Dec. 10, 2018 - Freedomain Radio - Stefan Molyneux
45:09
4264 How To Save Suicidal Doctors - And Health Care! Freedomain Interview
Stefan Molyneux, Host of Freedomain, interviews Dr. Teresa Mahaffey, a Pediatrician, on how to save healthcare and doctors from massive stress, suicidality and drug addiction.▶️ Donate Now: http://www.freedomainradio.com/donate▶️ Sign Up For Our Newsletter: http://www.fdrurl.com/newsletterYour support is essential to Freedomain Radio, which is 100% funded by viewers like you. Please support the show by making a one time donation or signing up for a monthly recurring donation at: http://www.freedomainradio.com/donate▶️ 1. Donate: http://www.freedomainradio.com/donate▶️ 2. Newsletter Sign-Up: http://www.fdrurl.com/newsletter▶️ 3. On YouTube: Subscribe, Click Notification Bell▶️ 4. Subscribe to the Freedomain Podcast: http://www.fdrpodcasts.com▶️ 5. Follow Freedomain on Alternative Platforms🔴 Bitchute: http://bitchute.com/stefanmolyneux🔴 Minds: http://minds.com/stefanmolyneux🔴 Steemit: http://steemit.com/@stefan.molyneux🔴 Gab: http://gab.ai/stefanmolyneux🔴 Twitter: http://www.twitter.com/stefanmolyneux🔴 Facebook: http://facebook.com/stefan.molyneux🔴 Instagram: http://instagram.com/stefanmolyneux
Theresa Mahaffey. Now, I'm not even going to go the serpentine and circuitous lower intestine route by which we managed to get together to talk, but talk we will, because I've been noticing, and I'm sure Theresa, you've noticed as well, doctors are not majorly happy in the United States at the moment, and they're not majorly happy in most places in the Western world, but when we connected, this seemed to be somewhat up your alley as far as discussing the discontents.
Doctors are kind of the one It's a set of people you really, really need to keep happy in your society because if it turns out to be a profession that produces a fair amount of misery, then society will not produce the number of doctors that are needed.
So, what is going on in American medicine these days and why are doctors like half looking at the patient door and half looking at the window they might jump out of?
Yeah, that's a really great question.
So, we have been bombarded with so many factors that are out of our control, it seems.
And as a profession that likes to supposedly be in control, it really throws us off balance.
Part of this started around the time of Obamacare, where the regulations came down, the electronic medical record came down.
That's the time I Personally, just anecdotally, I had to sell my practice because I couldn't afford the regulatory prescriptions.
I couldn't afford the EMR. I couldn't even hire another doctor and my patient population was burgeoning.
So yeah, it's very depressing right now for doctors.
Now, what were the specific Processes or events in Obamacare that you think most contributed to this burgeoning misery?
That would be the introduction of the electronic medical record because that is a device, as I'm sure you're aware of it, but anyway, if you don't use it, you get fined and it adds to your patient time exponentially because you're constantly typing away on a computer, you're not looking at the patient, you're worried about You know, am I going to get this note done?
And everything in there is tracked.
So right now I work for a system who tracks who I refer to, which is ridiculous because I want to refer to whatever specialist I want to refer to.
But anyway, everything in that record can be accessed.
It can be hacked.
And I spend all day in the office and for every day I spend, I probably have five hours of work after that.
Wait, so you're spending eight, ten hours a day in the office and then half of your workflow, like half of the day's workflow is electronic records?
Yes. So I've finally just kind of given up and I don't want to do it every night so I do it on the weekends.
So my whole weekend is planned around doing 70 to 80 charts.
So it's very invasive into my lifestyle for sure.
So basically what you're saying is that medical schools should not be teaching diagnostics as much as typing speed and typing skills because that would make things more efficient.
Now, there is this weird magic wand that goes on in society.
It's like, let's add computers and everything will be fantastic!
And that, of course, doesn't seem to really have occurred with this.
So what is the issue that the categories are crazy, that the interface is slow, that it's inefficient?
How is it so inefficient? Yeah, all of that, all of the above.
The way that it works is you have to include in your note certain markers or certain things so that you can code correctly and get paid correctly.
For instance, when you come to see a doctor in the US, your visit is coded Through the ICD-10 coding system, like a 99211 would be, you just saw a nurse.
A 99215 would be, you're just about ready to die and I better call an ambulance.
