MappedCon presented by Blueprint Test Prep 2024 is this Friday, October 26, 925 Eastern. I'm starting the day in my track, the pre-med track, planting the seed of your personal statement. We have three tracks going all day long and a couple hours of amazing exhibitors where you can learn more about their programs. Again, MappedCon presented by Blueprint Test Prep, October 26, register for free. It's a virtual event and all the sessions will be up after. So even if you can't make it live, go register and get access to the sessions. Go to MappedCon.com right now, register. That's M-A-P-P-D-C-O-N.com. If you're applying to medical school in 2022 to start medical school in 2023, join me Wednesday or Thursday, Wednesday night at 9.30 p.m. Eastern or Thursday at 11 a.m. Eastern at premedworkshop.com. Go register today. I'm going to show you how to tell your story in your application. Again, that's premedworkshop.com. If you are applying to medical school in 2022, be there or B-square. The Medical School HQ podcast, session number 62. Hey, this is Z-Dog MD, rapper, physician, legendary turntable health revolutionary and part-time gardener. And you're listening to the Medical School HQ podcast hosted by the irredeemably awesome Ryan Gray. Hello, and welcome back to the medical school HQ podcast. I am Ryan Gray, and whether you're a premed loss in your journey or a medical student discouraged on your path, we are here to help encourage, motivate, and enlighten you about why you are choosing to join one of the best professions in the world. We're here to help guide you on your path to becoming a physician. And today, guess who I have back? It's me. Hi, Allison. Hi, Ryan. How are you? I am doing well. How are you? I am doing well. Today, we have a different episode today. We're going to talk all about when the doctor becomes the patient. And we have some specific reasons for that. And we'll get into those in a minute. But first, if this is your first time listening, welcome. Go back. We have 61 other episodes for you to go listen to hours and hours and hours of awesome interviews and discussions and resources to help you on your premed path and your medical school path. So if you're just joining us, welcome. If you have been listening for one or two episodes or 61 episodes, some of you have, I know I've talked to you, go leave us a rating and review in iTunes, medical school, hq.net/itunes. It only takes a couple minutes. And we greatly appreciate it because iTunes moves us up in the rankings. And so more people can find us just like you found us somewhere, sometime. So I also want to share a quick premed resource for you premed students out there struggling with organic chemistry. I recently talked to a awesome person who runs a website all about teaching organic chemistry. And she's got a great YouTube channel that has 80 something videos on it. And the website is leah4sci.com. So her name is Leah L-E-A-H, the number four, and then psi, S-C-I like science. And if you go there, leah4sci.com, she's got a ton of great organic chemistry videos and instruction and a ton of stuff to help you pass your organic chemistry courses, which seems to be one of the hardest courses. I don't know about you, Allison, but organic chemistry for me was it was hard, but doable because I had an awesome teacher, but it's still pretty hard. I think physics was more of my nemesis, but Orgo is typically complained about the most. Yeah. So if you're struggling with Orgo, or if you're taking it relatively soon, go check out leah4sci.com. So, Allison, let's talk. All right, let's talk. Let's get serious. When the doctor becomes a patient, so as physicians, we go through our pre-med journey, we go through medical school. And for the most part, most of us are young, healthy individuals. There are some people medical school that have chronic illnesses. There are some non-traditional students coming back into their pre-med journey in medical school with chronic illnesses, but I would say the majority of us are young and healthy. So we don't really relate to the patient that's coming to us with a chronic disease or a new diagnosis of cancer or some life-altering diagnosis that they're coming to us for help. They're coming to us for treatment. And I think that's one of the biggest tricks that we learn, but it's one of the biggest things that we have to learn to do is empathize with them, even though we've never been in their shoes. And some of us, we tell the stereotypical story of why do you want to be a doctor? And a lot of us have family members that have illnesses and other reasons. And so we might have some close associations with people that are sick, but for us to be sick is typically not the case, right? Yeah, I think absolutely. I think as you go through your training in medical school and even in residency, there's this sort of separation about they're the sick and they're the well. And for the most part, you're in the you're the well group. And if you're not, people don't really talk about it so openly. And so that though can change as it did for one of us. Yeah, so it changed for one of us. And well, again, we'll talk about it in a minute, but I want to go back to the fact that it's just it's one of those things to try to relate to somebody when you've never had that experience. It's hard. It's doable, but it's hard. Yeah, it takes a lot of practice. I think it doesn't necessarily come naturally to everybody. No, and I think some med schools are good at teaching it, teaching empathy. And it's also one of those things I talk about as a non-traditional student, non-traditional students, I think have a leg up on this because they've lived life outside of school. So they know what it's like possibly to raise