In this episode, I chat with Dr. Zain Hakeem. He is a medical practitioner, and we talk about this unique model of medicine, considering goals and strengths in prescriptions, the intersection between physical and medical health, and so much more.
If you don't have a target, you don't have a place to go, a map is useless. Because, okay, like, what am I gonna do with this map. But at the same time, if you have a place to go, and you don't have a map, you can start creating a map by making a movement. So it'll take you longer than if you had a map. But just by having a place that you're trying to get to, you can start defining a map for yourself.
Welcome to doing the work. If you're okay with living a boring life with below average results, this is not your podcast, go ahead and tune out now. But if you want to live an amazing life full of purpose, love, joy, abundance, and elite health and fitness, you've come to the right place. This podcast is for people who are ready to stop making excuses and start doing the work that creates a life that they love. I'm your host, Athan Schindler in Airborne Ranger turns into a social worker, strength coach turned entrepreneur. I've spent my entire life learning how to be uncommon among the uncommon, I found my purpose and empowering people to reach their full potential. And this podcast takes a deep dive in how to prioritize what matters. Do the work, own your life, maintain compassion and kindness, and risk failure while enjoying every moment along the way. I talk to people who inspire me and share their gifts with you. This is my way of helping you find what sets you on fire and keeps the fire burning.
The doing the work podcast is brought to you by Strive Strength Conditioning, Backdrops, Premier gym, that helps you crush it in the gym, so that you can be happy, healthy and successful outside of the gym. Check them out@ www.dropbastrop.com Hey, what's up guys, I am coming to you, actually on Black Friday, which is the day after Thanksgiving, and I just want to say thanks for making it this far into the show, if you've been listening to any of my podcasts or episodes, and you've been enjoying them, or even if you haven't been enjoying them, I appreciate you, I appreciate you for listening, I'm learning a ton I'm personally getting a lot out of the process. And it's been exciting. So with anything new that you take on, I have been learning, one of my values is to fail often and I've certainly had some failures with the podcast today. The one that you're gonna listen to, I had here was the operator error, I forgot to hit record at the beginning of this conversation. And, then the space on my phone kind of cuts out at the end. So I'm just here to ask you to bear with me on this one, the sound might be a little off in the very beginning, because we're gonna have to use the the camera sound and, and then there's not going to be video towards the end and there'll be only sound but this conversation was awesome.
I think it's totally worth still putting it out there. I hope you get a lot out of it. And thanks again for bearing with me. So at the beginning, you missed the introduction of Dr. Zain. He came, he's a medical practitioner. He has a doctor's office here in Austin, Texas. And I just love his model of medicine. He runs a concierge medical practice. But general practice, but the way he approaches it, he comes from a goal approach. He tries to tell people what they're trying to achieve in their life and what their strengths are. And then he takes their physical health, their medical health and works it into their goals. And so it's a unique approach. He's definitely a pioneer. I think you guys are gonna love this episode. So without further ado, here it is. So I'm so excited to have this conversation with you. Like we were just talking about a couple minutes ago, you and I have had at least four conversations in the past where I walked away thinking man, that was such a good conversation and I wish I had captured that and and you know, your approach to work and your approach to medicine. And just the way your brain works is just fascinating to me. I thought to whoever is going to listen to this thing. I thought that they might really enjoy your perspective as well. So thank you so much for taking this time with me.
Yeah, my pleasure. I always enjoy our conversations and always something valuable for me comes out. Yeah.
So yeah, we'll just start out with like, is there anything fun and exciting to work on like that we kind of talked about a couple of projects I'm working on biome was top of mind several.
Well, the very top of mind is that is our fitness app that we've kind of batted around. Yes. We're going to take a look at that in a little Yeah, and as I've been working on it, I think just this, it plays into a bigger game for me that is being able to quantify and being able to project long term goals into the short term and say, oh, I want to be healthy in my 90s. Okay, that's a great goal. How will you know if you're on track? Find out when you're nine? Because, that's yes or no to that question, but it's not helpful in the short term. Right. So I think the app kind of reinforces that idea of bringing long term goals into what am I going to do today?