So anything in between there is, you know, a runny nose, ear infection.
You could have a kid come in saying they're suicidal, all that.
And you have to put all the components of the note together so that you can code And your system can get paid correctly.
So it all boils down to numbers and money, basically.
Right. And this is all online, is that right?
Or is it stored locally? It's all online.
Yeah. That doesn't seem like the very best idea, to sort of have cloud-based, highly sensitive medical information floating around.
Right, that's what I'm talking about.
It's craziness.
I went to medical school in Chicago in the late 80s, early 90s, and this is when we were on paper, and it was nothing like this.
Nothing. So let's talk about what it was back in the day before the terminators of the computers began to eat up the physician's time.
Because what you want, of course, is to have the physician patient-facing as much as humanly possible because it's the patients who need the resources, really not the computers.
And so what was it like back in the day?
How has it changed over the course of your career?
Well, I will say this.
It's become much more impersonal.
So back in the day, gosh, it makes me sound like a dinosaur.
You actually had patient-to-patient contact.
You got to know your patients.
You got to know the families.
You didn't spend all your time on a computer trying to figure out how you're going to code to see this patient.
I mean, that was part of the process, but it was nothing like it is today.
When we first moved to where we live right now, I opened my own practice.
I practiced for 15 years solo, and then I had a nurse practitioner with me.
The joy that I derived from my job was much higher than it is right now.
I sold to a local hospital who then got bought by a huge healthcare conglomerate And was told that if I wanted to leave, it was no problem because they could just slide somebody into my position.
So after 15 years of practice, building it, knowing these families, I was nothing more than a cog in a huge medical system.
That, to me, is really remarkable because, to me, at least half of healthcare is knowing more than just the body, but the relationships, the entire history, the health habits.
It just seems like healthcare, for stuff like broken bones, you set the bone and so on.
It's kind of an in and out shop.
And you're in the pediatrics course, so it's much more complex and you do need a deep knowledge, not just of the family, but of the environment, of the neighborhood, of where, you know, there's just so much human knowledge that's necessary that the idea that you're just pull out, push in, replaceable is incomprehensible to me.
It is totally incomprehensible.
Not only that, you also have to look at where people were trained Because there's such a variability based on, like, where you went to medical school, where you did your residency, how well did you do?
I mean, that doesn't even come into play in these situations where you're being hired and fired by large medical complex systems.
Right. Now, when it comes to categorizing ailments, you know, there's a bell curve, right?
Some are very easy to categorize, the majority are kind of in the middle, and some are very complex.
And I guess the challenge is that the categorization of ailments on the part of your patients is also part of your diagnostics, so you have to have it as accurate.
As possible and you can't just say well it's kind of like this because it becomes that you know it's in this neighborhood It's like well it actually becomes that and I assume you'd be liable for that kind of diagnosis so you have to get it absolutely right and it's complex.
It is and in my practice I specialize in kids with complex needs.
I have a son with autism so my Bent is special needs kids.
So, yeah, you have to be on your game every time you walk through that door.
Right. Now, what other factors over and above Obamacare have changed over the course of your career?
So, one of the things I've noticed, which is really disturbing to me, is that people these days, they don't want to wait.
Everything has to be Right now, I want to be seen.
This is a true story.
I'm just going to tell you the story. I had a mom run up to my front door with a baby who's three months old, floppy, blue.
I put the baby on a table and I was literally resuscitating this child when a mom came out of a room and asked me how long that was going to take because she was waiting.
Oh dear. And the funny thing is, with cell phones now, waiting has become a whole lot easier, but people have become a whole lot less patient.
Yes, and that's another point.
I can do a full exam on a child while he's on his cell phone.
Wow. And mother will say nothing.
Dad will say nothing. Wow.
Okay, so something else that has struck me about healthcare these days is that there seem to be an inordinate number of people who don't have the capacity or the will or maybe the sense of importance to actually follow doctor's instructions, to take their medication when necessary, to do the exercises that are required, to do the follow-up that is important.
And that seems to be growing.
This is something I've just sort of read in passing, but have you noticed that The basic capacity or willingness to follow doctor's orders has changed over the last couple decades?
Yeah. Well, you know, and in pediatrics, it's even more special because I can have a child who weighs 350 pounds and I can go over in excruciating detail diet, exercise, write it all out, everything like that.
