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What to Do When Healthcare Gets Confusing · Life and How to Live It with Dr Rocco

• 0:00
  SPEAKER_00: Do you sometimes feel like life is passing you life?
• 0:03
  SPEAKER_00: How would you like to get more out of life?
• 0:05
  SPEAKER_00: We explore all things life on this podcast.
• 0:09
  SPEAKER_00: Welcome to the Life and How to Live It podcast with Dr.
• 0:12
  SPEAKER_00: Ruffin.
• 0:29
  SPEAKER_00: Welcome to another episode of the Life and How to Live It podcast with me, Dr.
• 0:34
  SPEAKER_00: Rocco.
• 0:35
  SPEAKER_00: In today's episode, we will be discussing navigating the healthcare system.
• 0:40
  SPEAKER_00: Most people never think about the healthcare system until they have to, but then something happens to them or a loved one, and they find the system confusing, frustrating, and overwhelming.
• 0:52
  SPEAKER_00: I'm joined today by a great guest who has dedicated the last six years to advising people on how to navigate the system, Gerda Maysell MD.
• 1:04
  SPEAKER_00: I met Gerda about five years ago when I was sitting on my rehab unit writing patient notes, and a nurse came up to me and said, Dr.
• 1:13
  SPEAKER_00: Macelle is looking for you.
• 1:15
  SPEAKER_00: And I was like, Well, who is Dr.
• 1:17
  SPEAKER_00: Mayselle?
• 1:18
  SPEAKER_00: I don't really know that person.
• 1:19
  SPEAKER_00: So I picked up the phone, and there was Gerda on the other end of the line.
• 1:24
  SPEAKER_00: Um, and she was calling on behalf of one of her clients to see if that person was appropriate to be admitted to my rehab unit.
• 1:33
  SPEAKER_00: Um, so we talked about that client a little bit, and then afterwards I said, but you know, what is this thing that you're doing?
• 1:41
  SPEAKER_00: Because this is not your patient you're calling about.
• 1:44
  SPEAKER_00: This is someone you're advising for.
• 1:46
  SPEAKER_00: And in my 30 years in medicine, I was not familiar with this kind of a role.
• 1:52
  SPEAKER_00: So, you know, Goethe explained it to me, and uh, I thought it was brilliant.
• 1:57
  SPEAKER_00: I I thought this was a really great idea and a very important and needed thing for for people out in the world to have uh a doctor who can, you know, kind of advise them on how to how to go through this very complex system.
• 2:14
  SPEAKER_00: Dr.
• 2:14
  SPEAKER_00: Macelle is a physician who is board certified in physical medicine and rehabilitation, just like me, and is a patient advocate.
• 2:24
  SPEAKER_00: After years as a frontline physician and then a health system executive, she left corporate medicine to found My MD Advisor six years ago.
• 2:34
  SPEAKER_00: Nationally recognized, she now helps people with complex medical problems receive the best care possible by providing sophisticated medical care coordination and navigation.
• 2:47
  SPEAKER_00: She writes a short monthly essay with tips on how to successfully navigate our crazy healthcare system.
• 2:54
  SPEAKER_00: You can find her free blog called The Fog Light on Substack.
• 3:00
  SPEAKER_00: Gerda, welcome to the show.
• 3:02
  SPEAKER_02: Hey Rocco, thanks for having me.
• 3:04
  SPEAKER_00: Well, thank you so much for agreeing to be on the show and talk about this really important topic.
• 3:11
  SPEAKER_00: I I meant what I said.
• 3:13
  SPEAKER_00: You know, when I first met you, you know, on that phone call, I was really struck by what it what a great idea this was.
• 3:21
  SPEAKER_00: I'm wondering, what is it that led you to start My MD Advisor?
• 3:26
  SPEAKER_02: Well, Rocco, it was a combination of things.
• 3:29
  SPEAKER_02: Many of us as physicians get calls from family members or close friends when somebody has a tragic accident or an issue.
• 3:39
  SPEAKER_02: And so I you know, I've done it for years.
• 3:42
  SPEAKER_02: I bet you've done it.
• 3:43
  SPEAKER_02: Nearly all of us have given a little bit of information, some guidance, some support to somebody that we know.
• 3:52
  SPEAKER_02: And back in the beginning of the pandemic, back in the summer of 2020, I received a phone call from my friend who asked me to talk to her friend, who then asked me to talk, this is true, to her to her uncle.
• 4:06
  SPEAKER_02: And this was a wonderful couple.
• 4:08
  SPEAKER_02: Uh, the uncle and aunt had been driving across the GW Bridge in New York in a rainstorm, drove into the bridge, he walked away, and she became a quadriplegic on a ventilator with a uh high spinal cord injury.
• 4:23
  SPEAKER_02: And at this point, that had happened several months ago.
• 4:27
  SPEAKER_02: And the uncle, this wonderful man, although at the time I didn't realize how wonderful he was, I just knew there was this man on the phone, told me that she'd gone to rehabilitation and now is on a subacute vent unit.