Yeah, which is, and I love that you're thinking about that, like, as a medical practitioner, because just the fact of wanting to have your patients and the people around, you be healthy, down the road. And I'm a big firm believer that the habits of what you do on a daily basis is basically going to predict how you end up 10,20 & 30 years down the road. But I don't care enough about the doctors that I've been treated by the ones I hear anecdotally about staff really spending a lot of time really helping their patients and stuff work on that. So I love that you at least think about it.
Yeah, I think there's a lot to that, we have a system of medicine now that captures physicians. You know, one of my mentors in med school was a trial, amazing doctor in his own right. He kind of told me that look, the medical school residency, all of this training is the status quo. So you have to learn that. But you have to think about the fact that on the other end, you want to just keep doing the status quo, or do you want to keep building? Right, you need to think about that. Now, he had a very sobering sort of outlook on it, which was, he said, Look, if you think about the way med school is one, and others sad, he wasn't knocking it necessarily resist all the elements that cults use to indoctrinate members are present in its sleep deprivation, in group jargon language that no one understands separation from friends and family, a culture of superiority and elite ism, access to special knowledge. Right? Wow, I never really thought about it, but it's true. Yeah. And he said, no codes in the world take seven years minimum to do the indoctrination. You're in this for a period of time, that is unreason. If you're going to come out the other end as a free thinking individual, you need to be very conscious about how you write. You have to go into it with that in mind.
Yeah. Because it takes a lot of courage and a lot of, you know, strength to kind of be the one person standing out there alone or being the one who's always going to see but yeah, right. Yeah. Think about that. A high degree of disagreement. You know, I disagree with abilities. Yeah. So well, that's awesome. And they even had a mentor at medical school, kind of like talking to you about those couples.
Yeah. I mean, he introduced me to several books that kind of, like, open my view of alternate ways of thinking. One is called cells, gels and the engines of life, which is a biochemistry textbook at the end of the day, but it literally presents an alternate explanation for all the biochemistry we learn next, in med school and pre med, right? Just like, Hey, you learn all these things. Here's another way that could all be happening. Right? Interest, and it's like, okay. All the stuff we learned is not the only possible explanation.
Right. There are theories. Yeah. And there's some evidence behind them, as when I'm in school for exercise science, a little different. But they remember my professor saying, this is the sliding filament theory. And it's a theory because this is why we think it happens, but we're not really sure, in my mind is like, Okay, we haven't figured this all out. Yeah.
Yeah. I mean, it's very confusing. And one of my favorites. There's a context ACD. Yeah. And so one of my favorites there is, he's loving Google's code, right? This is our smartest engineers on the planet, optimizing code for several decades, right? Evolution is the harshest optimization pattern you can run and it's been running for 4 billion years, right? Well, things happen in the body. Nothing ever does. One thing is not that nothing is linear. Right. Everything is actually doing multiple different things. And to understand that is you've got to weave through layers and layers and layers and so that It kind of loops back around to the way I try to run the practice, which is, instead of trying to understand the micro thing, like, I can affect this receptor with this chemical or this drug, which is fine. But if you can pull some of the bigger levers, say, Hey, we're built to do better if we experience periods of stress and relaxation, rather than low level, chronic stress, right? So acute sprints and workouts, you're gonna do better than trying to do 40 reps, that's how we do that. Yeah. Fasting, similar things, we seem to have certain circuits that are triggered biochemically when we fast. That's just a lever. Now, you can get into the details of all the chemistry of what's happening there and say, Okay, maybe we can design a drug to do some of those things. But we could just pass right brain
juice to how it's been done. And the same thing is that people ask me all the time, like, should I fast you? How long does that sound like? Well, obviously, our ancestors are a good way to look back. Like, these are the real things that they had to deal with. And they certainly had fewer of the chronic diseases than we do, they had some others, probably, but so. So I love that, again, a doctor's kind of looking at that and trying to prescribe some of those things to some of our patients.
And it gets into really interesting stuff. So like one business that we know, but don't really know what to do. Right? intimate relationships and community decreases your chance of death, mortality card disease, we know it's actually pretty strong, right? It's one of the strengths that I think Dean Ornish, in some of his later books, said it's a stronger factor than almost anything else. Okay, that's great. We know married men live long. Right? But we only do like what, okay, I'm not married.