And I'm looking at a mom who probably weighs about 300 pounds as well.
Thinking none of this is going to be taken seriously, you know?
I mean, it's just too hard for them, I guess.
I don't know. There's no way they're airlifting those ding-dongs out of the pantry in that house.
So that is a big challenge.
Now, this, of course, is a huge issue as well, which is that childhood obesity is, you know, I mean, I try not to romanticize too much growing up in England in the 70s, but I did actually have a look just before we were talking.
I looked at my old boarding school photo with like 500 kids and nary a plump cheek among them.
I mean, that just didn't seem to be the case.
What on earth is going on with childhood obesity these days?
Because that's got to be one of the bigger things that you have to deal with, so to speak.
Yeah, it is. No pun intended.
Well, it's a huge problem.
The problem is it's multifactorial, of course.
It's video games, for one.
It's everybody, like I was telling you before, wants to be a YouTuber, so they're all on.
That's like the major thing.
I want to be on YouTube. And then they eat.
And people think kids have to eat all the time.
They don't have to eat all the time.
You know, you have breakfast, and you've got to give them a snack, and then lunch, and then a snack, and then dinner, and then, you know, it's too much.
And, you know, like I said, everything has to be easy.
You've got to get food that you can put in the microwave, you go to McDonald's, you know, whatever, fast food, all of that.
And soda. Soda was like an incredibly rare treat when I was a kid.
Like maybe once a month you'd have a couple of fingers of Coke, but it really, and juice.
Juice also is one of the, oh, juice is so good for you.
It's like, no, it's liquid diabetes in concentrated form.
Don't drink juice too much if you're a kid.
Right. That's another one.
Yeah, exactly. But it's also the absolute sedentary lifestyle that's evolving thanks to, you know, technology.
Yeah, I saw a tweet the other day that I think there's a new feature and the phones, I think it's the iPhones, that you can track screen usage and so on.
And one guy was posting that he freaked out because he checked his sons.
It was seven hours a day. Yeah.
Seven hours a day just on the phone, not even counting, you know, video games and other things.
And it's like, good Lord, I mean, we're really going to turn into teletubbies pretty quickly.
Yeah, exactly. I see it every day.
And the frustrating thing is because it's such preventable stuff when it comes to health care, they really are elbowing aside people whose health care issues are not the result of lifestyle choices.
You know, I've heard like 60-70% of health issues are lifestyle related.
They're somewhat under your control.
And so the people who are just allowing themselves to become overweight or allowing their kids to become overweight are really elbowing aside people who have desperate needs not of their own making and that seems kind of selfish.
It is, it is. And that's only going to get worse because as these people age, you know, they're going to consume Most of the healthcare dollars.
Well, that is true because I was reading about how if you have weight issues as a child, I mean, it's pretty sticky through time.
Like then you have this, you either give in or you have an endless battle, but it's not, I mean, if you don't have them, it's a lot easier to stay trim when you get older.
If you do, it seems almost impossible.
Right. And what really baffles me are parents who have had gastric bypass or some other sort of weight-controlled surgery, and then their kids are overweight.
So I don't understand that.
Well, I think it's also a neighborhood issue, too, that we used to feel, I mean, I remember being very much the roaming kid when I was growing up, just go to the neighborhood, you go roam out.
But there's anxiety around neighborhoods these days, and there's this desire to keep the kids close, keep the kids in the house, know where they are.
And, you know, when I was growing up, when I first moved to Canada, I remember tuning into a Buffalo station, and they used to say, it's 11 o'clock at night.
Do you know where your children are?
And it's like, okay, 11, I agree with you.
11 a.m., 4 p.m., you know, let them roam.
Let them be free-range children and have that.
But that really seems to have collapsed now that there seems to be huge anxiety about allowing kids to roam around.
Oh yeah, that's definitely a problem.
Yeah, I'm one of 11 kids.
We left the house, we came back in to eat, that's it.
But yeah, that's a huge problem as well.
And with crime rates so high in some of these neighborhoods, and down here we have trafficking of kids, all that kind of stuff, it's pretty scary sometimes for these parents.
Yeah. And what is the remediation rate that you're seeing, particularly around childhood obesity?
Is there much turnaround?
Is there much solution to this?
Or is it basically just managing a chronic condition?
It's managing a chronic condition.
I would hope to say something else, but I can't.
