WEBVTT 1 00:00:03.560 --> 00:00:14.759 Hello, this is the Itchy and Bitchy Podcast because being 2 00:00:14.960 --> 00:00:19.519 itchy is bitchy and our medical system sucks. I'm doctor 3 00:00:19.559 --> 00:00:22.960 Keith Nolica, a vetnary, allergist and dermatologist. 4 00:00:22.399 --> 00:00:25.280 And I'm Stephen Miller, a doctor of nursing practice and 5 00:00:25.320 --> 00:00:26.920 a que care nurse practitioner. 6 00:00:27.280 --> 00:00:31.359 Send us your questions at ask at itch not dot com. 7 00:00:32.079 --> 00:00:34.479 We love you, but we're not your doctors. The information 8 00:00:34.640 --> 00:00:38.359 we discuss is not direct medical advice. Please talk to 9 00:00:38.399 --> 00:00:42.399 your provider who is the expert on your care. The 10 00:00:42.439 --> 00:00:46.119 Itchy and BITCHI podcast is sponsored by Doc Itchy Medical 11 00:00:46.159 --> 00:00:49.640 Pets supplements designed to optimize your pet's health with the 12 00:00:49.759 --> 00:00:54.759 latest veterinary medical research. Visit docchi dot com or find 13 00:00:54.840 --> 00:00:57.880 us on Amazon. Don't forget to send us your questions 14 00:00:58.200 --> 00:01:07.959 to ask at dot com. Welcome back as always. I 15 00:01:08.000 --> 00:01:11.680 hope you're safe and well. How are you care, Captain? 16 00:01:11.719 --> 00:01:14.959 Are you feeling safe and well? I am good, okay, 17 00:01:15.359 --> 00:01:20.719 So welcome to myself, doctor Milica and doctor Miller, and 18 00:01:20.760 --> 00:01:25.640 we are happy to be taking the reins from Karen 19 00:01:25.760 --> 00:01:29.280 nicol who's done a wonderful job, been a dear friend 20 00:01:29.319 --> 00:01:32.000 with us, and I know personally taught me quite a 21 00:01:32.079 --> 00:01:35.840 bit about optimizing medical care in humans, which I've tried 22 00:01:35.879 --> 00:01:37.439 to apply to animals. 23 00:01:38.439 --> 00:01:40.959 What do you think, doctor, Yeah, I mean I have 24 00:01:41.239 --> 00:01:46.560 had twenty six years of experience as a que care 25 00:01:46.640 --> 00:01:50.079 nurse practitioner and doctor of nursing practice in cardiology, and 26 00:01:50.079 --> 00:01:56.000 so a lot of experience with patients and healthcare system, 27 00:01:56.560 --> 00:02:00.879 both on the inpatient and the outpatient side, Lots and 28 00:02:00.959 --> 00:02:04.319 lots and lots of experience and observation. 29 00:02:04.040 --> 00:02:07.760 All right. And I've had thirty years of experience postgraduate 30 00:02:07.840 --> 00:02:12.840 school from veterinary school, teaching in four different universities, and 31 00:02:12.960 --> 00:02:17.680 clinical practice lecturing all over the world textbooks. So we're 32 00:02:17.960 --> 00:02:21.000 both tend to be a little bit ocd. I'll have 33 00:02:21.159 --> 00:02:24.439 some slight insomnia, so we're up late doing all sorts 34 00:02:24.479 --> 00:02:28.240 of activities, and we're also very curious. We also part 35 00:02:28.280 --> 00:02:31.479 of the premise of this is itchy and bitchy Dakichi, 36 00:02:32.520 --> 00:02:36.919 and I've been Docicchi since I was assistant professor at 37 00:02:36.919 --> 00:02:39.479 the University of Georgia and one of the assistants there 38 00:02:39.599 --> 00:02:42.159 named me that, so this kind of fits. Well, thank you. 39 00:02:42.319 --> 00:02:45.280 I'm right add that I am not bitchy. 40 00:02:45.280 --> 00:02:48.039 So you're not Doc bitchy, okay, but we are bitchy 41 00:02:48.039 --> 00:02:50.400 about the system. So that's what the today's topic is. 42 00:02:50.439 --> 00:02:54.800 The system sucks. And so one of the reasons we 43 00:02:54.800 --> 00:02:59.599 were very interested in helping Karen transition this and not 44 00:02:59.719 --> 00:03:03.280 just having her stop giving the wonderful information that she 45 00:03:03.439 --> 00:03:06.400 provides to all of the listeners is that the system 46 00:03:06.479 --> 00:03:08.960 really is broken and it really does suck. And so 47 00:03:09.039 --> 00:03:13.479 we have a lot of experience, five children, a lot 48 00:03:13.479 --> 00:03:18.879 of medical experience, highly educated with treatments and pathomechanisms, and 49 00:03:19.039 --> 00:03:22.080 it's just a crappy system. So we're going to talk 50 00:03:22.080 --> 00:03:25.000 about why the system sucks today and get all of 51 00:03:25.039 --> 00:03:27.960 our venting out and so from here on hopefully we 52 00:03:28.000 --> 00:03:32.159 can talk more about treatments and biomechanisms and why things 53 00:03:32.199 --> 00:03:33.879 happen the way they do and what you can do 54 00:03:33.919 --> 00:03:38.840 about it. But this is the bitchy episode. Are you ready, Doc? Yeah? Okay, 55 00:03:38.919 --> 00:03:42.080 So here we go. So the first thing I just 56 00:03:42.280 --> 00:03:48.240 think is absolutely horrible is that the system is unbelievably abusive. 