Alright. Damn, yeah. Find someone you know, it's not is it? It's not just the well, maybe it is like, do you think it's literally just having a partner someone to share life with? Or is it more like having a healthy relationship? Or are there other distinctions?
There's just one scenario, I think, the more nuanced you get in a scientific endeavor, the fuzzier the data gets, because you have more factors now that you're looking at. Right, right. So stability seems to be part of it. So to that degree, it's almost any partner will do. Right. The other thing that seems to be a part of it is the degree to which you are vulnerable with the other person. Interesting. And so there's a support aspect, which is just the A, there's some other person who is risk tied to me so that we are mitigating and sort of creating risk pooling between the two of us. And that is, whoever's willing to make the trade war. Yeah, exactly. But the other factor, there does seem to be the emotional component of vulnerability and saying, this person really knows.
Yeah, that's fascinating. That part is fascinating to me. Because, again, not being a doctor, or a scientist who studies or anything like that, I can say that, how I experienced some people who people who seem to be a little less vulnerable, who seem to be bottle up their stress, you don't seem to have great pathways for getting some of that out, tend to me, like, they tend to have more health issues, they tend to be sick more often, they tend to not be as resilient, physically, they tend to have more injuries. And I've seen that over and over again, and I can kind of sometimes add, now I've been a coach for as long as I have, I can kind of see him coming from isolation. You kind of tell me he's gonna have some of those issues versus other people.
So you gotta wonder how much and just where my brain goes with you wonder how much of it is also coming out and things like over competitiveness, not knowing your limits? Well, maybe I don't know my limits, because I'm stressed and I'm trying to work out that stress and some physical way around the shirking attention to my body saying yes or no.
Or even just the fact that I haven't allowed myself to express myself by my wind, I haven't bounced my limits off of others and kind of know where those limits are. And, so that could be part of it, too.
Yeah. Well, Jordan Peterson talks about this a little bit like and he says we used to or do we belong to Still do we think of our, our sanity, as something internal, it's like a My mind is well formed is well structured in some way. But as social creatures, we outsource large parts of our saying, oh, without a doubt, yeah, well, if you know, if you don't see the guy in the corner, that maybe I'm gonna not talk about the guy in the corner, and to some degree stop seeing the guy in the corner. And it's interesting the degree to which our perceptions are governed by our social interaction. So there's too much data even in just this room. Like we could talk about the green of the weeds of the carpet, whatever, some, but we don't, right. And the reason I don't even see that until I call your attention to it, is because we never talked about it.
Right? So yeah, it's just not there at all. Yeah.
If it's not something that we might talk about a ringtone, you just don't, and so this is the social impulses at the core of everything, we see everything we perceive. And then if you don't perceive it, how can you act on it?
Right? And so it's always those brave souls, those people who are willing to call out the man standing in the corner and say, Hey, do you not see the guy in the corner? Do you not see the weave in the carpet? Can we talk about that, to kind of have a broader, he said for to be more saying.
I will tell a funny story. When my med school classmates were hilarious, and actually just texted me a little while ago, John Abraham, we were doing our psych rotation together. And habit, med school is a big gathering. There's a senior resident, and then the junior engineer, intern, let's lowly med students, and say they're attending, I'll ask a question like, Okay, this patient's complaining of seeing, you know, monsters in the road, what is possible explanation, and this could be schizophrenia. So effective, and like, by the time it gets to you, like all of these 30 minutes to do whatever. He just goes, monsters. Consider these just the truth. There's brilliance in that idea. Right. Well, I mean, he's hilarious as well. But there's also that idea. Well, and I've certainly taken that to heart in my practice, and patients coming to the hospital who seem very off Crazy, right? You know, they'll tell me some story that seems wild. But I always try to verify it's true, because what stuff happens.