a family. Some traditional students have raised families as well during all their training, but they know what it's like to have the stresses of a full-time job and come home and feed a family of four and and worry about bills and finances and everything else and not have time for exercise. A lot of traditional students go from high school to college to medical school all on loans or the support of their family, not really having to worry about that kind of stuff. Again, I'm stereotyping, but so non-traditional students have a leg up on this. Now, I'm not trying to say that somebody who's sick as a physician has a leg up on relating to sick patients, but it kind of opens your eyes. I think it does. It gives you a new perspective. It gives you a huge new perspective, and it's that perspective that we want to talk about today. So, Alison, during your residency training, you had some symptoms that you noticed during your training, right? Yes, I did. Talk about those. So in my, let's see now, my third year of residency, which was my second year of neurology, but my third year of residency overall, I started losing weight and I started and I apologize. I'll have to say folks in advance if a little bit of this is too much information, but I'll try to keep it in the not too much information camp. And also for all you listening out there, if you are going into medicine, there's not going to be any such thing as too much information at some point. But let's just say that I was running to the bathroom and I don't mean to pee, and it was happening very frequently. And I should also say that since I was like 11 years old, I grew up in a neurotic home and everyone was worried all the time about everything. And so I had irritable bowel syndrome. I would be constipated or of diarrhea, whatever, one of those things in life. But this was different. I was running running to the bathroom five or six times a day and really, really pretty sick. And at some point, I realized that something was wrong. And you might say, well, hello, that all sounds really wrong to begin with. Why did it take you so long to figure out that this was not right? And the reason is so why did why did it? Well, because I was a resident and I was seeing stroke patients in the hospital running around seeing lots of consults responding to stroke pages and here and there and everywhere. And I was just not focused on myself. I was not sleeping a lot. I wasn't even great. It's the typical life of a resident. So when I came to look at myself and weighed myself on the scale and then put it all together, I thought something is just not right here. In the background, I'll also add that my family is stocked full of GI problems. So unfortunately, my father has Crohn's disease and has had it for at least now goodness since 2002 or three. So it's been quite a number of years. My sister, who's younger, also has all sort of colitis. So the cards were stacked against me. But I had somehow skated through all these years and been fine. I was feeling well and a healthy individual other than a little bit of asthma and seasonal allergies and maybe a mango allergy that Ryan likes to disagree with me. Anyway, I was running around the hospital and finally put it together that something was not right. And I called my primary care doctor, who a year prior head said before you go out and talk about this, that the part about you were distracted really with patient care, you weren't thinking about yourself. You weren't taking care of yourself. That's something we dug into a lot with Dr. Drummond back in session 47, which you can listen to at medicalschoolhq.net/47. We talk about burnout as physicians and nurses and other health care providers, where we are taught to put others before ourselves. Yes, absolutely. But at some point, that's detrimental. It's true. I think I was in a very, very rigorous and intense residency program, seeing an enormous volume of patients all the time and patients who were very ill with significant neurological issues. It was just not in the forefront of my mind. I was doing the critical things that I had to do to function every day. I was showering and cleaning my clothes and eating and sleeping at least a little bit and seeing Ryan when he was in town because at that point, we were also living apart, which was a whole added stress in the background of everything. But I just was not focused on myself. My focus was my patients and that was, unfortunately, for me, somewhat detrimental. I think that the stress of everything that I was dealing with in the background was really adding up big time. The way that my body dealt with it was by getting sick, unfortunately. That's at least my take on it. I don't know if that's actually true. No one will ever know. But it is a little bit interesting, if you will, that the time that my body chose to get sick after being healthy for 30 years was right smack dab in the middle of a very stressful residency. Yeah. And not exercising and not eating properly. And probably not obviously not sleeping well. So stack all of those cards against you and you wonder how much environment played a role in your illness, which we haven't discussed yet. So continue on. Let's see. So I called my primary care physician. Finally, I think also at the encouragement or strong encouragement of those around me, they would see me sit at dinner at night after I'd get home from the hospital and run to the bathroom afterwards. I would put down my fork. It was just not right. This should have been clear to all of us, but it took a long time. Anyhow, I called my primary care and she said, "My goodness, Allison, you a year ago came into my office, have been healthy as a horse, and I said to you, basically call me