Just in my experience.
It's very rarely rectified in any kind of way.
Oh man, that's rough. And I mean, even as adults, what is it?
The numbers are in the low single digits of people who lose weight and keep it off.
You know, as far as weight goes, prevention is like 99.9% the solution because once that fat sticks to you, I mean, you basically have to take it off with a chainsaw.
This is not medical advice for those who are out there.
Please do not take, I am not a doctor and Teresa is not endorsing anything that I'm saying, just to be very clear.
Yes, especially not the chainsaw.
So, but yeah, I mean, it all boils down to, see, this is why I don't understand politicians, because all of these problems boil down to human deficits that are like so rampant, you know, selfishness, laziness. I know this sounds terrible, but all of these things, all the seven deadly sins will just ruin a population.
I see it all the time, all the time.
The solution to many of our issues being moral solutions to moral problems.
Everybody just wants to fix the body.
Nobody wants to approach the conscience or the soul or anything like that.
And it's all just about, give me a pill.
It's like, well, maybe you could be a better parent.
No, just give my kid a pill.
And, you know, it's the problem is the people who put shiny things on supermarket shelves.
It's like, no, the problem is the people who buy those shiny things on supermarket shelves and who shop in the center, not the outside.
And There is this abandonment of responsibility and this idea that there always must be an external solution to what are, to me, fundamentally, you say, seven deadly sins, moral problems.
I do. I firmly believe that.
And no, there's not a pill for everything.
Fix yourself. Go to church.
Do something outside yourself.
These are prescriptions that people just do not want to hear.
I did a video recently.
The guy who was here fixing my studio is a great cinematographer, and he did a shot of me in the woods talking.
And the number of people who were like, that's green screen!
It's like, no!
It's the woods! Go out into the woods and see!
Go out into the big blue room and meet the flesh people.
It can be a wonderful experience.
Yes. Now, how are your peers doing in this environment?
What's their motivation and morale like?
So, I belong to a few Facebook groups.
And we're all pretty much in the same boat.
I mean, you know, you read anything anybody says about doctors now, and it's all about burnout.
It's about doctor suicide.
There's a doctor who kills himself every day of the year.
400 primary care- Wait, what?
Every day? Yeah, yeah, yeah. Every day, 365 days a year, a doctor kills himself.
We have one of the highest suicide rates of any profession.
Still better than dentists, but that's for reasons everyone can understand.
I hate to sound sort of cold and calculating about it, Teresa, but the social and human and economic capital tied up into creating a doctor who then just jumps off a bridge, or I assume does something doctor-y to end his own life, Kevorkian style, but that is a tragic loss, obviously, to the person, to the family, but also just down one doctor, and you need a lot of healthcare these days.
Wow, that's appalling.
I mean, you'd think that would be some kind of national crisis that people would be talking about.
I hadn't heard that at all. No, no, it's true.
It's true. In fact, there's a doc who actually started a kind of a web-based program for doctors, and she has a retreat every year.
Her name is Pam Weibel. She was suicidal, and then she came out of it and now started this kind of support group.
But, yeah, so 400 docs, primary care, which is what I'm in, Leave the profession every year.
And that's getting worse. 400.
So you've got attrition of 365-odd suicides, 400 leaving the profession.
So that is astounding.
Right. And of course, supply and demand, I guess without Medicare, Medicaid and Obamacare, that would be driving the price up of healthcare because there's just less supply.
Yeah, well the way that the the suits get around that is they are now putting out nurse practitioners and in numbers that are unprecedented.
So I've been approached by a lot of them because these schools they go to are online and then to do their their clinicals they have to find their own positions to follow and really not many of us want to do that because When you're working in a system where you have to see 20 to 30 to 40 patients a day, and then you've got somebody following you who really isn't that interested in what you're doing but just has to check off a box, I don't want that person around me.
Well, you would inherit their liability as their mentor, is that right?
Yes, you would. And you don't get paid to do it.
Not that that matters, but it does show some respect for your time.
It matters a little. If you're taking on liability, then it matters a little.
Yeah, right. So anyway, they're churning out these.
I have one in my office.
And I said, where do you go to school?
And I'm in Florida. And she said, well, I go to school in Chicago.
And I said, well, how come you're not there?
And she said, well, it's all online.
It's all online. Chicago is really cold.
And violent. And violent, yes.