• 4:40
  SPEAKER_02: And so for people who don't know, there are these units in nursing homes.
• 4:44
  SPEAKER_02: There's not a lot of them, but there are a few where you can be there on a ventilator and sometimes they try to wean you, sometimes they they you're not weanable, but you get care, but it is at a nursing home level.
• 4:57
  SPEAKER_02: And I'm talking to this man, and he says to me, and I can tell he is trying not to cry.
• 5:04
  SPEAKER_02: And he says to me, They're killing my wife.
• 5:08
  SPEAKER_02: Well, when somebody says to you they're killing, you know, you're they think their wife's being killed, it's a pretty scary thing.
• 5:15
  SPEAKER_02: And of course, your heart goes out to them.
• 5:17
  SPEAKER_02: And of course, there's another part of you, at least of me, that says, Is this person for real?
• 5:22
  SPEAKER_02: Are they exaggerating?
• 5:23
  SPEAKER_02: Like, what up with this?
• 5:24
  SPEAKER_02: So, you know, it was relatively quiet since it was the summer of the pandemic, and I was back up in New York.
• 5:31
  SPEAKER_02: And uh I thought, you know what?
• 5:33
  SPEAKER_02: Let me just see if I can help this guy.
• 5:35
  SPEAKER_02: Let me look into it.
• 5:37
  SPEAKER_02: Well, I looked into it, uh, and he was right.
• 5:41
  SPEAKER_02: Her care was really substandard.
• 5:44
  SPEAKER_02: He she had a very high white count, which measures infection.
• 5:48
  SPEAKER_02: She'd been going up and down with these infections for months, and the particular doctor was simply reordering the same antibiotic, and that antibiotic covered really urinary infections.
• 6:00
  SPEAKER_02: And that's all he thought this was.
• 6:01
  SPEAKER_02: When in fact, it turned out later, she had pneumonia as well as infections and some skin ulcers.
• 6:08
  SPEAKER_02: And so as I got a little closer to this, I ended up helping him get her out of there and get her to the hospital.
• 6:17
  SPEAKER_02: And so in the hospital, a couple weeks later, she's doing much better.
• 6:21
  SPEAKER_02: They treated the various infections.
• 6:23
  SPEAKER_02: And two, you know, let's say two, three weeks went by and she's ready for discharge from the hospital.
• 6:28
  SPEAKER_02: He calls me in a panic and he says they want to send her back.
• 6:33
  SPEAKER_00: Back to the place that was trying to kill her.
• 6:36
  unknown: Yeah.
• 6:36
  SPEAKER_00: Yeah.
• 6:37
  SPEAKER_00: Uh-huh.
• 6:38
  SPEAKER_02: And I said, say no.
• 6:40
  SPEAKER_02: And he said to me, I can say no.
• 6:44
  SPEAKER_02: And it was like a lightning bolt for me when I realized how many people don't understand what they have to do and what they don't have to do, how they get out of a bad situation, what really is a bad situation.
• 7:00
  SPEAKER_02: Because if you're not a doctor, if you you know, or a nurse and you don't have that clinical experience and you don't know the rules of the insider game, it can be really hard to know what to put your foot down for or who to trust and what to do.
• 7:14
  SPEAKER_02: So bottom line is no, she didn't go back there.
• 7:17
  SPEAKER_02: We got her to a different type of care, uh, something called LTAC.
• 7:21
  SPEAKER_02: And eventually we got her home.
• 7:24
  SPEAKER_02: And that was just such a rewarding experience.
• 7:28
  SPEAKER_02: And I realized there is just so much need for people with really complex conditions to get advice on what's what's real and and what they can do to get better care.
• 7:42
  SPEAKER_00: Yeah.
• 7:43
  SPEAKER_00: Yeah.
• 7:43
  SPEAKER_00: I mean, what a what a great story.
• 7:45
  SPEAKER_00: And um clearly not unique.
• 7:49
  SPEAKER_00: Clearly not unique given, you know, both of our experiences uh over all these years doing this work.
• 7:56
  SPEAKER_00: You know, it's it's sad to say that.
• 8:00
  SPEAKER_00: It's sad to have to say that that's not a unique experience.
• 8:04
  SPEAKER_00: I think what was unique about that experience was that you were there to help them, right?
• 8:09
  SPEAKER_00: You know, not everyone has that person in their corner who who knows who knows medicine, who knows kind of the rules of the game, etc.
• 8:18
  SPEAKER_00: So so was it at that point that you said, oh, there's an idea.
• 8:23
  SPEAKER_00: I could do this now.
• 8:26
  SPEAKER_02: Well, it was a lightning bolt that this was such a tremendous need.
• 8:32
  SPEAKER_02: I'd sort of always had an idea.
• 8:34
  SPEAKER_02: And at that time, I was uh working, I was president now of a medical group inside a health system.
• 8:41
  SPEAKER_02: In the past, I'd always been chief medical officer.
• 8:44
  SPEAKER_02: And I'd had this impression that once I was president, that you know, now you know everything would be great and I could, you know, do every anything I wanted.