57 00:03:49.039 --> 00:03:52.560 Our system in America is broken. If you look at 58 00:03:52.599 --> 00:03:55.919 other first world countries that are not perfect, but the 59 00:03:56.319 --> 00:03:59.960 overall experience and the quality of care for the cost 60 00:04:00.080 --> 00:04:04.439 us is a much better value added package. Currently, in 61 00:04:04.479 --> 00:04:09.439 our current system with insurance companies corporate hospital care, the 62 00:04:09.439 --> 00:04:13.400 only people that are really making significant profit profits are 63 00:04:13.560 --> 00:04:19.680 the CEOs, the CFOs, the c suite leaders of the corporations, 64 00:04:19.680 --> 00:04:21.879 and then maybe the investors that own the stock in 65 00:04:21.959 --> 00:04:26.000 the companies. Everyone else, the providers, the doctors, the nurses, 66 00:04:26.079 --> 00:04:30.560 the patients, the families, the staff members are all being 67 00:04:30.639 --> 00:04:34.399 abused by the system. It's just a horrible system. Like 68 00:04:34.439 --> 00:04:37.839 I said, you know, we have five kids. I'm almost 69 00:04:38.199 --> 00:04:40.959 fifty nine years old, so I've had a variety of 70 00:04:40.959 --> 00:04:44.519 health issues. I do have chronic migraines that have worsened 71 00:04:44.519 --> 00:04:47.560 in the years, and trying to navigate as a trained 72 00:04:47.600 --> 00:04:52.279 medical individual, trying to navigate the insurance system, the provider 73 00:04:52.360 --> 00:04:57.160 system to get medications for a chronic disease like migraines, 74 00:04:57.720 --> 00:05:02.519 It's just been horrible and abusive, and I've even thought 75 00:05:02.519 --> 00:05:05.519 about giving up several times. It's just crazy. And then 76 00:05:05.720 --> 00:05:10.399 I watch people like Steven Miller, doctor Miller here, you know, 77 00:05:10.560 --> 00:05:15.120 trying to do cardiology in a clinical setting, and the 78 00:05:15.160 --> 00:05:17.800 providers are being abused just as much as the patients 79 00:05:17.800 --> 00:05:20.160 are being abused. And it very often comes down to 80 00:05:20.199 --> 00:05:23.439 the insurance companies deciding what treatments they will or won't 81 00:05:23.519 --> 00:05:27.879 allow based on revenue and cost structure, and has nothing 82 00:05:27.920 --> 00:05:29.959 to do with the patient or the provider in the 83 00:05:30.040 --> 00:05:32.360 exam room. It's just a crazy system. 84 00:05:32.519 --> 00:05:37.319 I would also argue too, that the healthcare systems within 85 00:05:38.279 --> 00:05:43.519 hospital systems are getting abused at some level, and that's 86 00:05:43.600 --> 00:05:47.759 because we in the US don't have a minimum standard 87 00:05:47.800 --> 00:05:53.480 of care that we can agree upon between our illustrious politicians, 88 00:05:53.879 --> 00:05:57.720 and so we haven't established what the minimum of care is, 89 00:05:57.759 --> 00:05:59.920 and therefore the hospital systems are put in the diff 90 00:06:00.319 --> 00:06:04.680 place of providing care to all, you know, especially through 91 00:06:04.680 --> 00:06:07.399 the emergency departments in this and that, and so there 92 00:06:07.439 --> 00:06:11.160 are some subtleties of that that I would argue on 93 00:06:11.480 --> 00:06:14.040 the side of the system, even though I'm in the 94 00:06:14.120 --> 00:06:17.199 system and there are many days when I'm just utterly 95 00:06:17.240 --> 00:06:22.879 exhausted with the current system. So yes, the providers, the 96 00:06:22.920 --> 00:06:28.000 doctors and nurse practitioners and nurses are getting, you know, 97 00:06:28.279 --> 00:06:34.560 worked very hard and some many times under challenging circumstances 98 00:06:35.040 --> 00:06:38.920 to try to provide the best of care for people. 