sort of, we joke that, you know, the kids are the easy part, the parents are the
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hard part because, you know, kids are actually, for the most part, a lot more resilient than
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But rightly so, parents are very, very stressed about anything related to their kids.
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But, you know, taking care of kids, we have a little bit of a different perspective because
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Well, so say more about that because I think a lot of the parental stress is predicated on
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When you've gone onto Google and read the fine print on whatever this scary diagnosis
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is and you see all of the horrific possibilities, you sort of transfer that knowledge or pseudo
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We'll talk about the problems with Google onto your kid.
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And I think it just tacitly where you're just assuming that, you know, this dark cloud
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hanging over your life now is casting the same amount of shade in your kid's mind, or
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And of course, your kid, depending on the age, I mean, if your kid is in fact a kid, your
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kid knows nothing of these possibilities unless you tell them.
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And it's very likely that your concerns are out of proportion to the actual probabilities.
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And now speaking of me and many of our listeners, you not being a doctor are not weighing these
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And so tell me a little more about how you perceive the experience of a child dealing with
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So, you know, I hear a lot of concerns from parents and some of these concerns are very,
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very well-founded, you know, for instance, if they're concerned about anesthesia or concerned
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about medications, you know, there's a lot of solid information about that, that they
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But, you know, as you mentioned, Google, and that's what most people, doctors included,
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actually use when we're looking something up or, you know, we're questioning something,
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is set to find the most extreme, most exaggerated information that, you know, it's devastating.
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And it's, it's, all it does for the most part is create some confusion and panic.
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We love to sort of find the most extreme, whatever it is, certainly when it comes to
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our health or our child's health, and it will be easily found if you do a search.
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So, you know, a lot of what I do day to day is calming people down and trying to put things
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And what often people think about is the risk of an intervention, whether it's a medicine
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or a surgery, but few people are really thinking about the risk of not intervening.
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And they think of that always as less invasive, when oftentimes, and certainly in my practice,
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being less invasive, less invasive or less proactive can actually be higher risk and more
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But a parent obviously just thinks of it as protecting their child from something.
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But that something could actually be much more beneficial than the risk of not doing something.
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It is an interesting view of human health you get working only on kids, because I think
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as you say, kids are, for the most part, the healthiest people on earth.
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But obviously, there are the rarer cases where there's something very serious going wrong and
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Is there more to say about the resiliency of kids with respect to adults, I mean, in terms
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of just recuperating from procedures that work out or just, you know, most conditions
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I mean, how do you think about the resiliency of a kid versus the resiliency of someone
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So for the vast majority of kids, they are much more resilient than most adults.
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When they have an infection, they recover more quickly.
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When they have any sort of surgery, they recover more quickly.
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And, you know, it's astounding as some, you know, kids will go home the same day or
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You know, kids have these devastating illnesses or a devastating event and they bounce back.
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It's really, they are almost a different, you know, obviously not a different species,
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but they're really a different type of being than adults.
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And because they seem so much more fragile and helpless, we rightly want to protect them
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more, but their resilience is so much better, stronger, and quicker than any adult's resilience
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that, you know, we who take care of kids have, you know, sort of a different view on what
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And it's a lot more than what most adults can tolerate.
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Yeah, I once saw my daughter fall down the stairs from a distance.
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I mean, this is still, I'm still horrified by this sight.
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I can't get, I still have PTSD, I think, from seeing this.
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And this was a fall that would have absolutely paralyzed a stuntman.
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I mean, this was just, everything was wrong about this fall.
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It looked like her attempt to break her own neck and she was completely fine.
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So you sort of lose sight of that when you're being dragged through this labyrinth of medical
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And yeah, some of the, you know, kids, if you, if you look at a little child and, you know,
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we always say, oh, children are not just small adults.
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Their, their necks are smaller, their heads are kind of puffier and more, you know, kind of
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So, you know, a lot of just physiologically and physically kids are physically built to
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Their babies, they're even like something as simple as a baby's vocal cords.
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They're crying, but they don't develop hoarseness or nodules or, you know, vocal issues from crying
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for 10 hours per day because they're built to withstand that.
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So, you know, it's some sort of evolutionary ability for kids to withstand a lot of the
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trauma that we as adults, you know, if we fell down the stairs, we'd crack our necks or break
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But kids, you know, literally we say they bounce and, and it's great.
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You know, that's, that's why they can go on to adulthood and then get hurt.
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Well, I want your doctor's eye view of being a patient essentially, or, or, or the parent
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And I want to know how you go through these experiences of getting sick or having people
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in your life get sick and just, you know, how it is you would navigate a hospital and,
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you know, how you think about second opinions and all of that.