So anyway. So they're kind of filling in the cracks with less qualified people.
And they don't have to get paid as much, you see.
So this is the wave of the future.
So they put these people in CVS pharmacies, in Walgreens, you know, all these pharmacies have these little minute clinics.
That's where people want to go because they don't have to wait.
Right. Well, the substitution of lower quality for higher quality is one of the hallmarks of increasing government control.
And it is one of the things, because it's an attrition, there's no particular turning point.
Like, they don't say, hey, we're replacing half the doctors with nurses.
It's just little by little, here and there.
And it's hard for people to then trace the cause and effect as to why outcomes may be worse or costs may be in the long run higher.
Because when it comes to healthcare, man, Pennywise and Pound Foolish is the name of the game.
Right. So I had a patient go to one of those Minute Clinics and came to see me that Monday afterwards.
Saying, the nurse practitioner told me that I had thyroid cancer.
This is a child.
Thyroid cancer? Yeah, yeah.
In a pharmacy, they can do the...
So just think about the testing that had to be done around that.
What a waste of money.
Oh, and the weeks, days, weeks, that you have to sit there thinking, well, that's it.
I've got to make my piece with my maker.
And it's like, oh, no, I'm fine.
Oh, man. That's what I'm talking about.
That is what I'm talking about.
You cannot replace four years of medical school, four years of residency and internship, and all the experience with somebody who goes to school for two years post-college.
Now, when it comes to multiculturalism and all the joys of diversity, there is also a big challenge, which I think people are not talking about as much with regards to healthcare, which is you have language issues, you have cultural issues, you have multiracial differences.
And all these people who say race is a social construct, it's like, well, if you try as a doctor treating all races the same, you'll be sued into oblivion within minutes because you can't treat all races the same and neither can you treat all genders the same and so on.
Right. Is there burnout partly because just of the challenges of language barriers and cultural barriers and some of the attendant risk that may be associated with diagnosing people whose physiology and particular ethnicity you may not have studied as well?
Yeah, I mean, I don't see that too much where I am because I'm in Northwest Florida, but surely if you practiced in South Florida or...
Yeah, yeah, especially, yes, yes.
I also trained in Oakland, California.
So we had a lot of immigrants there who, yeah, it was hard to communicate with.
But yeah, that would surely add to burnout.
Right. Let's talk a little bit about a very complex subject, so maybe more than a little bit perhaps, but this question of malpractice, malpractice insurance, defensive medicine, I think everyone recognizes the complexity in that, yeah, there are bad doctors out there who make bad calls and need to be held to account.
But on the other hand, there are also vengeful people out there who don't take responsibility for their own health care and like suing doctors.
So it is a complex issue.
Challenge. My sense, which is of course entirely outside the field, but my sense, Teresa, is that it swung a little bit too far on the patient right side.
And when you talk about Dr.
Suicides, I don't think it's because they're overburdened with filling out forms.
I think it's because like, oh no, I've now been sued for the fifth time and I just can't go through it again.
Like I can't go through this multi-year process of stress and expense and worry.
And I do have the sense that If this is one of the things that's taking down the literal lives of doctors, we've gone a little too far on the defensive medicine side.
Yes, that is absolutely true.
Yeah, I think about it every day, you know.
I have been fortunate that I've never been sued, but I've had friends who have been sued for very frivolous things.
For instance, taking a cast off a child.
This was another resident who trained with me in California who won the award there as best resident.
She was awesome. And she took a cast off and the saw she was using just barely grazed the child's arm and they sued.
She, I don't even know what happened to her.
That devastated her.
Well, it puts a very different...
I mean, you kind of have to love your patients.
I don't want to tell anyone how to be a doctor.
But the more affection and positive feelings you have for your patients, I think the better doctor you're going to be.
And if it's like, well, hope they don't sue.
Hope there's no error.
Hope there's not some miscommunication or something.
That is an uneasy position to be in.
With your patients and, you know, not for you, I'm sure, because it's not as big an issue, but for some doctors, how do you come back from that?
Because some doctors have multiple lawsuits, and again, some of them may be justified, but I think a lot of them are money-grabbing, and how do you have the same relationship going forward with your patients after that kind of situation, especially if it's occurred multiple times?
Yeah, yeah. I don't know how you come back from that.
I mean, like I said, I've never been in that situation, but I can't imagine the self-doubt that would be just absolutely magnified if that happened.