99 00:06:39.600 --> 00:06:44.040 So that can be challenging when you're held to standards 100 00:06:44.199 --> 00:06:48.480 of production when it's a for profit system. 101 00:06:49.040 --> 00:06:51.560 Yeah, So I think one of the tendencies with my 102 00:06:51.800 --> 00:06:55.639 family and talking to friends and just kind of listening 103 00:06:56.079 --> 00:06:59.560 to the general public is to blame the provider because 104 00:06:59.560 --> 00:07:00.240 they're sort of of. 105 00:07:00.160 --> 00:07:03.800 The doctor the face of the right. 106 00:07:04.439 --> 00:07:06.240 So you know, the doctor won't let me do this, 107 00:07:06.360 --> 00:07:08.319 or the doctor does this, or the doctor does that. 108 00:07:08.920 --> 00:07:13.040 But I've watched doctor Miller here and he often will 109 00:07:13.199 --> 00:07:19.480 will go into start hospital rounds, aren't cardiology patients seven am? 110 00:07:19.600 --> 00:07:22.800 And then sometimes you know, be done with the day 111 00:07:23.360 --> 00:07:25.720 at five o'clock, but have to finish up clinics for 112 00:07:25.759 --> 00:07:29.560 another hour, hour and a half. And then how much 113 00:07:29.639 --> 00:07:32.279 time do you spend on your own time at home 114 00:07:32.839 --> 00:07:34.800 doing lab follow up or call? 115 00:07:35.279 --> 00:07:39.199 So I come home and I work many nights three 116 00:07:39.240 --> 00:07:42.839 hours sitting on the couch with my computer rolling through 117 00:07:43.439 --> 00:07:49.560 with the current electronic medical record, phone calls and messages 118 00:07:49.720 --> 00:07:53.199 and buckets. We call them buckets. And the buckets are 119 00:07:53.399 --> 00:07:57.160 like laboratory buckets and testing buckets and messages and this 120 00:07:57.199 --> 00:07:57.439 and that. 121 00:07:57.839 --> 00:08:01.759 So so you know, a lot of current work trends. 122 00:08:02.240 --> 00:08:04.920 One is that people can opt in for a four 123 00:08:05.040 --> 00:08:07.680 day week and they can do ten hour shifts or 124 00:08:07.680 --> 00:08:10.199 twelve hour shifts, which seem like a really really long time. 125 00:08:10.720 --> 00:08:14.759 Very often, I think you put in easily fifteen hours 126 00:08:14.800 --> 00:08:17.399 a day. Would you every day every day? And then 127 00:08:17.519 --> 00:08:21.240 when you're on call, you're on call every other month ish. 128 00:08:21.600 --> 00:08:23.439 And when you're on call, how many days in a 129 00:08:23.519 --> 00:08:26.519 row will you have done clinics and hospital rounds And 130 00:08:26.560 --> 00:08:29.600 what's the maximum like duration that you're every single day? 131 00:08:29.720 --> 00:08:30.519 Bam bam bam bad. 132 00:08:30.879 --> 00:08:33.240 So I call that a twelve day week, and so 133 00:08:33.320 --> 00:08:36.799 that's basically Monday through Friday clinic and then being on 134 00:08:36.919 --> 00:08:43.159 coverage for the weekend. And so, you know, you get 135 00:08:43.240 --> 00:08:50.159 pressed because of the burden of the work. You feel 136 00:08:50.360 --> 00:08:53.639 challenged to take your time off because there are so 137 00:08:53.720 --> 00:08:56.360 many people trying to get in to be seen and 138 00:08:56.440 --> 00:08:59.879 no spots to put them in. And it's become particularly 139 00:09:00.120 --> 00:09:05.320 were since COVID. So there was this post COVID analysis 140 00:09:05.360 --> 00:09:08.440 where we found that people sat on their care and 141 00:09:08.440 --> 00:09:13.200 then there's been this title wave that's come after COVID, 142 00:09:13.519 --> 00:09:16.559 and now clinics are strained and stressed because there aren't 143 00:09:16.759 --> 00:09:22.480 enough spaces to see all the patients. Number one, number two. 144 00:09:23.080 --> 00:09:30.279 There's this huge amount of retirement that's occurring among senior providers, 145 00:09:30.360 --> 00:09:35.399 nurses and doctors, and all of that plays into the 146 00:09:35.399 --> 00:09:40.600 fact that resources are a limited resource, and so you 147 00:09:40.679 --> 00:09:47.559 start to get squeezed. And then as the AI and 148 00:09:49.080 --> 00:09:52.320 you know, online information has become more available, people have 149 00:09:52.440 --> 00:09:59.039 become more demanding because they feel like they need now 150 00:09:59.039 --> 00:10:02.120 they've got all this in information on you know, the web, 151 00:10:02.840 --> 00:10:07.879 and so they message you at night with these very 152 00:10:08.240 --> 00:10:11.519 detailed messages that are really not appropriate for just a 153 00:10:11.600 --> 00:10:16.200 quick message through the EMR. And so most of those 154 00:10:16.200 --> 00:10:18.559 things really need an office visit to sit down and 155 00:10:18.600 --> 00:10:21.559 have a proper conversation and evaluation of their case. 156 00:10:21.919 --> 00:10:25.720 Yeah. So you know, just imagine working fifteen hour days 157 00:10:25.720 --> 00:10:28.679 for twelve days in a row, and then next time 158 00:10:28.679 --> 00:10:32.399 you think that the provider is causing the problem, just 159 00:10:32.639 --> 00:10:34.759 you know, kind of ponder that for a minute. Okay, 160 00:10:34.799 --> 00:10:36.159 we're going to take a break and then we'll come 161 00:10:36.159 --> 00:10:44.759 back and we'll continue our little bitchy session here. All right, 162 00:10:44.879 --> 00:10:48.000 we're back, and this is the bitchy part of the 163 00:10:48.720 --> 00:10:53.559 Itchy and Bitchy Podcast. So Stephen, what's on your list? 164 00:10:53.759 --> 00:10:57.639 Yeah? I think one thing I hear as a big 165 00:10:57.679 --> 00:11:02.080 frustration from a lot of page is the lack of 166 00:11:02.240 --> 00:11:06.639 integration of EMRs in our current system, and it's become 167 00:11:06.679 --> 00:11:12.919 a big issue because it's led to in efficiencies in 168 00:11:14.200 --> 00:11:19.399 communication between providers, inefficiencies and the sharing of the laboratory results, 169 00:11:19.720 --> 00:11:22.960 which then leads to higher cost of care because everybody 170 00:11:23.000 --> 00:11:23.960 needs their labs. 171 00:11:24.639 --> 00:11:30.360 And we actually do have a so EMR. We're talking 172 00:11:30.519 --> 00:11:32.720 electronic medical records. 173 00:11:32.559 --> 00:11:35.080 Or which are electronic health record. There are a couple 174 00:11:35.120 --> 00:11:36.320 of ways to refurther. 175 00:11:36.080 --> 00:11:39.039 So one of the big attempted developments was that if 176 00:11:39.039 --> 00:11:41.759 we had everything computerized, then all of the clinics, all 177 00:11:41.759 --> 00:11:45.679 of the hospitals, Medicare, Medicaid, could share the information and 178 00:11:45.720 --> 00:11:49.240 no matter where you went, your information would follow you. 179 00:11:49.279 --> 00:11:51.480 For optimal health care, that was the goal. 180 00:11:51.759 --> 00:11:54.480 And in the current health care system we are all 181 00:11:55.200 --> 00:12:01.080 sort of forced into utilization of electronic health records or 182 00:12:01.519 --> 00:12:06.639 electronic medical records, and that's all been very closely regulated 183 00:12:06.679 --> 00:12:09.759 through the US Department of Health and Human Services, which 184 00:12:09.799 --> 00:12:15.440 is really the central authority for health data interoperability, and 185 00:12:15.519 --> 00:12:18.759 so there are national standards that are set for those things, 186 00:12:18.799 --> 00:12:21.840 and so we're held to that standard and they oversee 187 00:12:21.919 --> 00:12:27.559 information exchange. There actually is an Office of Integration that 188 00:12:28.080 --> 00:12:30.759 is there, but they've been there for years and we're 189 00:12:30.799 --> 00:12:34.360 still not integrated, so that it's very, very very slow. 190 00:12:34.799 --> 00:12:37.679 So what are people frustrated about or what's your frustrated 191 00:12:37.759 --> 00:12:37.960 in the. 192 00:12:37.879 --> 00:12:40.399 Fact that they may go in the hospital and that's 193 00:12:40.440 --> 00:12:42.879 one medical record and show up in the office and 194 00:12:42.919 --> 00:12:45.200 I'm on another medical record and I can't get the 195 00:12:45.200 --> 00:12:48.879 hospital record that they had a different system, or they 196 00:12:48.960 --> 00:12:53.519 saw their primary care who was on one medical record 197 00:12:53.519 --> 00:12:56.399 and I'm on another medical record, or we might even 198 00:12:56.440 --> 00:12:59.559 be in the same medical record, and we have a 199 00:12:59.559 --> 00:13:03.039 situation where the data tables don't cross communicate, and so 200 00:13:03.919 --> 00:13:08.559 it's really layered and complex, but also has led to 201 00:13:08.600 --> 00:13:14.679 a lot of frustration, duplication and healthcare and just lack 202 00:13:14.759 --> 00:13:16.399 of collaboration. 