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We've touched a couple of these issues already.
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You get a diagnosis that sounds scary from one doctor.
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You go home and Google it and get properly terrified by the, what is in many cases, a
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And then it's certainly standard procedure to get a second opinion.
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Certainly if there's any significant intervention on the menu, like a surgery.
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At this point, I have gone down this path enough that all this is anecdotal, obviously, but
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if you're judging from my experience, both when I'm the patient and when my kids have
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been, it's fairly alarming how often I've gotten a false diagnosis, you know, that is
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And in some cases, the first diagnosis came with a very strong recommendation for treatment
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I once left a doctor's office where, I forget, this is now 10, 15 years ago, I was having
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There were plausible reasons why I might have pain in my hands.
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But I wound up in the care of a rheumatologist who diagnosed me with, I think it was psoriatic
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arthritis and sent me out of the office with a month's supply of methotrexate and Humira,
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which are significant medications, and basically it was, you know, putting me on these drugs
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And, you know, it seemed quite crazy at the time.
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And I went and got a second opinion and another rheumatologist said, well, you don't have psoriatic
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But that kind of thing has happened with my daughters.
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And in fact, I met you in this context, or at least I've met you professionally in this
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context, where I think my daughter had been diagnosed with a cholesteatoma by a pediatrician.
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And I brought her into you and you took one look in her ear and said, well, she doesn't
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But, you know, I had spent 24 hours previously having Googled a cholesteatoma and realized how
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So how do you think about second opinions and what advice do you have for people?
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Because doctors obviously can quite confidently represent some state of affairs that isn't
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Yeah, second opinions are, you know, surprisingly a luxury.
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A lot of people don't have the wherewithal or the means to obtain second opinions, unfortunately.
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So a lot of people, you know, just are lucky and feel lucky that they can just get in to
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And unfortunately, a lot of people are misdiagnosed or, you know, receiving overly aggressive or
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You know, I, as you, you know, you've had the experience with your daughter, you know,
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I, I see patients and I, you know, sometimes they're a bit disappointed when I say, nope, there's
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And your child doesn't need surgery and the family actually leaves a little bit frustrated
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because they, they almost wanted there to be something.
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And I, I tell them, you will find a surgeon who will operate on your child, you know, guaranteed.
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And it, there isn't really the, why this is happening, why people in different medical centers
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recommend different treatments, unless it's something that's, you know, has several pathways.
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For instance, if, if you have a cancer patient, there are several different ways to approach
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it, whether it's surgery, chemotherapy, surgery, chemo radiation, you know, there are some variations
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And a lot of that depends on the medical status of the patient, how healthy they are, their age,
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But, you know, this sort of stuff where somebody doesn't have something and then they end up
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getting a surgery, that is not good medical care, unfortunately.
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I think, you know, if you have a new problem and you have the wherewithal to obtain two or
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even three opinions and it's not something urgent, I think I do encourage people to do that.
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And for the most part, you will find, you know, for instance, if it's a surgical issue and you
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see two surgeons, you're, you may find some minor variations in how they do the surgery or exactly
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But if one surgeon says operate and the other surgeon says absolutely don't operate, then
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you need a third opinion to sort of break the tie.
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So, you know, surgeons have the tool of surgery and I think it's a common concern and maybe
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a valid one that if you go to a surgeon for advice, really his or her choice will always
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And that could bias you in the direction of getting surgery that perhaps you don't need.
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I mean, I guess this is somewhat linked to the question of whether or not to get certain
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I remember once, again, this is back to my own personal martial arts generated problems,
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but I was having some back pain and I asked my doctor whether he thought I should get an
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And he said, well, you know, you're whatever it was at the time, 40 years old.
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I can guarantee you, you have at least one bulging disc.
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You'd be a miracle not to have something that we can image there.
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And seeing it in your scan is not going to tell you whether it really is the source of
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And then you are going to want to have a conversation with a surgeon and you will find one who will
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say, yeah, we could shave that off for you or this is something that we can talk about.
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And, you know, why start that process at all when what I'm going to recommend you do,
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whatever we see on that film is, you know, do physical therapy, back off the martial arts
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and avoid surgery at, you know, at almost any cost for a problem of this scale.
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There's this problem of too much information and maybe there's this problem of talking to
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I like to tell people that they don't need, that their child doesn't need surgery.