Plus, you'd have to really start looking at yourself like, what's wrong with the way I'm practicing?
I don't know. I think if you have a good relationship with your parents and your patients and you're honest and open and you admit if you made a mistake, then you're in pretty good shape.
Right, right, right. As a pediatrician, what is it like, is there a big difference dealing with, I mean, there will be, but I'm just thinking emotionally, dealing with the kids versus dealing with the parents?
Oh, yeah. Oh, yeah.
You know, I would love to work in an orphanage if I could.
That's not a sentence I was expecting to hear today.
It's like something out of a Dickens novel, but all right.
I don't think we have orphanages anymore.
I don't know. Anyway, yeah, I mean, most parents are great.
They really are. But it's the few that just can make your life a living hell.
I'm thinking of the Munchausens, the Munchausen by proxy.
Now, you know, what that is, is it's a parent who fabricates illness in their child and To gain secondary gain through the medical system.
Your research assignment, oh listeners, if you don't know what it is, is to watch the movie The Sixth Sense, which goes into this in great detail.
But yeah, I mean, there are the hypochondriacs who make up hysteria for themselves, which you would deal with, I guess, more as a GP or a specialist.
But yeah, the parents, in particular the moms who create these ailments or maybe even manufacture these ailments, Oh, I can't even.
That's just so astounding.
That's a personality.
There's an old saying that nothing human is alien to me, but that's pretty close.
Listen, so I thought I had seen most of everything by training in Chicago, the South Side, Oakland, San Francisco.
I came here and I... Literally inherited three Munchausen by proxy parents.
Now, in your whole career, you're only supposed to see three.
I've already had countless.
And it is the hardest, but I will say this.
The one thing that gets them out of your office is to tell the mother she needs a psychiatrist.
Then they just look for their next victim.
Oh, that's interesting.
And, of course, I would imagine these people are pretty trigger-happy on the old lawsuits if they don't get what they want.
Oh, yeah. It's like they're trying to defuse a bomb in your office while the kid's watching.
I was threatened by one at one point because she was convinced her daughter had some horrible illness.
And she wanted to use the airline, you know, where the pilots, they fly at their own expense.
They'll fly these sick kids to another center.
So she wanted to use that.
And I knew that the pilot, I mean, they use their own fuel, their own plane, everything.
So I called him and I said, this kid really is not sick.
And so he canceled the flight and she threatened to sue me.
Wow. Wow, that's...
Well, that will get your attention.
It focuses your day enormously on, okay, how can I not deal with the situation again?
So let's talk, I hate to use this term, prescription, but let's talk about the Rx for what your wish list of Magic Teresa Wondage would put into the healthcare system.
If you could, do anything you wanted, repeal anything you wanted, enforce anything you wanted.
What do you think would be the very best approach to dealing with the crisis in healthcare?
Wow. I'd like to go back about 50 years and go back to developing relationships with patients not based on money, not based on RBUs.
I didn't even get into that.
Every patient has a relative value unit.
So when you come in and you tell me, my ear hurts, I'm giving you, that's a 99213.
But then if you tell me, oh, I have a cough and I may have pneumonia, then all of a sudden you become a 99214, which pays better.
So that's how people approach this.
Not all doctors, I'm just saying.
But I'd like to go back where you actually had a relationship and got to know families and had time To spend with your patients.
That time is fascinating to me.
And again, it's eaten up, as you said, by the five hours per workday of filling out forms.
And most, of course, younger people have never had any history of time with doctors.
What does that look like?
So you go on to see a doctor, and what would it mean if the doctor actually had time and incentive to spend more time with you?
What would that mean for patients? What would it look like?
Well, you know, you wouldn't be able to see as many patients in a day, that's for sure.
And with a shortage of primary care, that would be an issue.
You know, it's so foreign to me to even think about anything better because I can only see it getting worse.
I hate to be so dismal.
But it would be spending a half an hour with a patient when they first show up in your office.
The other day I had a patient.
I've never seen this child.
She's older. She's suicidal.
She's pregnant. All this.
I had 15 minutes to see this kid.
Huh. Yeah.
So, I mean, what do you do with that?
I don't know. I don't know.
I can't even come up with a prescription.
And that's not 15 minutes to interview.
That's 15 minutes start to end, right?
