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