when you need me. See you when you need your next pap smear or something." It was very low-key and now it had shifted to, "Okay, there's something really potentially very wrong here." So she got me a consult with a gastroenterologist and I somehow found a way to squeeze this consult visit into my day as a resident. I didn't want to go and start asking for time off or time to do things. I figured, "Okay, I have so-and-so number of patients to see in the morning. I'll write my notes. I'll run over to the GI office, ask one of my co-residents to cover that stroke pager for me for an hour and a half or whatever it takes for this visit, and then I'll go right back to work." And it didn't quite go that way. It sort of did. I went to the GI doc and they were certainly quite concerned. Adding up my symptoms, looking at me, they said, "We're quite concerned that you could have inflammatory bowel disease." And for those out there, that is not the same at all as irritable bowel syndrome. Inflammatory bowel disease includes Crohn's disease and ulcerative colitis, which are autoimmune diseases of the GI tract. Which, as you mentioned, your dad and your sister both have one of each. Right. Some can have both. It's true. That is absolutely true, unfortunately. So I was quickly, I did go to that visit. They drew some blood, they examined me, and three days later, I had to have a colonoscopy. So I did have to tell my program, I said, "Look, I'm gonna have to do a bowel prep," which for anyone out there who's had one is one of the most miserable things, you'll spend a day doing. You drink the most vile substance on earth. Okay. We're getting into TMI. All right. Sorry. Well, it's just gross. Anyway, needless to say, I had to sit out a day, and my program was very understanding and quite concerned and said, "Do what you need to do, and we will see you back when you're back." So I did that bowel prep. My sister kept me company, and the next day I went for my scope. And the very, very nice gastroenterologist came out afterwards. I was coming out of my delirium from having been on conscious sedation for the procedure, and she said, "Well, it looks like Crohn's disease." And they did do biopsies, and sure enough, it was actually severely active Crohn's disease. Okay. So, bam, all of a sudden you go from a healthy, healthy 29-year-old physician running around the ward, taking care of everybody else, and now you're labeled. Yeah. You're labeled with a Crohn's disease that you're never going to shake, and it's changed you. It changed us. Yeah. Like I said, I knew a lot about this because I'd seen my family go through it, but it just was not something that I saw as being a part of my life, and in a personal way, obviously. And it was a big shift. I have to say that I was quickly set up with one of the most wonderful specialists in gastroenterology, and he's taken amazing care of me. And that all, despite the fact that this was such a humbling experience for me to go through, and we can talk more about that, I think the silver lining was that I had such great care, and felt really taken care of and safe because of that. Yeah. And hopefully all patients can feel that way. Yeah. But just as you said, it's very different when you go from being a physician, running around, taking care of people, and that I am your doctor and here to help you to whoops, now you're sitting in the chair on the other side of the desk, and you are vulnerable, you are sick, you're in need of help, and also I have to say, yes, I went to medical school, but and did I know about Crohn's disease? Yes, I was educated enough about it, but it's certainly it's a specialized thing. I didn't know about what treatments I needed. I didn't know what the future held. I didn't know really what to expect at all. And it was a very vulnerable place to be. And felt I remember the first time I went into the office carrying this new diagnosis and feeling really humbled, just really humbled by it all. And it gave me even in that moment, a new perspective on G, this is what it's like, potentially, similar, different, but but similar enough, when a neurology patient comes in and they have a new diagnosis of some chronic illness that they're going to be stuck with for the rest of their lives and how humbling that is. So let's start talking about the whole when the doctor becomes a patient here, because this is what I wanted to talk about was as a physician putting yourself in the patient's shoes, and now you are in the patient's shoes, literally. Obviously, when you're diagnosed, you were diagnosed with Crohn's. You had some medical training to kind of fall back onto and be able to think about Crohn's and what was it and dig through the textbooks that we have and call our friends that are doing gastroenterology training and ask them questions. Now, for all of those that are listening, when you're going through your medical training and you're out there practicing, try to think what it's like to be a patient that does not have those resources. Obviously, in the world of Google, we can Google things, we can go on to journal, read journal articles and become informed. And the whole informed patient is a huge movement now, and it's a great movement, but there's still a large majority out there. And some of them choose not to go looking because they don't want to know. But can you talk a minute about knowing what you know the way you handled it and try to put yourself in the shoes of somebody who doesn't have those resources and doesn't have that medical training? Absolutely. I think that I did have another, again, silver lining. I kept trying to look for these silver linings was that I did have a background in medicine. And I had an understanding, at