• 8:53
  SPEAKER_02: Well, you know, the higher up you get in any corporation, and medicine is a corporation, not only do the elbows get sharper from your peers because everyone's competing for resources, but uh you realize you can't do everything that you want to do.
• 9:09
  SPEAKER_02: And uh it all sort of came together for me.
• 9:12
  SPEAKER_02: And I realized that part of even though, yes, now I was a president, you know, and it was like five, six hundred doctors, I was a president, but still the fundamental expectation of my job was to discipline doctors with bad social skills who complained in a way that somebody didn't like, and to cut the budget yet again.
• 9:32
  SPEAKER_02: And you know, this really wasn't rewarding.
• 9:35
  SPEAKER_02: I went into medicine to help people and cutting budgets and telling doctors you can't say that in this way or that way really wasn't fun.
• 9:45
  SPEAKER_02: And uh I realized after after helping this family that this just might be something that could be a business.
• 9:54
  SPEAKER_02: And I took the fall to unwind and then officially launched my MD Advisor with an LLC and all that good business stuff in January of 2021.
• 10:04
  SPEAKER_00: Yeah, and it and it like I say, this is uh a brilliant idea.
• 10:08
  SPEAKER_00: Now, um, are there a lot other advisors?
• 10:12
  SPEAKER_00: Or are you the only one?
• 10:13
  SPEAKER_02: Or it's funny that you say that.
• 10:16
  SPEAKER_02: At the time, I thought I'd made it up.
• 10:19
  SPEAKER_02: Yeah, well, it turns out I'm really not that smart.
• 10:21
  SPEAKER_02: Other people have had this idea, and I didn't even know that it was called patient advocacy when I did it.
• 10:28
  SPEAKER_02: I just knew there was a need.
• 10:31
  SPEAKER_02: And so, but as I began to network, as I started doing this as my job and talking to people, I realized, okay, it's called patient advocacy, there's a board, there's, you know, and patient advocacy, by the way, splits into insurance advocates, which I'm not, and clinical advocates.
• 10:50
  SPEAKER_02: Um and so, yes, there are people, there's multiple organizations that do it, although there are still relatively few physicians who do it.
• 11:00
  SPEAKER_00: Yeah, are most of the people who do it nurses?
• 11:03
  SPEAKER_02: Uh the clinical folks, I've met nurses, I've met pharmacists, I've met speech language pathologists, uh, of a wide variety of clinical backgrounds, but we're all held together by wanting to improve the experience of people as they travel through the health system.
• 11:23
  SPEAKER_00: Yeah, and that's that is a a great goal.
• 11:26
  SPEAKER_00: And that and and you're right, you know, I've I've held um I've held administrative and leadership positions myself.
• 11:35
  SPEAKER_00: And I did find them uh rewarding for the most part, but I also did find the same thing as you that you know, a lot of what we did as leaders, physician leaders, was not why we got into medicine in the first place.
• 11:49
  SPEAKER_00: Yeah.
• 11:49
  SPEAKER_00: And and it sounds like what you're doing now is really helping people using that medical knowledge to do what you got into medicine for in the first place.
• 12:00
  SPEAKER_00: True?
• 12:01
  SPEAKER_02: Absolutely.
• 12:02
  SPEAKER_02: And I'm uniquely lucky in a couple of ways.
• 12:05
  SPEAKER_02: And you know this, Rocco, as a physical medicine and rehabilitation doctor, you have a broad clinical basis, but you also know a lot about recovery.
• 12:15
  SPEAKER_02: And that turns out to be very useful because many people want to know about all the stages of how they get better.
• 12:22
  SPEAKER_02: And then it the business, the time that I spent spent as a healthcare executive really does help because I understand the hidden economic drivers.
• 12:33
  SPEAKER_02: So much of what patients and families run into are driven by um financial systems that they don't understand.
• 12:42
  SPEAKER_02: And because I did this at a leadership at a fairly high level, I know the different payment mechanisms.
• 12:49
  SPEAKER_02: And that really does help because you can you can understand why something doesn't quite make sense and if it comes down to the money.
• 12:58
  SPEAKER_02: And so when you know how the money flows, you can help people make more sense of why something's happening and you can also help them get around it, or sometimes not get around it.
• 13:09
  SPEAKER_02: I'll give you just a brief example from this week.
• 13:12
  SPEAKER_02: Very lovely, lovely family hired me.
• 13:15
  SPEAKER_02: Their loved one had a um, I will just say broadly, a brain injury about a year and a half ago.
• 13:22
  SPEAKER_02: And they had thought that if they could get enough therapy in his nursing home so that he was tolerating three hours a day, he would be able to be admitted into inpatient rehabilitation.
• 13:33
  SPEAKER_02: And that's not the way the system works, that's not the way the money works.
• 13:38
  SPEAKER_02: And so I had to explain that that'd be lovely, but but it's not about that at this stage, a year and a half out.
• 13:46
  SPEAKER_02: Um, if he gets a hospitalization and he's after and and he's re-evaluated, then he might be able to get to inpatient rehab if there's something new.