203 00:13:17.000 --> 00:13:20.559 Yeah, and this is also why for the last ten 204 00:13:20.639 --> 00:13:23.759 years five years especially, would go see a provider, they 205 00:13:23.840 --> 00:13:26.960 spend a lot of time typing into a computer or 206 00:13:27.039 --> 00:13:30.840 electronic device because they're entering information into the electronic record. 207 00:13:31.399 --> 00:13:35.159 And I think at least we use an EMR in 208 00:13:35.240 --> 00:13:37.360 the veterinary side as well, and ours is much more 209 00:13:37.399 --> 00:13:40.639 efficient and the human side because it's not regulated, so 210 00:13:40.679 --> 00:13:42.519 it just does what we need it to do. But 211 00:13:43.080 --> 00:13:48.080 it really can be a barrier to communication and relationship building, 212 00:13:48.519 --> 00:13:51.000 and then especially if it's not providing the efficiencies that 213 00:13:51.039 --> 00:13:53.039 it was really intended and designed to do, I can 214 00:13:53.080 --> 00:13:55.960 see how that would be really frustrating. Yeah. 215 00:13:56.320 --> 00:13:59.480 Yeah, it's very frustrating when people go, for example, to 216 00:13:59.519 --> 00:14:02.039 their prime here and they get lipids done two months ago, 217 00:14:02.159 --> 00:14:04.679 and then they're coming to my office and I'm held 218 00:14:04.679 --> 00:14:08.639 accountable for the lipids since I'm cardiology, and so then 219 00:14:08.799 --> 00:14:11.279 I don't have the lipids, and so then we either 220 00:14:11.320 --> 00:14:14.120 have to track it down, track it down, have a 221 00:14:14.200 --> 00:14:17.679 nurse that call and get those results, which then puts 222 00:14:17.720 --> 00:14:21.679 a burden on our clinic, and then delay in care 223 00:14:21.879 --> 00:14:24.159 because I don't have them at that visit, and then 224 00:14:24.440 --> 00:14:26.320 I have to once I get them, I'm on the 225 00:14:26.360 --> 00:14:30.799 couch at night reviewing records and having to comment on 226 00:14:30.879 --> 00:14:35.879 their LDL. So it's just led to a lot of 227 00:14:35.879 --> 00:14:40.320 inefficiency in the system and massive frustration for patients. 228 00:14:40.600 --> 00:14:42.519 Yeah, and if it was optimized, I think it could 229 00:14:42.600 --> 00:14:46.399 be much much better. And now the trend is and 230 00:14:46.960 --> 00:14:48.879 she may have a different opinion, but the last time 231 00:14:48.879 --> 00:14:52.440 I went in for my migraine headaches, the neurologist, I 232 00:14:52.440 --> 00:14:55.759 think it was actually a nurse practitioner, really really great guy, 233 00:14:55.840 --> 00:14:58.799 so thank you very much. But he used his phone 234 00:14:58.840 --> 00:15:03.200 and an AI app to record our conversation and then 235 00:15:03.440 --> 00:15:07.200 it would enter it into the electronic health record or 236 00:15:07.240 --> 00:15:10.240 medical record, and he didn't spend any time typing on 237 00:15:10.279 --> 00:15:14.799 the computer. And I found that experience really actually quite 238 00:15:15.039 --> 00:15:20.080 much more pleasant than just typing. But I think you've 239 00:15:20.120 --> 00:15:24.200 had problems with the AI bots and the accuracy with those, 240 00:15:24.320 --> 00:15:27.000 or what's your what's your issue with. 241 00:15:26.960 --> 00:15:30.159 The well So there's multiple issues, and so I certainly 242 00:15:30.240 --> 00:15:34.039 would disagree with you on the use of AI bots 243 00:15:34.639 --> 00:15:42.200 recording patient provider interactions and integrating conversations, and it's some 244 00:15:42.279 --> 00:15:48.600 of the issues are that it records a conversation and 245 00:15:48.639 --> 00:15:52.080 then every visit between every patient sounds basically exactly the same, 246 00:15:52.639 --> 00:15:57.639 and so there is a lack of individuality of the node, 247 00:15:57.759 --> 00:16:03.720 or at least it seems that way. The bots are inefficient. 