least a basic understanding of what the disease was and what potentially the outlook was going forward and in general what the treatments were. And I tried not to, but I did. I did go on forums online and started Googling around to see when they started talking about the different treatments that they were going to be considering for me. I went online and started Googling. And it's hard. You read these forums and people are terrified. They don't know what they should do. Their physician is telling them one thing and they're scared of what the physician is recommending, or maybe they don't agree, or maybe they can't afford their medicine, just so much fear. And I tried to stay away from it also because we also, as physicians, always tell our patients, don't go online. Dr. Google is the most dangerous doctor out there. You'll find the worst case scenario that people are posting about and it's only going to scare you more. But I think as a person, I have to say the other thing that struck me at the time and still does is that you want to be able to talk to other people who are going through this. And it's not like I could sit there or get up on a little pedestal in the middle of the hospital and say, Hey, I'm a resident. I also have Crohn's disease who wants to talk about it. Oh, you're lucky you had your family. I did. But in terms of talking with someone else who was going through the same situation, he was a young 30 something year old and also in medicine. I was looking for other people just to hear about what they were going through. And also, my family members had not been on the same therapy that I was put on. So I had a lot of questions about what was that like? What was that going to be like? And so I did do that patient thing where you go online and you start looking around. Did it help? Not so much. But I think there is that feeling. I also registered with me that as a patient, you want to be able just to talk about what it's like to have an illness. And that's not something that we spend a lot of time doing as physicians. I think that's something that we rely on social workers for and nurses to help us with because as much as you may want to spend a lot of time in the office or in the hospital talking with a patient about how does this make you feel? We don't have the time and the day to do that as much as we should. Really, we should have half the visit to talk about the diagnosis and the treatment and the whole other half to talk about how does this make you feel? And just talk about your feelings. But medicine just isn't arranged that way anymore. The insurance companies don't pay for that really. But I think that that hit me as well. The last statement that you made about taking the time as a physician to sit down and talk to the patient about how they're feeling, their fears, their anxieties, that in my mind is treatment. That's treating a patient. And I'll talk about some of the things that you were going through. As an outsider, I was watching you go through it. And I would watch you email your physician. You were lucky enough to be in the same email system because you were a resident at the hospital where you were being treated. So you had access to everybody's email addresses. Right. And he did give me permission. I didn't just start emailing like crazy. That would not be helpful or respectful at this time. But he did tell me that it was very nice that he offered that to me that I could just email him if I had a question. And there were often times you had questions and you would email him and he wouldn't email you right back. And you would check your email and why isn't he answering? Right. And he was actually very responsive but I'm an impatient person. But you're an impatient person. Yes. And I was a scared person. Exactly. And so again, trying to put, for those of you listening, try to put yourself in your patient's shoes. This, Allison is one patient out of how many patients does he treat? Oh, thousands probably. We'll just say a thousand. What is it? 110.1% of his patient population sitting there checking your inbox in your email, constantly refreshing it. I'm exaggerating a little bit. But you're anxious. You're waiting for an answer. A patient might get frustrated and call and say, why isn't he answering my questions? And so now put yourself back in your doctor's shoes. And when a patient calls and says, hey, I haven't heard from you in a day or an hour or do you respond differently to them now knowing that? I think I do. I don't think I've ever thought about it in that way. But absolutely. I think when I get messages in my office now that somebody is called or if I do receive an email from a patient, it is a big priority of mine. I sometimes will actually stop the work that I was doing before so that I can take time to answer that phone call and respond back to that patient. It is almost never that I wait until the next day. I really do not leave the office until I call everybody back because I think they're scared. They have questions. They're looking for help. And if I can take 10 more minutes out of my day to help and respond to their question and not leave them hanging with that anxiety over their head for the rest of that night into tomorrow, then that's what I'm going to do. Yeah. Okay. So it gives you that perspective again that we really wanted to talk about today. Definitely. So let's take it up a notch and talk about insurance. So insurance, I think, is the bane of our existence. It's one of those. I wouldn't say it's a necessary evil because I don't know how necessary it is. But somebody has to pay for this, right? And so most people have insurance. And as physicians going through medical training, we don't get a lot of instruction on