• 13:56
  SPEAKER_02: But he can't go from a nursing home a year and a half after injury to inpatient rehab, even if he's tolerating three and a half, uh, sorry, three hours a day of therapy.
• 14:07
  SPEAKER_00: Yeah, and and sometimes that's that's the role of an advisor.
• 14:12
  SPEAKER_00: Is it's not always telling you what you want to hear, but explaining, you know, the the lay of the land and the rules and how things work so you can stop putting a lot of your energy into something that's not going anywhere and focus your energy in other places.
• 14:28
  SPEAKER_00: Yeah.
• 14:29
  SPEAKER_00: So what's like explain a little bit about what you actually do when you work with these clients.
• 14:35
  SPEAKER_02: Well, what I do is very customized.
• 14:39
  SPEAKER_02: I do different things for different people, but fundamentally, there's a couple of basic categories.
• 14:46
  SPEAKER_02: I often have people where they have a loved one in the hospital.
• 14:49
  SPEAKER_02: I've got a couple of those right now, actually, loved ones in the hospital, and this isn't the loved one's first time in the hospital, and there's something complex, and they may feel like the doctors aren't listening to them, they may feel uh they don't understand what's going on, they may feel rushed with medical decision making, and they want someone to help them know both how to advocate for their loved one, but also which things to focus on and which things to let go.
• 15:22
  SPEAKER_02: And it's impossible to know that if you don't have an insider's knowledge of the system and of clinical matters.
• 15:29
  SPEAKER_02: So helping folks in the hospital or in rehabilitation is a common thing that I do.
• 15:36
  SPEAKER_02: And another thing is the person in the community.
• 15:39
  SPEAKER_02: The person in the community might be somebody who's getting older, and the children are frustrated because mom's got 12 doctors and 30 meds, and nobody talks to each other, and she's falling, and they want to know is she being over medicated, which doctors, you know, Dr.
• 15:57
  SPEAKER_02: A says one thing, Dr.
• 15:58
  SPEAKER_02: B says something else, what's the truth, and how do they figure it out?
• 16:03
  SPEAKER_02: And so I I uh early on in this journey started giving talks on polypharmacy, meaning people that are on too many medications, because I've seen it over and over again.
• 16:16
  SPEAKER_02: And so one of the first things I do, regardless of setting, is take a look at the medications and look at the side effects and the interactions so that we can help maximize the person's function.
• 16:29
  SPEAKER_00: Yeah, and uh, you know, I can definitely attest to that.
• 16:32
  SPEAKER_00: You know, polypharmacy is a huge problem uh in you know in this country.
• 16:37
  SPEAKER_00: Now, you're reviewing these medications, but you are not their treating physician.
• 16:42
  SPEAKER_00: It's very important to clarify that you're not their doctor.
• 16:47
  SPEAKER_00: So, what are you doing when you see a list of 30 meds and you think maybe seven of them could be eliminated?
• 16:53
  SPEAKER_02: Well, so what I do is first it starts with understanding the client, what they're experiencing, and what bothers them.
• 17:02
  SPEAKER_02: So, for example, I had a client, um, a woman in her 70s, and her daughter wanted me to get involved with her because mom it wasn't bad enough that people were saying dementia, but mom was complaining that she had some brain fog, she didn't feel great, she couldn't think straight, she was a little bit forgetful.
• 17:25
  SPEAKER_02: And they wanted to start by just looking at the med list.
• 17:28
  SPEAKER_02: And one of the drugs that was on there was a fairly high dose of an older drug called Elevil.
• 17:34
  SPEAKER_02: Now, Ellavil is is very enicholinergic and it's not great for older people.
• 17:40
  SPEAKER_02: And she was, it turns out she was also taking some Benadryl to help her sleep that was compounding things.
• 17:47
  SPEAKER_02: So I first I said, you know, Benadryl, not such a great idea.
• 17:52
  SPEAKER_02: You know, there's other ways we can work on sleep.
• 17:54
  SPEAKER_02: And then I suggested she talk to her prescribing doctor about whether or not a dosage reduction in her Eleville might make sense.
• 18:05
  SPEAKER_02: And she did.
• 18:06
  SPEAKER_02: And she went off to Benadryl and she lowered the dose of the Elevil.
• 18:10
  SPEAKER_02: And guess what?
• 18:11
  SPEAKER_02: She feels a thousand times better.
• 18:13
  SPEAKER_00: Yeah, that's great.
• 18:14
  SPEAKER_00: That's great.
• 18:15
  SPEAKER_00: And and so you made that suggestion to the correct the patient or the the family, or do you talk to the doctors directly sometimes?
• 18:27
  SPEAKER_00: Sure.
• 18:28
  SPEAKER_02: It all depends on the style of the client.
• 18:31
  SPEAKER_02: So some clients want me there with them on the phone or in person at every doctor's appointment.
• 18:38
  SPEAKER_02: Other people want me there for some doctor's appointments, and yet others prefer to talk to the doctors directly.
• 18:44
  SPEAKER_02: And no matter what, if I'm there talking to the doctor, my job is not to second guess the doctor.