I mean, it's important to start with, let's just find the facts, like, and if this guy saying something, let's say, for me, it's better to just even as a tactical problem solving than any kind of thing is like, it's better for me to start to rule things, it's easier to start to rule things out. There are some things that we know or think we know are good, we don't start there. And you're not okay. I was a social worker. I had to work with a lot of folks who I worked with people with severe and persistent mental illnesses. And that's a heartfield. Because like you said, sometimes they were telling it was really true. Yeah. And that's the worst part. Well, you're already doing your mental health and people are already treating you like you're crazy and unreliable. That further deepens you into your realness. And I developed the practice of just kind of like, okay, let's act as if this is true, and then eliminate it if we have to.
And just seeing somebody's humanity and saying, okay, sounds wild to me. But the key part is to me, and to see if we can find common ground, do you find something that you agree on or whatever, and being able to find those pathways into exploring truth.
That kind of like is a good segue for me because one of the things that I've been curious about and I'm always interested in like, why he will do what they do you know, you what, what led this person to to follow this path and spend that amount of time and that amount of money doing what you do? And so what actually got you into medicine? Like what is it that brought you cuz you didn't you were in software or something before that are?
Yeah me well, so that started as a summer job though, okay. But I got into it, considered it for a while and I was in high school. I like pure math, physics. I thought I was going to pure mathematics. And there were a lot of other influences. My mom's a physical therapist and taught me a lot of things about manual therapy about relaxing muscles and doing that kind of stuff. So a lot of the osteopathic cranial sacral work I do is extensions of what she taught me. And so it was just kind of keeping kids quiet. Like, if you, give us a quarter and say, Okay, put it in your pocket. And why feel? Are you telling me besides just developing that sense of touch, right? Yeah. And also, like, as I'm occupied with time consuming. Yeah. And so, I began developing those skills. That's part of it, my dad's that my grandfather in Pakistan was sort of the top physician in that province. So huge. Were my roots, quarter mile radius, and basically the only physician, real Calvinism back then right anymore. There's no one else. Right. And so he did operations on hotel dining tables, like cutting tumors out here. Here the scalpels tell the staff to go boom, and you're mad.
I’m just happy to be me. This is on me. This is yes, this is for me to take ownership of, and I'm going to do the best I can. And I know what I'm doing, and maybe I don't, but I'm the last both
Anesthesia and the surgery. Wow, it's me. It's crazy stuff. Yeah, I mean, the other thing that was always told about him, and they're my family, I think, theory but like, seasoning, the animal that I think I did from a young age was he had a knack for sort of knowing what the diagnosis was, and could explain it afterward. Maybe like, Okay, we'll get the tests figured out. But yeah, I just like that kind of thing. Certain intuitive sense.
I think some people are born healers, and they just somehow, I have my theories about how we know things that we know, or whatever. But I totally believe there's people with that type of intuition.
Yeah. And he had for all small stories to kind of have come down from that time. And so that was an influence. I think the other big one for me was I did philosophy in undergrad. So that was pure math, science, physics, like hardcore, technical stuff. And I took an intro to philosophy course, and fell in love with philosophy. I kind of realized that I wanted something out of the ivory tower, and medicine, I think it's interesting, cuz people talk about medicine, like there's a lot to learn. And there is a fair bit to learn. A lot of it's just rote memorization. Unfortunately, there's just a certain amount of like slogging through piles of data. But the real challenge of medicine is making judgments under uncertainty. Right? If I don't have all the information like, I made a couple days ago to the hospital, like, sound down in the street homes. They are unconscious when they come in, like, all your mates will train as local as to Asia along the surface. No, I'm conscious. Well, how old is the lady? Right? And so how to make judgments under level and then they have other patients who will give you happily and another patient the same day who weird rash, constellation of joint pains and symptoms and whatever, talk through probably an hour and a half, and you're getting a great history on all trying to put the pieces together, right. But still, there are a lot of possible explanations. So again, the uncertainty and that, to me, was kind of like applied ethics. Right? It's fine to talk about ethics or bioethics in the ivory tower, but doing it and being there making those decisions. Hey, should I recommend that the family give up on this patient? Should I remind them that hospice is an option? Do you want dialysis?
I try to instill undying hope, how do you know where you are and what do you do? Yeah, what do you do? Yeah.