insurance. Not at all. We get about zero training. Yep. And now as a patient yourself, seeing medical bills come in and going, "Holy crap, that last infusion cost $10,000." And going, "Who's paying for this? Why am I getting billed for it? Who do I need to call?" That's a whole nother level of stress that as a patient you have, and as a physician, patients are coming to you with. And again, now you have that perspective of, okay, understand what you're going through. Truly, I do. Here's what we need to do. Absolutely. I think I've had several panic moments since this diagnosis began. I think I've tried to be as level-headed as I can. And maybe Ryan can attest to that because he knows that I'm more a worry-word, but I've tried. But I, just to go back a step, after I was diagnosed with Crohn's, I was put on Remicade. And Remicade is a biologic therapy. It's an antibody therapy. Basically, it's made from a mouse. So we have this joke that I'm part mouse now. And I was placed on the drug and I receive it every eight weeks. It's an infusion. It takes two hours to administer. And I sit there and I do my email or read or sleep, yes, on occasion. And I had to work with my residency program at the time to make time for that. I also had to work with my boss when I joined the practice to allow time for that, because if you think about it, that's a significant portion of the day. It's a three-hour or so turnaround time between getting hooked up, sitting there, finishing up. And I love the nurses who've taken care of me. They've been amazing people. And I have to say that that's also, that is one other thing I'll just interject before we jump on the insurance piece about how just safe and comfortable I felt in the care of such wonderful nurses and how I came to appreciate nurses that much more. I think in residency training, if you're paying attention and realizing all along that it's a team sport and making friends with the nurses is one of the top things on your priority list. They're wonderful people. You work together to make patients' lives better. And that said, as much as I respected and admired and was so appreciative of nurses during my residency training, having people come, having a place to go over eight weeks where you know that you're going to see these same friendly faces who are putting in your IV and monitoring you and making sure that you don't have a reaction to this big drug that you're getting. Having them take good care of you and make you feel safe and at home and even appreciated, they smile and they give you a huge hug when you come in. I can't tell you, as a doctor who becomes a patient, that's such a special thing. So, to all the nurses out there, thank you for what you do. Anyhow, so this bill. So, Remakeeth is extremely expensive. The drug is not as well- The drug's not expensive. Getting Remakeeth, I should say, is very expensive. So, because of having great insurance as a resident and then also with tri-care in the background, being a military family, we really didn't see any medical bills. However, when I lost my primary insurance after graduating from residency, there was a whole big glitch in the system because Allison didn't realize that Allison needed to call, try care, and tell them, "Hey folks, you're now my only insurance company." So, I started getting all these bills in the mail and one day, a bill comes from the hospital saying, "You have a bill for your latest infusion." And it was literally $10,000. I think I sat down on the stairs and started pulling my hair out. I said, "Ryan, what am I going to do?" I was freaking out. And he said, "Pause, breathe. We'll figure this out." But I, and since that time, have started to work it out with the company and they're going back through and dealing with each of these charges and making their way through them and helping me with it. But I thought, "My God, I've had people that I've met with corons who say that they can't even afford the infusions that they're getting or can't afford the injections they're getting. And I used to think, "Well, God, that sucks. That's a huge bummer for them." But here, I was getting this bill for myself and thinking, "What if they are going to be $10,000 every time? What if my insurance company doesn't cover this? What are we going to do?" We're doctors, right? We're rich. Yeah, no. We have student loans and car payments and everything else, like everyone else. We've worked through it. We're working through it. But yes, right? And it gave me another huge glimpse into what it's like to be a patient and how frustrating it is to fight day in, day out with these insurance companies to just try to get the coverage, just the care that you need for whatever disease you're dealing with. Yeah. Not only, again, if you think of a typical patient who is dealing with the stresses of their life that might have led to their diagnosis in the first place, then they're dealing with the stresses of their diagnosis, stresses of their diagnosis, diagnoses, the stresses of insurance companies, the stresses of not hearing back from their doctor right away. Let's talk about the communication between you and another doctor, a patient and a doctor. In your case, you're a physician as well, so it's doctor to doctor, and for the most part, would you say that you've been talked to like another physician? Yes, very much so. I think the way we talk to each other, it's probably a little bit quicker than it might be if had I not had a medical background because we just sort of speed through and he gets me up to date on what I need to know about the latest GI, X, Y, and Z. But I don't need all of the sort of catch me up to understand. When you see a new person, do you make it a point to say, by the way, I'm