• 18:50
  SPEAKER_02: My job is to enhance communication so that the doctor gets in one or two sentences what they really need to know.
• 18:59
  SPEAKER_02: And the patient's point of view in terms of what they're really worried about is uh clearly stated.
• 19:06
  SPEAKER_02: After listening into a lot of doctor's appointments, let's say a person's got 10 minutes, sometimes the the patient will spend six or seven minutes talking about a whole lot of different things and not necessarily really uh getting to the information the doctor is trying to get out of them.
• 19:26
  SPEAKER_02: So by coaching my clients beforehand or even at the time of the appointment, clarifying some things, we can use that time with the doctor far more wisely, wiser, or we can use it, the time with the doctor better, so that the doctor's expertise can really be brought out because they have the facts they need and they understand clearly what the issue is that the patient is bringing to them.
• 19:54
  SPEAKER_00: Yeah, you bring up something really interesting there.
• 19:57
  SPEAKER_00: It's this um how how do you, as a patient, prep to go to your doctor's appointment?
• 20:05
  SPEAKER_00: You know, I think at this point we all understand that our doctors are have very limited time with us, and some of the time they have with us is spent documenting in their little computer, which is always annoying to see.
• 20:19
  SPEAKER_00: Uh, I'm old enough to remember when we used to just look at our patients, maybe have like a notepad and take a couple of notes.
• 20:27
  SPEAKER_00: Now you have a screen between you and um your patient, or between you and your doctor, depending on your point of view.
• 20:35
  SPEAKER_00: Um what do you recommend for people before they go to a doctor's appointment?
• 20:42
  SPEAKER_02: So my recommendations boil down to a couple of key things.
• 20:46
  SPEAKER_02: One is make sure you know why you are there.
• 20:50
  SPEAKER_02: And that that sounds obvious, but I can't tell you how many times when I say, Well, why are you going?
• 20:57
  SPEAKER_02: And then the patient or the family says, Well, because the doctor scheduled a follow-up.
• 21:01
  SPEAKER_02: I'm like, okay, let's rewind.
• 21:03
  SPEAKER_02: There is a there should be a medical reason you're taking your time to go in.
• 21:09
  SPEAKER_02: So first of all, know why you're there.
• 21:12
  SPEAKER_02: Maybe it's because uh they're following up on your blood sugar from last time.
• 21:16
  SPEAKER_02: Okay.
• 21:17
  SPEAKER_02: Second thing is don't assume the doctor knows everything they need to know about you.
• 21:23
  SPEAKER_02: So if you're going in for, let's say, you're seeing your endocrinologist for blood sugar follow-up, you would say, hi, I'm here.
• 21:29
  SPEAKER_02: And when they say, you know, why are you here?
• 21:31
  SPEAKER_02: How are you doing?
• 21:32
  SPEAKER_02: You say, hi, I'm here for follow-up of my blood sugar.
• 21:34
  SPEAKER_02: Last time my hemoglobin A1C was seven and a half, and uh, you upped my dose of my trusepatide by you know from five to 7.5.
• 21:47
  SPEAKER_02: Since then I've lost 10 pounds.
• 21:50
  SPEAKER_02: I had lab work drawn last week and we're here to review it.
• 21:55
  SPEAKER_02: Tee up the doctor for what you need from them and orient.
• 22:00
  SPEAKER_02: them to what they did last time, what you and and why you're there.
• 22:05
  SPEAKER_02: Because doctors, they're moving patient to patient to patient.
• 22:08
  SPEAKER_02: They are not going to remember every detail.
• 22:10
  SPEAKER_02: So you want to bring that detail that's important forward for that doctor.
• 22:17
  SPEAKER_00: Yeah, that's that's great advice.
• 22:20
  SPEAKER_00: And I'm sure that most patients um just would assume that their doctor knows uh all that stuff walking in the room.
• 22:29
  SPEAKER_00: You know, I mean I think that I think a lot of people give uh the medical uh community more credit than they deserve.
• 22:38
  SPEAKER_00: Now I'm not saying that to denigrate doctors, nurses, etc.
• 22:42
  SPEAKER_00: But but the amount of of patience and moving parts that are happening in a on the day-to-day, minute-to-minute basis for most doctors, you would not believe it.
• 22:53
  SPEAKER_00: So you cannot assume that they know everything about you when you walk in the door.
• 23:00
  SPEAKER_02: Yeah, and and it's a big surprise for a lot of people.
• 23:04
  SPEAKER_02: Many times people have said to me, but it's in the chart, why don't they know?
• 23:08
  SPEAKER_02: Because they've you're the 20th person they've seen today.
• 23:12
  SPEAKER_00: Yeah, another thing that I I think that patients assume because the patient is the patient, right?
• 23:18
  SPEAKER_00: So the patient has gone to their primary care doctor, they've gone to their cardiologist, they've gone to their endocrinologist, etc, etc.
• 23:27
  SPEAKER_00: So they've been present for all those visits, obviously, since they're the patient.