To the point where you have to see the next patient.
Yes. Wow. And so here's another thing.
Here's another thing. So I think medicine...
It's a reflection of society in that, to me, I'm older, so what I see are people, as I said earlier, getting less patient, more mental health problems.
Gender fluidity is another one I didn't even touch on.
All these problems that are so incredible from a mental health perspective, that has worsened exponentially since I was a medical student.
So, how do you deal with that?
I mean, because that lies underneath all the physical ailments, as far as I can see.
So, yeah, so the mental health has been declining considerably since you started.
Ugh! How is that showing up?
You mentioned the gender fluidity, but how is that showing up in your office?
Depression in a five-year-old.
ADHD in a three-year-old.
Suicide attempts in an 11-year-old.
Just overall anxiety.
Everybody's anxious. Everyone.
And the kids too, right?
Because the kids pressure these days, I mean, the obvious and simple one, though complex to deal with is that, you know, when I was never subjected to any bullying, but, you know, the kids who were, at least when they left school, it was done, right?
But now with social media and cell phones and so on, the bullying can be three o'clock in the morning, it can be at your breakfast, it can be all over, and it can become chronic to the point where your, you know, cortisol levels are up, your fight and flight mechanism is continually activated, that's going to wear you down over time.
Right, right. Yeah, exactly.
And so last week I was at a meeting in San Antonio and there was a talk given.
I want to get back to the gender fluidity thing.
So this is causing anxiety in our kids as well.
It's that it's okay to be anyway.
It's okay. It's absolutely fine to not know Who you are or who you want to have sex with.
And it was presented to us doctors in such a way that why should you even have an opinion on that?
You know, this is just like another visit.
I have kids in my office who are seven, eight years old whose parents tell me that they're transgender.
I'm like, how do you even know?
How did this even come up?
I don't know. Well, I think some of it comes out of the education the kids are receiving in school around these issues, which, you know, boy, I mean, when it comes to sex ed, the idea of turning that over to the hands of the state is one of the most egregious things, I think, that you can submit your kids to as a parent.
That's a private family matter and should not be taught by obviously, well, sometimes obviously ideologically motivated teachers for...
Right. Various political purposes and well, that might be a whole other conversation, but that to me is not.
That's a whole, yeah. So what proportion of the kids that you're seeing have ailments that aren't psychological, that aren't lifestyle related, and it's like, wow, bad luck?
In my practice?
Yeah. My practice, 80% have mental health issues.
20% have real...
Real illness. And of those 20%, how many of those illnesses, and I know this is all just rule of thumb stuff and it's all very guesstimate-y, but of the 20% who don't have the mental health issues and have the physical ailments, what percentage of those do you think have health ailments that are related to lifestyle choices of food and lack of exercise and so on?
I would say 15%.
Yeah, of the older kids.
And then 5% have actual illnesses.
And, you know, this is going to sound really bad, but when I get a kid who has an illness that's not self-propelled or related to mental health, I think it's so easy to deal with.
What do you mean? Well, it's just, yeah, this is what it is, and I don't have to worry about...
The fact that you're depressed and that's what's causing it.
You know what I mean? It's like this snowball.
You're treating a body rather than a whole mental system and personality and family structure.
Yeah, that's the easy child.
But I actually prefer more complex kids.
But I will say this. We have around here a community of people called Mennonites and they It's a joy when they come in my office because there are very few mental health issues and they eat well and they play outside.
Now they are technology skeptic but not Amish rejecting, is that right?
That's right. Right, right.
So yeah, the kids are outside, they're getting sunshine, they're getting exercise, and wow.
So when you say you want to go back in time, it may actually be more than 50 years if we're talking about the virtue of the Mennonite Society, because they're like 18th century, right?
Yes, although they do have cell phones.
But when they call me, when I get a call about a patient who's a Mennonite, I know that I'm gonna either have to admit him to the hospital or something really bad just happened.
Oh yeah, no, they have some sort of hay bale implement through their legs or something like that, right?
That's exactly right. One of them fell out of a tree.
Yes, yeah. So I just want to pause here for a sec, Teresa, because this will blow people's mind.
And again, we're just skyballing here, right?
It's just like this all off the seat of our pants, so to speak.
But if we think about this, that of the patients that you see, so half the time you're spending in paperwork.
Right. About 95% of the patients that you see have either self-inflicted issues or parental-inflicted issues for the kids, or they have mental health issues.