also a physician? I think I do at some point if I find that they're talking to me in a way, explaining a lot of things that I already know to save them time and effort, I might say thank you and I appreciate that. I am a physician, so I know some of this, and it's I think only helpful because it saves them time, so I do try to make a point of that. I want to talk about today specifically. You came home and you were frustrated. You had an infusion today. I did. And you had a discussion with your GI doc about your thoughts about your treatment path and some of your concerns and some of your hopes for your treatment path. And from what I took, it was more of a paternalistic view that he took. And for those of you listening, paternalism in medicine is where as a patient, you do what the doctor says. The doctor says you need to go run 10 miles a day to get healthy. You're going to run 10 miles. You need to take this medication three times a day. You take that medication three times a day. You don't ask why you just do it. That's the way medicine was practiced for a long time. And in some parts of the world, some physicians still practice that way. But it's changed over the last what, 10, 15 years maybe? Maybe I don't even know if it's been that long. And now it's a collaborative effort between the patient and the doctor. They have a conversation about what works best for the patient. Right. The latest wave is really focused a lot on patient autonomy, a patient's ability to take in the information that they receive and try to make informed decisions with that balance, like you said. Yeah. So our job now as a physician is to inform the patient about all of their options. Just discuss the pros and cons of each option. And then yes, say this is the option I would choose because XYZ. So you're still adding in your expertise in your thoughts and you're trying to push a little bit. And you're guiding. Yeah. I tell people all the time, everything you do in life is a sales job. And you're selling them on one treatment. You're giving them all the options, but you're selling them on the Jaguar. This is the car you want. And today you weren't treated that way. Right. I did have a frustrating day. The infusion was fine, but I love my GI doc dearly. I really do. He's I'm grateful to him. He's taken wonderful care of me and just been really a godsend since I met him. And I disagree with him about what I want to do with my Remicade. This is a very authentic episode, by the way, folks, this is like latest headlines from Allison's life. But I am happy to share with you all if it makes a difference to you and your life and on your path. So I would love to come off this drug. The drug has done wonders for me and helped me actually removing gluten from my diet has been an enormous positive change in my life and my health and has made me feel leagues better than I ever thought I could after getting diagnosed with this disease. And that's a podcast for another day. But I at this point would like to try to come off of it. I want to say, what can Allison's body do without the drug? I've been feeling great for quite a long time. No, not gone away. That'll continue. Do I really need to stay on this drug for the rest of my life? And my doctor, who I love, really, when I raised the option of going off of it today, he was just like, no. And I think I tried to advocate for myself, which is so important as a patient to be able to do because you do want to put your two cents in there and stand up for yourself and say, well, this is what I think. And what do you think about that? But he was very much, this is what I want you to do. And let me give you a big hug. And this is what we're going to do. And I felt frustrated because what I found missing was a lack of other options. So what are the other options? What else could I do? Let's just entertain my perspective for a moment and go down that road and see, well, if we did go off the drug, what are the options for you? So I left the office today feeling frustrated because we really didn't go over any other options. And I felt like I was being told, this is what you need to do. And kind of that's that. Yeah. So you mentioned that you were advocating for yourself. And I know your doctor, great guy, he probably, and obviously you're not one to throw a big fit in an office. But I think there are patients out there who try to advocate for themselves. And then they get labeled. Difficult. Difficult patient, right? Yeah. They go, oh, this patient doesn't want to listen. They're difficult. And I need to get them out of my practice as soon as possible. Yeah. Or you're just your perspective changes on them, definitely. Yeah. And all they were possibly trying to do is advocate for themselves. So as a physician, you need to understand that if a patient pushes back a little bit, they're not being defiance. They're maybe they're possibly not just throwing out your opinion. They're advocating for themselves, they're saying, I read this online. Can you inform me a little bit more about this treatment or that treatment? Can you inform me a little bit more about what might happen if I come off this medication? Yeah. And I think, Ryan, it's easy to go through your life with blinders on and not be thinking outside the box and challenging your own practices and how could you make them better? And we learn things from patients all the time. We don't know everything in medicine. There are there are things that we're still learning and seeing that patients experience that we can't explain that we don't have good answers for. We learn so much from our patients. So I think it's not a good thing to go through with blinders and just keep doing the same thing you're doing and shut out