And how I put central lines in the ICU, the ID neck has a certain complication rate is all any medical field does. And we have to get informed consent from the patient or family. Well, the way I talk about those risks, I can guarantee a signature or non signature,
Right. I know what to say. Yeah
I mean, we're not and I say the same words, different tones. And yeah, I can say that family, I can get the family to be like now No, it's too much risk. I don't think about it in the movie lecture. Yeah. And what are the ethics is that you can slap the informed consent with the same words just by tone.
That's right. Right. And I mean, as this goes back to, yeah. Wow, why am I doing you know, I can, our ego can get caught up into what you know what we're doing? Or why you might want to get somebody to do something or not do something you're
Is it really questionable? On ethical dilemmas or fun faces? Yeah, we definitely had patients in residency, where do they really need it? I probably wouldn't put it in now. They're my patient. Now, but I needed to train. Right? Well, you could do it later. So I could do it later. So all the people that I felt years later have benefited. But that was a questionable call, you know, that was maybe more risk than that patient needed individually. But then in the bigger picture, I'm one of very few internists who practice in the hospital, who does his own procedures, and doesn't have to call a specialist and doesn't, you know, may not be available. And I've been working on border towns, and I can work in underserved areas, because I can do all
these things. I got the reps and you know how to do it.
And so then there's the above that is the ethics of like, okay, well, how do those things that anyway, so that's how I got from philosophy into kind of medicine, and always looking all the way back around. I always have a fairly philosophical view of like, what should we be trying to do? What is this about? Right? It's easy for me, but modern medicine largely is about, you know, patching, patching holes, just treating symptoms. And I felt that we could do better. And I think in my third year of med school, again, on top of my school, that was my choice, but lots of other philosophy that resonated with me. The core principles are the natural state of the body, yourself, mind, body and spirit outward as a single unit. And function and structure are intimately interrelated. And rational treatment proceeds from those first treatments. Right. And that always makes sense to me, I think that resonated with my view. And the founder of osteopathy had a saying that. He said, It is the role of the physician to find health, any idiot can find disease. And there's an interesting thing there is like, what are we doing in medicine to find healthy people, we label diseases, and then we treat those diseases, but we're not actively encouraging health mechanisms like fitness is like, that's definitely an area where you can build up. It's not just about preventing breakdown, right? Yeah.
Yeah. So he said, It's really how I ended up being, owning a gym and everything else was like, you know, as a social worker. And the day I was diagnosed, what I was doing, I was treating, I was just patching bandaids, patching holes, giving people band aids treating symptoms. And, again, working in a field that really wanted to just diagnose everybody was something like, did they ever kind of the system wanted you to be ill, so we could put a label on you. And potentially, I mean, if you were in a nonprofit or whatever, they would benefit from you having said level, we wanted you to have that so we could exist ourselves and they just was endlessly frustrating for me to and I wanted to be a part of, like you said this solution was something that was felt like it was keeping people out of those places and having fewer labels. So I love you to approach your practice like that, and I'm what you're. In the conversations you and I have had, your practice is a little bit different here. And so like how would you what's your elevator speech on how you describe your
So for me, exactly this is, I think medical practice should be about building up, not patching holes. If you're going to build up you have to have a target to build towards. And so, I tried to start with figuring out what people's dreams are. What do you want out of your life? What is your definition of success? And a lot of people don't know. I had a really phenomenal conversation with a patient who just joined who had a clear vision. What his definition of successful is, he was very successful in his career. He came in and started talking. And when we started fleshing it out, he very quickly came to realize that, or Neil already came to tell me that success and his relationship and his family was his new Mote is like, I've already had all the career success that I want. Now, it's about relationships and family and making the people who are closest to me feel loved. And that was amazing. So we started, yeah, I'll do whatever fitness test and he's not. He's not interested in those things. But by and by far, his definition of successful is that and so the fitness is actually in service of those relationships, right? It's Hey, you want to be around long enough to continue doing that making those people feel love? Okay, keep yourself in good shape. You don't be a burden on them. All those things play in, but now he has a reason every time he goes to the gym. It's tied to his purpose. Okay. Hey, this is so that when I'm 90 Kids, yes. Motivation. So going off the LHB?
Well, no, well, I'll come back to that. Yeah.