248 00:16:05.279 --> 00:16:09.919 Sometimes they'll be down. Many times. You may like parts 249 00:16:09.919 --> 00:16:12.000 of what the bot says, maybe in the history of 250 00:16:12.000 --> 00:16:14.080 present illness, but you don't like what it does with 251 00:16:14.159 --> 00:16:17.240 the physical exam, so you have it do that in 252 00:16:17.279 --> 00:16:18.840 the exam room and then you have to go out 253 00:16:18.879 --> 00:16:22.200 of the exam room and spend time regenerating whatever part 254 00:16:22.279 --> 00:16:24.720 of the note. And if you're a good typer, and 255 00:16:24.799 --> 00:16:27.399 I think I'm a good typer, my air rates probably high. 256 00:16:27.440 --> 00:16:30.399 But you can do a bulleted note that's much more 257 00:16:30.440 --> 00:16:35.120 efficient and quick and integrated, and you don't have to 258 00:16:35.120 --> 00:16:38.519 go out of the exam room and spend another ten 259 00:16:38.679 --> 00:16:44.799 minutes undoing whatever the body did. And so it's the 260 00:16:44.840 --> 00:16:47.960 same thing that technology can be really really great, but 261 00:16:48.039 --> 00:16:52.320 it's not always the miracle answer that we hope it is. Well, 262 00:16:52.360 --> 00:16:56.600 and another frustration of the system is that all of 263 00:16:56.639 --> 00:17:01.679 these things are new, right, and so now theer you know, 264 00:17:01.799 --> 00:17:08.160 all these these bots are getting launched prematurely before they're optimized, 265 00:17:08.720 --> 00:17:12.799 and they're launched into these clinics, and so then you 266 00:17:13.000 --> 00:17:17.039 have the the reps for these bot companies who are 267 00:17:17.079 --> 00:17:20.480 coming to the providers wanting to learn from them how 268 00:17:20.480 --> 00:17:23.880 to make the bot better. So the providers are already 269 00:17:23.880 --> 00:17:26.920 stressed with their burden of workload and taking care of patients, 270 00:17:27.200 --> 00:17:30.839 but now we're spending our time educating the bot companies 271 00:17:30.880 --> 00:17:32.359 on how to make their bot better. 272 00:17:32.640 --> 00:17:34.519 And again this is kind of my point that the 273 00:17:36.039 --> 00:17:39.200 providers are truly getting abused in this situation too. So 274 00:17:39.480 --> 00:17:41.599 AI bots sound like a great idea. You know, if 275 00:17:41.640 --> 00:17:45.039 I were a CEO and organizational COEO, you know, it's like, 276 00:17:45.079 --> 00:17:46.720 oh my gosh, that would you know, make things so 277 00:17:46.799 --> 00:17:49.039 much more efficient and I could save twenty percent and 278 00:17:49.079 --> 00:17:51.519 all of these great statistics, and so I could push 279 00:17:51.519 --> 00:17:54.920 it downstream and have the providers required to use it. 280 00:17:55.200 --> 00:17:58.720 And suddenly, now that's you know, one more giant thing 281 00:17:58.799 --> 00:17:59.799 that's piled on. 282 00:18:00.119 --> 00:18:03.880 And this is across the board, you know, with now 283 00:18:03.920 --> 00:18:09.759 that we have remote monitoring with certain devices like pacemakers, defibrillators, 284 00:18:09.759 --> 00:18:12.960 this and that, and those companies have these systems that 285 00:18:13.359 --> 00:18:17.279 out there, and we try to use these across the 286 00:18:17.279 --> 00:18:21.519 board so that we can more efficiently take care patients. 287 00:18:21.559 --> 00:18:24.920 But then again here you have these companies coming to 288 00:18:25.039 --> 00:18:30.200 the provider in between visits or setting up meetings to 289 00:18:30.279 --> 00:18:32.279 have you come and teach them how to make their 290 00:18:32.319 --> 00:18:37.000 system better. And so the providers are getting so squeezed 291 00:18:37.240 --> 00:18:44.640 right now with technology improvement and should be yeah improvement, yeah, improvement, 292 00:18:44.960 --> 00:18:50.240 whereas you know, what we want and are good at 293 00:18:50.279 --> 00:18:54.400 is spending time with our patients and providing care on 294 00:18:54.440 --> 00:18:55.960 an individualized basis. 295 00:18:56.000 --> 00:19:00.440 So technology is a pet peeve a broken system. Okay, 296 00:19:00.440 --> 00:19:02.519 we're going to take another break and we'll be right back. 297 00:19:18.759 --> 00:19:23.720 All right, we're back. And one of my next issues 298 00:19:23.759 --> 00:19:26.119 that I have with the medical system relates to something 299 00:19:26.119 --> 00:19:30.039 that we were talking about before, and that's social media 300 00:19:30.079 --> 00:19:35.400 and doctor TikTok. Social media is not a doctor. It 301 00:19:35.519 --> 00:19:42.640 is not a provider. Chat and Claude and Xai are 302 00:19:42.680 --> 00:19:45.720 getting better and they're better than just doing a Google search. 