• 23:32
  SPEAKER_00: Now they go back to their primary care doctor with this assumption that the primary care doctor uh knows about everything that happened and all those appointments they had.
• 23:43
  SPEAKER_00: Or maybe the primary care doctor is more likely to know this.
• 23:47
  SPEAKER_00: But say you go to your endocrinologist, they don't hardly ever know what happened when you saw your cardiologist, you know, and so they these are assumptions that people should not be making that there is some sort of you know coordination of information, you know, especially you know like I think people make this assumption because you know we've got these electronic records and if you're within one health system you have access to all the records but still there isn't time to read every single thing for every patient.
• 24:22
  SPEAKER_02: Exactly right.
• 24:23
  SPEAKER_02: I mean just yesterday that happened where I had a client who went to a pulmonologist and at the beginning of the point the pulmonologist uh asks why are you here and they really don't answer coherently and so the pulmonologist starts with a a wide uh review of systems asking about pneumonias and smoking history and a variety of things trying to politely figure out why the person is here.
• 24:51
  SPEAKER_02: And when I could see that he was kind of still struggling I said Dr.
• 24:56
  SPEAKER_02: X ordered a surveillance CT because she had a retal cancer and uh nodules turned up and we're here to see if you think these nodules are clinically significant and if something should happen.
• 25:11
  SPEAKER_02: Focus that laser focus now he pulls up the CT, he looks at it and now he is able to speak to what they really were there for what they needed to know with what those nodules meant.
• 25:23
  SPEAKER_02: Turns out absolutely nothing don't worry about it they're too tiny to care.
• 25:27
  SPEAKER_02: And now they're reassured.
• 25:29
  SPEAKER_02: But even though the family knew this going in they weren't able to articulate it well because they assumed the doctor already understood that because they had a con the doctor had had a comprehensive view of why they were there.
• 25:43
  SPEAKER_00: Yeah yeah and once again maybe surprising to listeners you know but what you said uh earlier was was great it's like know why you're going to the appointment and have your information straight the appointment is not a social visit it's not a time to talk about your cat or this or that you know um sadly those days are behind us you know the those there used to be a time when you could really have those conversations uh about everything else in your life but now everything is focused on what is the what is the matter at hand and so patients should know that going in.
• 26:25
  SPEAKER_00: I think that's great advice.
• 26:26
  SPEAKER_00: Any other things that you can think of that people should be keeping in mind with uh when interfacing with the system well I'll I'll answer that in terms of just interfacing with doctors which is I can talk about a few points of frustration.
• 26:44
  SPEAKER_02: One is to ask questions.
• 26:47
  SPEAKER_02: No, sometimes the doctor is backing out of the room and you don't have room to ask the questions but do ask questions.
• 26:55
  SPEAKER_02: That's what you're there for and the days of the doctor says you have condition X, take pill Y and call me in the morning kind of thing should be behind us.
• 27:06
  SPEAKER_02: It should be an explanation of your condition, the treatment options and then some shared decision making around if you take pill Y, what does that mean?
• 27:18
  SPEAKER_02: What are the side effects?
• 27:20
  SPEAKER_02: What happens if you don't take pill Y I have come to the conclusion that a lot of what we used to call noncompliance meaning people didn't do what we told them was because we didn't give them options or explain what happens if they choose not to follow the treatment.
• 27:37
  SPEAKER_02: Maybe pill Y is the best treatment but maybe there's pill Z or um exercise Z.
• 27:46
  SPEAKER_02: You know there's a sometimes it's not quite as black and white and I encourage people to ask questions and feel comfortable with that doctor and your medical decision.
• 27:58
  SPEAKER_02: And if you need to if there's not enough time go back make another appointment or see the nurse practitioner or the PA in the practice if you need more time to get your questions answered.
• 28:09
  SPEAKER_02: So that that's one tip I I give to people is you know try to get to get to the bottom of what the issue is.
• 28:16
  SPEAKER_02: Another frustrating point for people are getting in for appointments.
• 28:21
  SPEAKER_02: And I hear that all the time oh the appointment is four months from now with some specialist you know what do I do?
• 28:29
  SPEAKER_02: And especially at least in New York there's a certain amount of the I got a guy culture meaning oh if you've got the right person they'll pull a string and they'll get you into the famous orthopedist.
• 28:41
  SPEAKER_02: Well occasionally that works but that famous orthopedist is also being tapped by a thousand other people all trying to get their special favors.
• 28:49
  SPEAKER_02: So sometimes it works sometimes it doesn't but many practices do offer waiting lists.
• 28:55
  SPEAKER_02: So do ask if they have a waiting list.
• 28:59
  SPEAKER_02: Recently NYU I've got some clients on waiting lists there and it's an electronic thing.
• 29:04
  SPEAKER_02: It comes up you get a text you take the the appointment yes no if not you know you can go on and uh if you don't take it you'll still stay on the waiting list.
• 29:13
  SPEAKER_02: So some systems are electronically managing waiting list.