Anyway, so one of the tangents is, number one, picking dreams, finding what the obstacles are to, to overcoming those dreams, and then creating a quick feedback loop to make progress toward those tours to overcome those obstacles? And that's how
Do the people who come to you usually already, I think, come in because they're having some sort of symptoms that they want to treat? Or is it generally someone who's, who's just looking to have a new doctor, kind of just set for general health
stuff? Yeah, usually there. I've had one person come to me just wanting general health. So usually, most people know they want general health stuff. But that is not sufficiently motivating to actually get them in the door. And then something happens. And they say, Oh, I wish I had a doctor who knew me and was taking care of me. I knew all my history. And now I'll go out and try and get that. And so almost inevitably, in the first few interviews, there is a problem, right? And then you have to work through that problem. I think that one of the hard parts is, all my training is dealing with problems. And it's easy for me to fall back into the lab's thoughts and say, Okay, we'll just deal with the problems, and they'll kind of focus on those, and we'll try and work the problem. And to not do the thing, where it's like, let's create a problem for a second.
Right, let's come from a strength based approach. Yeah, you know, things are going well, where do you want this to be in service of? Yeah. And it's funny, cuz I have the same struggle as a, as a coach or as a trainer, you know, someone will come to the company, why they come to me is often not always, but somewhat flawed. You know? Yeah, it's, maybe they're not, they don't have great self esteem, and they want to look better, or they live in a single unit. Find somebody. Yeah, the purpose, right. I know. But that's true. That is true. And that's something that is part of it. But it's like, sometimes people come to me or to our gym. With the end, they're in a state of being in a high level of fitness, like that's their home. And, that's just kind of a life of misery. One, it's somewhat fleeting, how do you even define it? You know, is it even possible for your version of elite fitness? Is your body is your mechanism and your organism even capable of that, and it just seems to me like, what it should that your health and your fitness should really be contributing to
a bigger purpose. I'm right away. I think one of the things I've written about on the website as well, in practice, is health. To me the best analogy is something of money. Right? If you're just making money to make money, there's a little bit of emptiness that money in some sense should be there to do something, even if creating experiences meanwhile, your yeah means right. And so it means without an end. That's kind of silly, right? And the same thing is true of health. Imagine You know, you live a really healthy life by yourself. And you live to 150 but contribute nothing. Okay, I mean, if you're particularly if you're a particularly happy and optimistic purpose, maybe you find that okay. But I think most people needed some sort of meaning more than that, that they loved someone, they touched someone, they improved something. And the health was to allow them to keep doing that. Right?
Do you not get too philosophical, even though I know that's kind of your background, but like, do you? Do you think that there's an actual or do all of us have a purpose? Or is there a reason why we're all here or,
I tend to be pretty staunchly in a freewill kind of category, on most things. So I think that we all need a purpose. But I think that purpose is something that we create and put out into the world, not something that is pushed on to us. With that said, I think that we also have personalities that are not fully under our control and gifts that, genetically or from our parents or whatever, are not something we chose, and there are things that stand out in the world as being more interesting or important than other things. And in defining our own purpose, I think we need to pay attention to what stands out from our unconscious, right?
That's kind of my thought on it. I don't think that we all, I don't think that we all have a predetermined purpose, like, sure you were born to do this thing. I mean, that's kind of evidenced by a lot of people who don't accomplish anything in their lives, for whatever reasons. And so I do believe that we get to choose our, we get to choose our purpose. And, and we are here too. That's part of why I think we're here to pick it. Yeah, to contribute in some way, but not to have it assigned to you.
Yeah, no, I think that's true, I think it, meaning is one of those weird things whereas you define it into the world, you create the map of the world that you see, that kind of, we were talking earlier, if you don't, if you don't have a target, you don't have a place to go a map is useless. Because, okay, like, what am I gonna do with this map? Yeah. But at the same time, if you have a place to go, and you don't have a map, you can start creating a map by making a movement. So it'll take you longer than if you had a map. But just by having a place that you're trying to get to, you can start defining a map for yourself in some ways.