303 00:19:46.319 --> 00:19:50.000 But one of the things that drives me absolutely crazy 304 00:19:50.319 --> 00:19:54.160 in my clinic, my own veterinary clinic, is that people 305 00:19:54.200 --> 00:19:58.839 will find something on social media, call it doctor TikTok, 306 00:19:59.319 --> 00:20:02.680 and they'll absolutely go down this rabbit hole. And some 307 00:20:02.759 --> 00:20:07.400 of the things are bizarre that you know, they're willing 308 00:20:07.400 --> 00:20:12.079 to give their dog or take something that's incredibly toxic 309 00:20:12.720 --> 00:20:15.759 instead of something that's much much safer that might be 310 00:20:15.839 --> 00:20:19.720 prescribed or an FDA approved drug, but since it's part 311 00:20:19.759 --> 00:20:25.160 of the government or some perceived formal system, they just 312 00:20:25.200 --> 00:20:28.000 have issues with it. So but they're replacing something that's 313 00:20:28.039 --> 00:20:31.240 much much safer and effective with something that's way more toxic. 314 00:20:31.759 --> 00:20:35.519 The other thing that I think is just crazy crazy 315 00:20:35.559 --> 00:20:39.319 to me is that if there's no biological mechanism for 316 00:20:39.400 --> 00:20:43.279 some of these things, and they're just downright dumb. They 317 00:20:43.319 --> 00:20:47.200 don't even make sense for someone that graduated middle school. 318 00:20:47.240 --> 00:20:49.480 So one of the things I came across recently is 319 00:20:49.480 --> 00:20:52.960 that if you take hydrogen peroxide, it'll increase your penile size, 320 00:20:53.279 --> 00:20:55.960 so it'll make your penis bigger. Well, we give hydrogen 321 00:20:55.960 --> 00:20:59.599 peroxide to dogs that ate garbage or toxic substances to 322 00:20:59.599 --> 00:21:02.039 make them vomit. So you can give, you know, a 323 00:21:02.039 --> 00:21:05.680 golden retriever a tablespoon of hydrogen peroxide and ten minutes 324 00:21:05.759 --> 00:21:08.119 later there's a big pile of vomit on the floor. 325 00:21:08.400 --> 00:21:10.400 So whoever came up with that, it was a big 326 00:21:10.480 --> 00:21:13.240 joke on whoever decided that they wanted to try it out, 327 00:21:13.319 --> 00:21:15.119 because that's not going to work out. 328 00:21:15.720 --> 00:21:18.400 Well again, I mean, I think the driving force for 329 00:21:18.519 --> 00:21:23.119 doing this podcast, at least on my part, was to 330 00:21:23.160 --> 00:21:28.720 be able to educate people about proper evidence that's out there, 331 00:21:30.240 --> 00:21:35.519 helping people know how to tease through evidence. So educating 332 00:21:35.559 --> 00:21:38.400 people about studies and how studies are done and what 333 00:21:38.440 --> 00:21:43.400 population size means. And you can find evidence for anything, 334 00:21:43.880 --> 00:21:45.559 but it's. 335 00:21:45.319 --> 00:21:48.240 Well evidence again in air quotes that one person said 336 00:21:48.279 --> 00:21:50.759 one thing or in veninary medicine. We have a big 337 00:21:50.759 --> 00:21:54.480 problem that six dogs did something, and six dogs is 338 00:21:54.519 --> 00:21:58.759 not statistically reliable, you know, So one quote, one patient, 339 00:21:58.839 --> 00:22:02.440 one experience does not mean that's the truth. 340 00:22:02.880 --> 00:22:06.640 Right, and so a study of one is not a 341 00:22:06.720 --> 00:22:11.759 valid study. It's a case study or a case representation, 342 00:22:12.880 --> 00:22:14.240 a case report. 343 00:22:14.119 --> 00:22:16.119 And which could be useful. 344 00:22:16.319 --> 00:22:20.039 It could be useful at the beginning leading to evaluation 345 00:22:20.519 --> 00:22:25.640 of something downstream. But again the issue comes in that 346 00:22:26.519 --> 00:22:29.599 people just don't know what to do with all of 347 00:22:29.640 --> 00:22:33.240 the evidence that's at their fingertip on their cell phone, 348 00:22:33.359 --> 00:22:37.519 which and they don't know how to integrate that into 349 00:22:37.559 --> 00:22:42.240 their care. And so when you have people that spend 350 00:22:43.079 --> 00:22:45.960 years of their life in their doctorate work or whatever 351 00:22:46.079 --> 00:22:50.440 learning