• 29:17
  SPEAKER_02: Sometimes it's a matter of if you figure out who the scheduler is calling politely and regularly to see is there an opening so that if some of it's being done just by the reception by the person receptionist or scheduler that they think of you when an appointment comes up.
• 29:36
  SPEAKER_02: And so I I see that a lot and probably the on the other tip I have for you in terms of doctors is never hesitate to get another opinion.
• 29:46
  SPEAKER_02: And it doesn't have to be just surgery that's removing a lung it can be about anything because you are different each time you go to a similar specialist you know more.
• 29:59
  SPEAKER_02: And so view doctor's appointments in part as educational for you to learn about the particular issue.
• 30:07
  SPEAKER_00: Yeah I think that um you know patients at least at least some patients think that if you get a second opinion your doctor's going to get mad at you they don't they don't get mad they're you know they're they're fine with that.
• 30:22
  SPEAKER_00: So I think you know what what you were just saying about the waiting list is really interesting because I think we've all experienced this you know it takes like four months six months to get in to see somebody um and and maybe we don't know that there's the opportunity to be on a waiting list especially an electronic one I like that.
• 30:45
  SPEAKER_00: Yeah it's very very spiffy so what about uh you know you mentioned something earlier when you're you're telling the story about the man who was you know kind of at his wit's end and he's gonna cry about his wife and that car accident.
• 31:01
  SPEAKER_00: When he his wife was hospitalized and they wanted to send her back to the original facility you said just say no.
• 31:10
  SPEAKER_00: Say more about that.
• 31:11
  SPEAKER_00: I don't think that people know they can say no to stuff.
• 31:15
  SPEAKER_02: Yeah well in that particular case you know he was a very polite kind man and came from a a culture that tended to to obey authority and so I just said tell him that you were very unhappy with the care at that facility and you would like other options and no you won't agree to let her go back there.
• 31:40
  SPEAKER_02: It was really as straightforward as that and they went oh you won't let her go back and he said no and they then worked on other options and it took a day or two more but they got her someplace better.
• 31:51
  SPEAKER_00: Yeah and and and that is an option people have that option you know um clearly there are regulations that have to do with Medicare guidelines or uh private insurance but you always have the right as a patient or or the representative of the patient to contest a decision to um you know to appeal a decision.
• 32:16
  SPEAKER_00: And usually when you do that you know you'll you'll get involved with the the case manager um who's in who's got your case uh and and they want to help you they you know that's what they're there for they want to help you um I I think a lot of people especially older people have the you know they don't want to upset the doctor they don't want to make you know make people mad at them but you know this is your life and your health or the life and health of your loved one you know like that poor man imagine if he just accepted that like if you weren't there to to cons you know to advise him he would have gone back there with so much fear and guilt that he let his wife go back into that situation.
• 32:57
  SPEAKER_00: So yeah you don't have to do it.
• 33:00
  SPEAKER_02: Exactly and there are I always advise people you know be be kind and be reasonable um you do have to leave the hospital at some point um but do express your preferences and do if there's a particular place that you don't want to go you can say that.
• 33:22
  SPEAKER_02: Yeah yeah so uh what what other ideas tips uh experiences have you had that that come to mind oh I've got got many of them and if if people want to know more I would suggest I've been writing a short essay this uh fog light it's on a website called Substack where writers can publish things it's just substack.com and then just search for the fog light I'm not saying this is a commercial uh because it's free I don't make any money you know it costs my time to do it I just like doing it because I'm learning myself with every passing uh day things from my clients and I like to share the tips.
• 34:05
  SPEAKER_02: So I mean I just finished writing about things to bring to the hospital and things not to bring to the hospital.
• 34:11
  SPEAKER_02: I did you know one one not list but a little essay um in June and another little essay in July.
• 34:19
  SPEAKER_02: And this you know this is a good place I think the fog light to find tips for things if you're struggling with the healthcare system and you can just browse through them and see what might be helpful to you.
• 34:31
  SPEAKER_00: Well that that's a great resource.
• 34:34
  SPEAKER_00: You know I wonder so so you're the thing that you're doing is called patient advocacy right and you mentioned that there are there's a an organization or something like behind it.
• 34:46
  SPEAKER_02: Is there a way for people to find is there like a website or a place where people can find a patient advocate if they're if they need one yeah there's a couple of national organizations for patient advocates so one of them is called GNA like uh G for Goethe and for Nancy A for advocates greater national advocates that's one website there's another one called NAHAC N-A-H-A-C National Advocates Healthcare I don't quite have what what it stands for but NAHC has lists and for people out on the West Coast there's another one called Health Advocate so any of those places will have lists and you can search by zip code and you can look for an advocate and I would be remiss if I didn't also mention geriatric care managers because geriatric care managers sometimes people don't need insurance or medical issues.
• 35:42
  SPEAKER_02: They really need somebody to coordinate the services for an aging loved one and geriatric care managers are amazing and they're great they're local they're in the boots on the ground and they can help you know make sure that the right medications mom is taking the right meds they can uh make sure mom goes to the doctor's appointments if mom needs um her cat food delivered they can figure out an arrange for that she needs a swing program at the Y they can find it whatever whatever that aging loved one needs and geriatric care managers and I often as you can tell I love them I often partner with them but a geriatric care manager their association is ALCA Aging Life Care Association um and so if if what someone needs is less about medical or insurance then consider a geriatric care manager.