all the the voices which are telling the voices who are telling you to do something different. Are you hearing voices? No, I'm not hearing voices. I mean, the voices of your patients or their families advocating for them. I will say, I've seen you and I both have seen the whole range. We've seen patients who spit, who curse, who are violent, physically abusive. That is not good stuff, obviously. But speaking up for yourself, asking a physician, talking about just as you said, this is something I read, or what do you think of the other options available to me? Those are such important conversations to have. And you should make it a point to respond to those in an open minded manner, in my opinion. Not just in your opinion, that those are good, good points. But even even taking it, taking it a step further and, and defying the doctor, the doctor says, no, this is the medication that you're going to be on for the rest of your life. You as the patient say, no. You say, no, I, I do. I, I, I have heard everything you've said, but I do want to stop the medication. Now support me in that decision. And I think a lot of physicians and just being humans, we don't like being told, no, we don't like somebody disagreeing with us. Yeah, we don't like change. I mean, there are a lot of reasons. So as a, as a physician, you need to be able to go, okay, I've, I tried my best to make them understand XYZ. This is their decision. They, they came to it in an informed manner because I laid out all the cards on the table for them. They made this decision. I'm going to support them the best way that I can. Right. And it's not to say, again, out there, if you are hearing this and saying, well, does that mean I always have to go along with something my patient says, no, actually there are laws about this. If let's say just as an example, a patient goes to a physician and asks for an abortion and the physician doesn't do them or believe in them or any of that, they can say, I'm sorry, I can't see you for that. Or, you know, my answer is no, but here is someone else that I can send you to. That's actually our job. We're required by law to, to send someone, give the person another name of someone else that they can see. So I think my feeling about all this is that if you're, if a patient really disagrees with you and says, look, this is what I want to do, unless you feel like it's going to be a huge departure from what you think is safe and or the patient's being physically abusive and there's some other reason to actually discharge them from your practice, I think the best thing we can offer is providing or supporting that person, that patient with what their choice is in the safest manner possible with all the options laid out. Yeah. So I think we covered a ton today. Do you have any, so let me ask you, so going through this process now, and I know you're still going through it and haven't processed it fully, but do you think this has made you a better physician? Oh, absolutely. I think it's given me a lot of perspective. I think one other thing I didn't mention, Ryan, is that sometime during my residency, I was sitting in a morning report and they were talking about a patient who had come in with Crohn's disease overnight and the patient had some kind of neurological issue and there was a moment at which point one of the attendings made kind of a crack, a joke about how, oh God, it's a Crohn's patient, you've got to get them out of your office as soon as possible and you just got to get rid of those patients. And I was dumbfounded. I looked at the floor. I felt like I was going to vomit. I was just floored. This was a physician who was revered, who I, he's one of my mentors, someone that I look up to so greatly in my field and in medicine in general. And he had just said this thing, which was so really quite frankly evil. It was just so hurtful. And at that point in time, I had not talked about my diagnosis openly with my co-residents or my program. And so I don't, he certainly didn't know that. I'm sure he wouldn't have said something like that if he knew about what I was dealing with. But everybody started laughing and I thought, this is just awful. This is that whole thing that we talked about before about we are the well and they are the sick. And there's that separation between us. We are the higher ups. It's that hierarchical thing that sometimes doctors have a way of losing themselves in it that we're the bettors and those are the sick and we need to help them. The muggles. The bad ones or the bad seeds. Anyway, I just was so floored and so disgusted and I felt just horrible. And that taught me, you know, in general, when you're going through training, you want to take the good things and leave the bad. So that day I said, okay, I will never ever in my life again, you know, make a cracker joke about a patient or what they're dealing with because you never know what people are dealing with. You really don't. And in my experience, have I the other patients who I know with Crohn's disease, are they awful people you need to get out of your office right away because they're huge complainers? No. I'm sure that physician had met quite a few, but it's never a good idea to make blanket statements. You never know what people are dealing with. And it taught me more than anything that there should never be such a barrier. It is not we are the well and they are the sick. It is we are human beings, all of us. And at some point in your life, you will have a medical diagnosis or a surgical diagnosis to deal with. And at that point in time, I hope that you have bridged that gap between understanding that we all suffer from disease, we are all human beings and prone to illness. And we need to not have such