about studies and adjudication of studies, and you're expecting 352 00:22:50.559 --> 00:22:53.759 someone who may or may not have those skill sets 353 00:22:54.200 --> 00:22:56.799 to interpret, then that's a. 354 00:22:56.720 --> 00:22:59.599 Lot Which brings me to one of your points that 355 00:22:59.640 --> 00:23:02.920 you mentioned and earlier, is that now both you and 356 00:23:02.960 --> 00:23:06.400 I in ventary medicine human messin are having to explain 357 00:23:06.599 --> 00:23:13.240 a lot more facts where before before we had Google especially, 358 00:23:13.359 --> 00:23:16.759 but now chats and TikTok. I really do think TikTok 359 00:23:16.839 --> 00:23:19.519 is a big issue. Why pick on TikTok, But we're 360 00:23:19.519 --> 00:23:23.279 having to explain things where before people patients are collients 361 00:23:23.400 --> 00:23:25.680 would just assume that we were the experts and trust 362 00:23:25.680 --> 00:23:28.319 our judgment, trust us, and we'd say, you know, this 363 00:23:28.359 --> 00:23:30.720 is the therapy or the diagnostics we need to do, 364 00:23:31.119 --> 00:23:34.200 and it was a very efficient process. And now because 365 00:23:34.240 --> 00:23:37.920 they did their research air quotes again, then we have 366 00:23:38.000 --> 00:23:41.240 to explain the biomechanisms and why we're suggesting and what 367 00:23:41.279 --> 00:23:44.720 the diagnostics are. And it's almost this mini course in 368 00:23:44.799 --> 00:23:48.799 whatever the diagnosis and disease processes, which takes up another 369 00:23:49.160 --> 00:23:50.599 huge amount of time, and. 370 00:23:50.559 --> 00:23:53.759 You're given fifteen minutes to see a patient or less 371 00:23:53.920 --> 00:23:56.960 because now you have medical system, so you're given fifteen 372 00:23:57.000 --> 00:24:00.160 minutes and sometimes you might even get double booked a 373 00:24:00.200 --> 00:24:04.559 fifteen minute slot. And so then you've got someone who 374 00:24:04.599 --> 00:24:09.599 wants to dive into the finer details of cortisol metabolism 375 00:24:10.240 --> 00:24:13.759 and you're trying to balance that with getting to how 376 00:24:13.759 --> 00:24:16.640 do we get you taken care of and stabilized and 377 00:24:17.240 --> 00:24:21.200 empowered to be in a good place health wise, and 378 00:24:21.279 --> 00:24:23.799 so it's it is challenging. 379 00:24:24.000 --> 00:24:26.559 It's just it's just drives me crazy. 380 00:24:26.599 --> 00:24:29.839 The exam room is not meant to be a college course. 381 00:24:30.319 --> 00:24:33.279 It's meant to seek the advice of an expert within 382 00:24:33.319 --> 00:24:37.119 their given field on a treatment plan for you and 383 00:24:37.119 --> 00:24:40.640 what your current health situation is and where you go 384 00:24:40.720 --> 00:24:42.799 from there, and just. 385 00:24:43.839 --> 00:24:49.200 Pay attention for just blatantly dumb ideas like hydrogen peroxide 386 00:24:49.240 --> 00:24:52.680 to make your penis bigger. Okay, we're going to take 387 00:24:52.680 --> 00:25:06.559 a break and we'll be right back. All right, We're 388 00:25:06.720 --> 00:25:11.680 back where their final pet peeve, So, Steven, what you got? 389 00:25:12.039 --> 00:25:16.920 Yeah? So, I think that another frustration for many patients 390 00:25:17.200 --> 00:25:22.759 is the current payer system or insurance companies driving health care, 391 00:25:23.119 --> 00:25:29.119 healthcare insurance driving care and so like for example, when 392 00:25:29.160 --> 00:25:34.000 you got your migraine headache, that was a nightmare, yes so. 393 00:25:34.480 --> 00:25:37.880 And a lot of patients who have made their way 394 00:25:37.920 --> 00:25:42.279 through multiple, multiple, multiple multiple treatments hit this quote nightmare 395 00:25:42.640 --> 00:25:47.160 where a medication is recommended by their provider and then 396 00:25:47.559 --> 00:25:52.160 the insurance company or payer then puts them through the 397 00:25:52.319 --> 00:25:56.160 prior authorization process, and then you get denials, and then 398 00:25:56.200 --> 00:25:58.920 you get appeals, and then the provider on the back 399 00:25:59.039 --> 00:26:01.680 end of that is having in addition to all the 400 00:26:01.720 --> 00:26:04.480 many other things that we take care of, we're now 401 00:26:05.079 --> 00:26:07.400