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And I think, you know, we have to sort of wonder, you know, where, if it's that much of a concern,
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if you, if people are feeling that you, you can't go to a surgeon for an evaluation because
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they are a hammer and they're just looking for a nail, you know, that, that says, that's
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a pretty negative feeling or, you know, concern about medicine in general that, you know, if
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you go to a certain specialty, they will find a problem related to their specialty.
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And I, you know, and I think that's, what's created a lot of, you know, sort of mistrust
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of, of medicine and rightly so, because people are, you know, known to overoperate.
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As you said, you know, you have a small disc problem that could probably be remedied just
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by taking, you know, some physical therapy or resting or doing different exercises as
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opposed to, oh, you know, you have a disc bulge, we need to operate on it.
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And, you know, unfortunately there are a lot of doctors out there, a lot of surgeons out
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there who are sort of cutting, you know, recklessly or unnecessarily and, you know, with the same
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result as not doing surgery, but, you know, it's, it's unfortunate that that's, that's
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how it's become, that people feel that if they go to a rheumatologist, you're going to
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leave the office with a rheumatologic disease, or if you go to a spine surgeon, you're going
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to leave, you know, scheduled for spine surgery.
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And, you know, I think that's, I don't know how to sort of purify medicine or how we can
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sort of get back to, well, if you go to a surgeon and the surgeon tells you, you don't
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Actually, some people are disappointed with that recommendation and they'll go find someone
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But I think if there is something so drastic that's recommended, then you do need to get
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Does this all just fall into the bin of there being a normal distribution in the talent and
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knowledge and ethics and any other relevant variable among doctors as there is in almost
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And I think this is something that people don't realize or don't want to realize because there's
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But I mean, we recognize that there's a normal distribution of ability in any domain.
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I mean, baseball players aren't all the same skill level and you could extend this to every
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But I think we all want to assume that doctors are all at the same level or that the differences
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I mean, when a friend of yours has to get a surgery and is asking you, you know, how to find
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a good surgeon, is there a kind of insider knowledge of there being good surgeons and bad surgeons
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in medicine or do the bad surgeons magically disappear?
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You know, I think there is a little bit of an insider track that we in medicine are privy
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You know, certainly if you work in a large medical center, you know, we sort of know certainly
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how to navigate this very complex system internally and then even around the country.
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You know, for instance, if I get a call from a friend across the country and their child
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or they need a surgery or have a specific medical problem, you know, it's one of those almost
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like a six degrees of separation, but it's usually only two or three degrees within a phone
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call or two. I could find them the right person that is trustworthy, has a good background, has it,
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you know, has good ethics, as you said, and is not just operating because they feel everybody
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needs a certain type of surgery. So, you know, there is just as with most fields, there is a little bit
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of an insider track. And one of the benefits of being in medicine is that we have pretty good
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All right. So we'll give your phone number at the end of this podcast and you'll just get a few
00:23:59.580
So this just brings me to my wanting your doctor's eye view of getting pushed or dragged into the
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machine of medical attention. And so you are sick or someone close to you is sick and you now have to
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go to the hospital. What do you as a physician know about checking into a hospital that the average
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patient might not? What are your concerns? What do you want to avoid at all costs? What kind of
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questions do you ask that might not occur to the average person to ask? How do you navigate a hospital?
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So, you know, that really depends on whether it's something that's planned, you know, a scheduled
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procedure or scheduled admission or surgery versus an emergency situation. Obviously, if there's an
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emergency situation and it's something in my home hospital, whether it's as when I was a resident
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in, you know, across the across the country or now here in Los Angeles, you know, we do have there is a
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little bit of professional courtesy, just as with if you're in any other line of work, you will get a
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little bit of professional courtesy and perhaps get in the door a little more quickly, get seen by who
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you want to get seen a little more quickly. But what I've found and, you know, certainly living and
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working in Los Angeles where we have a very substantial VIP population, you know, as we say,
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everybody's a VIP, but we have VIPs. They often try to create and navigate their own treatment plan.
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And it ends up being creating the worst possible medical care. They may ask for somebody who they
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think is the best anesthesiologist, for instance, but because the person has a high administrative
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title, but they have no experience with their medical, their family member's medical condition,
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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
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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
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way of practicing and then somebody tries to change that routine because they think they'll get better
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care, it actually just makes for more anxiety on the part of the caregivers and can create actually
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a worse care situation. So oftentimes, you know, it's best to just go with the flow of a hospital
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because they know what they do best. They know their routines, how they do them best. And sometimes
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trying to alter that, even if doctors, we as doctors try to alter the routine of the caregivers,
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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
00:27:42.480
star fuckery going on. Is that what you're thinking of when you, when you talk about this?
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
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