So you could drop the cost of healthcare by 95% with diet, exercise, and good mental health practices.
95%! Again, this is all just, you know, it's back of the napkin calculations, of course, right?
But that's pretty significant, you know, and that seems like something we should really be addressing more as a society rather than saying, well, what we need is Obamacare and more paperwork for the physicians and more rights for the patients to sue even for frivolous things.
It's like, no, how about...
Finding what's wrong with the kids, and I think a lot of it has to do with being dumped in daycare, lack of value system in the West as a whole, fragmentation of societies, multiculturalism causing problems playing outside, and so lots of things that we could talk about for a while, but the fundamental issue is 95% of your costs, or the costs that are being borne by society, are not what we would traditionally think of as bad luck, you didn't do it to yourself, and it's not a mental health issue.
I agree with that.
Yeah, but then who would make money?
You know what I mean?
So my goal is this.
There's a new movement out there which is giving me hope and it's called Direct Primary Care.
And it's basically where you just go off on your own again and you just charge cash for whatever you do.
Right. And that way you can set your own time.
You can see the kids you want to see.
Granted, I probably wouldn't be able to do it if I were a sole provider for my family, but it is one of the solutions to the problem right now.
Because you can be a little bit more picky choosy, right?
If people are coming in and paying cash, then you can choose to deal with the patients.
Because, you know, it's important for doctors to have life satisfaction as well.
You guys are not like serfs that just are slaves to the body collective and people's endless needs.
You guys got to enjoy your job.
I want doctors to be as happy as humanly possible so that they want to keep being doctors and more people want to be doctors.
Because if the system gets worse, you have doctors who were already in the system when it was more fun.
But next generation, there will be far fewer doctors because your kids may look at you and say, oh man, you know, boy, she had a great career at the beginning, but I don't want a career she had at the end for me starting out because it's going to get worse from there.
So it's just a rant. I desperately want doctors to be happy in this society, and it really bothers me that they're less happy.
Well, one of the things that kind of gives me hope, too, is I actually teach medical students from Florida State.
And some of them are the brightest minds.
And, you know, I hope they don't get burned out like I do.
But I try to tell them what to do not to make this happen to them.
But, yeah, I don't know.
You know, and another thing I was going to bring up earlier was the whole thing with the nurse practitioner push, you know, and all that kind of We are now referred to not as doctors, but as providers.
Oh, so you can hide the term.
You can hide the less. A non-doctor can just be under the umbrella term.
Yes. Oh, yeah. Yeah.
So, yeah, that blows my mind, too.
So let's close with this.
Advice for doctors? Because you're saying that you talk about this with the students that you teach.
What advice do you have for doctors starting out or doctors in the midpoint of their career who are starting to feel the nihilistic tendrils of burnout begin to suck the marrow out of their spine?
What would you say to them? Take some time off.
Don't start drinking because it'll never end.
But anyway... Or using any of the other substances that doctors have fairly easy access to, which is also a problem.
That's a huge problem.
No, it would be just enjoy the moment with your patient and try to carve out your own schedule so that you don't have these other people dictating who you see or what kind of problems you see.
Make it something that you really enjoy.
I derive incredible pleasure from seeing my kids with autism, Down syndrome, you know, any of those special needs kind of categories.
I could do that all day, and as long as they didn't have to come home and type in everything I just did.
But yeah, no, I mean, it boils down to you're doing this because you want to help someone.
Not to sound trite, but you love your fellow man.
It's appalling.
That's why we do it.
I really appreciate that.
I'm always fascinated by Different lives and the experience that you shared here I think is going to be fascinating to people because you know when you've been waiting for three hours and you know your doctor seems kind of hurried it's easy to get mad at the doctor and I don't view it that way I think most doctors go into the profession because they really want to help people and they want to make a difference in people's lives and they do But seeing it from the doctor's perspective, I think, is so important for people.
And yeah, it is my hope that we will recognize that you can't just wave a magic wand and make bad lifestyles better.
And you can't just put kids in stressful, difficult situations and expect everything to go fine.
And we'll start dealing more with cause.
Doctors, to me, are the last-ditch line of dealing with effects.
If we can't deal with causes, we're going to overwhelm the healthcare system.
And I think that's what's happening at the moment.
So this perspective, I think, is enormously important.