• 36:37
  SPEAKER_00: Yeah that is a great suggestion and I'll I'll put a plug in for um season one episode 17 the title was end of life planning and I had a geriatric care manager as my guest so if you want to learn more about that just look for episode 17 season one so Gerda I feel like maybe we've kind of talked talked about everything we need to talk about today is anything else you'd want to say before we sign off it's been a pleasure Rocco thank you so much for having me.
• 37:09
  SPEAKER_00: Yeah it's it's really been a pleasure it's great to uh talk with you and um before I let you go uh I want to ask you the question I ask all my guests yeah so uh the question is you know if if you have the opportunity to put a message on a billboard in your town and you knew that thousands of people would drive by it every day what would your message be?
• 37:36
  SPEAKER_02: So I'm feeling a lot of pressure to be profound here Rocco.
• 37:39
  SPEAKER_02: I don't know if I can rise to the occasion I I couldn't pick one so I came up with two and they're slightly at odds with each other but here are two things that I do say regularly which is have fun and get it done because I do believe in working hard but I also think you should have fun and do something that brings you joy.
• 37:59
  SPEAKER_02: If you don't have joy in your life like what's the point of showing up to life you got to do something fun and then the other wait let me just say have fun and get it done.
• 38:09
  SPEAKER_00: Yeah wonderful I love it.
• 38:11
  SPEAKER_02: Now I think you have to pay extra to get a second billboard but go ahead what's your second billboard well maybe it's a footnote and I it's one that I started saying more as I've gotten older because the older I get the more I realize how limited time is and so I've started saying more time is the most precious resource you have so spend it wisely whatever that means for you time is the most precious resource you have so spend it wisely I love it.
• 38:44
  SPEAKER_00: All right I guess we'll give you two billboards it's you're a friend yes Gerda Mesell thank you so much for being a guest on the show and now we're moving on to the next segment now it's time for Dr.
• 38:59
  SPEAKER_00: Roccozarix Dr.
• 39:00
  SPEAKER_00: Rocosarix now it's time for Dr.
• 39:06
  SPEAKER_00: Roccozarix this week my recommendation is the book The Emperor of all maladies a biography of cancer written by Siddhartha Mukherjee M-U-K-H-E-R-J-E-E published in 2010 this book won a Pulitzer Prize and was named New York Times Top 100 books of the century there's a recent update that adds four more chapters to reflect new scientific discoveries and medical advances so this book is extremely well written and interesting and uh has anything you'd ever want to know about cancer in including history going back to ancient Egypt and ancient Greece and science discoveries patients uh stories medical treatments etc so I will say you know the book is it's kind of a heavy topic you know cancer has affected uh probably all of us in some way and it's uh it's a tough topic to read about uh but you you'll not find a a better place to learn just sort of like a book for the general public about cancer.
• 40:21
  SPEAKER_00: I will also say that although the book is written for the general public there are some places in it that are you know kind of sciencey and I think that's there it's it's worth it.
• 40:32
  SPEAKER_00: You might struggle through that if you're not a science person, but the book overall is very good and highly recommended.
• 40:40
  SPEAKER_00: So pick up a copy of that one.
• 40:56
  SPEAKER_00: I will leave you today with a quote from Sir William Osler.
• 41:00
  SPEAKER_00: Sir William Osler was a Canadian physician uh from the late 19th and early 20th century who was recruited to be one of the founders of Johns Hopkins medical school uh I did my training at Johns Hopkins and uh Sir William Osler's aura is still there you know there's there's medical wards named after him there's quotes from him he was known as a uh like a quote machine he had so many quotes and um some people call him the father of modern medicine.
• 41:35
  SPEAKER_00: So the quote is the good physician treats the disease the great physician treats the patient who has the disease so I hope that you can all find those great physicians and I hope that we who are physicians can be that great physician and treat patients not just diseases.
• 41:56
  SPEAKER_00: That's it for today's show.
• 41:58
  SPEAKER_00: If you would like to learn more about Dr.
• 42:01
  SPEAKER_00: Macelle you can find her on mymdadvisor.com or you could find her on Substack with the foglight.
• 42:11
  SPEAKER_00: Thank you for spending a little time with me today I've enjoyed the time and I hope you've learned something.
• 42:16
  SPEAKER_00: Until next time, so long thanks for listening to the Life and How to Live It podcast with Dr.
• 42:22
  SPEAKER_00: Rocco.
• 42:23
  SPEAKER_00: If you'd like to book a coaching session with me simply visit the show notes and schedule a discovery call.
• 42:30
  SPEAKER_00: And if today's episode encouraged you or added value to your life please subscribe and leave a review.
• 42:37
  SPEAKER_00: Remember life is not a dress rehearsal.
• 42:40
  SPEAKER_00: Until next time