barriers between us and realize that that we we all need to be taking care of each other in a mindful manner and in a way that that does not does not make people feel badly about about these illnesses that they're dealing with. Well, son. So I feel pretty strongly about it. I think it really in so many ways that like you said, I think we've tried to highlight today, becoming a patient when you're a doctor gives you a lot of perspective about a lot of things and really helps you reflect on the patients who are coming into your office or into the emergency room for help and trying to put yourself in their shoes. It's a lot easier. I'll tell you to do it once you've been dealing with with a chronic illness, but it's something that we all must strive for, even if you're healthy. And if you're healthy out there, good. I hope it lasts as long as humanly possible for you. But know that if you're making yourself a better physician and other physicians out there are adding that perspective into their lives and trying to put themselves in their patient shoes, when one day you need their help, they hopefully will be there for you in a way that works and is good for you. All right. That's awesome. Is there anything else you want to add? One last thing, I think, the other really positive thing that has come out of this experience in dealing with Crohn's is that Ryan and I met a whole community of other people out there who are dealing with Crohn's and are also trying to raise money and awareness to get rid of this awful disease once and for all. And really, this came from the fact that when I was diagnosed, I was in my GI office and they had some pamphlets about this thing called Team Challenge. So we signed up and what Team Challenge is, it's an organization that is part of the Crohn's and Colitis Foundation of America. And Team Challenge runs, not runs, but Team Challenge has these groups all over the country who get together and run. Team Challenge does run. That's true. I meant to say, I was going to say runs marathons. They don't actually run them. But basically Team Challenge has all of these groups all over the country and they're running groups and people get together every week and they train and they raise money as well for research and also awareness in the battle against Crohn's disease, all sort of colitis and inflammatory bowel disease in general. And so Ryan and I joined a team and we figured we would wait until I was healthy enough to really get on one of these teams because you are running half a marathon. So we joined a team and it was so such a positive experience for me because it was a great way to exercise work on my own physical health and strength. And we met this wonderful community of other people who had been through similar illness and other people who also just had family members like Ryan, who was running for me and I was running for my dad and my sister and also me. And so we met all these wonderful people who all had the same mission of trying to do something positive against this disease, these diseases. And we had a blast. We ran in the December 2012 rock and roll half marathon in good old Las Vegas and we did pretty darn well. So it was just a blast and I really had such formed really strong connections with these other people on my team. And we just, I really can't say enough but things about it. So I would just put in a plug if I can for team challenge and the CCFA and all the great work that they're doing out there and encourage anybody out there who is living with Crohn's or ulcerative colitis and maybe just or you have a family member, not just maybe you have a family member or a friend who's dealing with it. And it's a wonderful way to both get in shape and give back. Yeah, that was awesome. I hate running. I still hate running but I loved running the half marathon and we'll probably do it again. Definitely. And when we do, we'll probably let you the listener know and you can help support us on that on that goal. And we ran the half marathon in Vegas and we raised over $7,500 between the two of us. Yeah, it was awesome. So for those of you out there listening, I hope sharing our story, Alison's story, helps give you some perspective as you go on your journey to medical school, through medical school, through residency and understand that that patients are vulnerable. Patients have a lot of stresses. It's not the fact that they're trying to make your life miserable. They have a lot of stuff going on. You have a lot of stuff going on. At the end of the day, as Alison said, it's human-to-human interaction. And you need to understand their stories and understand their stresses to be able to fully treat them. And hopefully sharing some of our personal stuff today will help you do that in a better way than you would have otherwise. So hopefully you enjoyed that a little bit different. We didn't teach you anything on how to get into medical school today but I think this is much better information. So if you have any of your own stories you want to share with us that made you a better doctor, made you a better person, go to our show notes medicalschoolhq.net/62 as in episode 62. You can say hello to us on Twitter. I am at medicalschoolhq. Alison is at Alison_mshq. We still need to get her some more tweets. Or you can go to our feedback page medicalschoolhq.net/feedback. We'll take you to a page where you can actually send us in an audio recording that we can play here on the podcast. So please go continue the conversation and let us know what you thought about today. I hope the information provided will help better guide you on your path to becoming a physician. I hope you join us next time here at the medical school headquarters. [Music] [BLANK_AUDIO]