Yeah. Well, it's kind of funny, like, you and I have had conversations about your business and your practice. And like, you had a vision, you had this end goal, this destination, but there really hasn't not, there's not a map to practice. Like, and so you're writing it as you go. And you may end up your model may end up being someone else's map. Definitely.
So, I think that's the, that's the real dream is that I'm able to refine this map, enough to give it to someone and say, Hey, you could do it this way. Right. And the practice of medicine as a whole, worldwide, could be different, because now this map has been enriched in some way. Yeah. So
with that in, or extended? Yeah, having said that, that's, you know, a goal of yours. Is it your intention to teach down the road? Or is it more of like, kind of like, a business? I'm gonna use the word franchise, just first language? Like, is it more kind of like that? Or is it more like, Hey, let me be a disruptor in the medical field, but by teaching or
it's actually both, I think that I will have to, I suspect go the franchise route, in order to refine the map enough to where it can be taught. So having a physician come in trying to teach them what I do, is in itself going to be a learning process?
Right? Yeah, cuz I see that a lot where it's just you can only capture even so much data in one with one office with the number of patients but if you can create satellites of capturing data at different ways of practice and learning with different types of people, not just you, because this works for you. Yep. But it may not work for everybody. So you'd have to get some reps in there.
And I think the interesting thing to me is something I think about a fair bit is the structures that we create in medicine. So one of the great problems that we have nationwide worldwide, and in medicine and all these different layers is what is the correct degree of centralization for a problem. Because, if so, imagine a fairly centralized version of my practice where I have created this map, this is how I do things. And now you're a franchise, and I'm going to tell you how you have to practice in order to be a franchise of whatever and it's very sort of draconian, whatever, well, maybe I can replicate some of the successes, but I also can't grow. Because that person can never add value. So, but the degree to which I decentralized and say, Okay, well, you can do whatever you want. Well, they can add, they could potentially add a lot of value by creating their own maps, enriching it, all of that. They could also sort of destroy the practice, right? By ready to
go completely off the rails. Yeah.
So that's an unsolved problem. I don't have an exact answer for that. And I think that's part of the calculation I'm trying to do is, hey, as you start franchising, how do you manage the need for one of my favorite books is Ender's Game. And he's a sort of commander in the army. And he gets one of the younger kids who's extremely bright. And he sort of creates his own, like, sort of special ops type team or whatever. And the kid asked me, Why, or the cat asked him, like, why did you do this? Like, you're brilliant. You're a brilliant commander. And he says, as brilliant as I am, there's a limit to the number of brilliant ideas I can come up with in a day. I'm creating your team for that day when my idea doesn't work. Right. And it's really interesting, like, I don't even know when that day is. I don't know what that day is. I just know it's coming. Where right I don't have the answer.
and you want there to be others who will?
Yep, that sort of decentralized, Hey, okay, I need you to go off and do this. And he tells him, he's like, I want you to do things that no one else has done, because they were the dumbest thing you've ever heard, like, start doing stupid shit. Because somewhere in there as an idea, nobody saw stuff, or was dismissed.
Yeah. And that's kind of the cool thing about you, the people who I really look up to, and I really admired that they are just ballsy sons of bitches, that they were the crazy person until they weren't crazy anymore until what the crazy thing they were doing, actually made sense and became the normal way and the thought leaders and then then then then the courageous people who are who were brave enough to follow that idea and not just let that person be out there. The one person dancing out in the middle of the field.
I wrote my residency, I did a residency, internal medicine and pediatrics and our graduation project, we had to give a presentation to all the residents, med peds and emergency medicine. And so my research project was, as you might imagine, fairly philosophical, on sort of the limitations of what if you've heard the term evidence based medicine, and so was on the limitations of evidence based medicine. And then, as I was doing the research for it, I read the story of how we came to surgically treat heart disease, as we do it now. So it's fat. If you don't mind me, the story guy I want to hear is a fascinating story. So I'm in the 1900s, they, kids were born with, or a certain small percentage of kids are born with the pulmonary artery in the aorta transposed. So you're supposed to have a circulation system where your heart pumps to the lungs on the right side, it comes back to the left side, and the left side pumps it to your body, and then it comes back to the right side. So it's sort of a figure of eight schematically.
But instead of a figure of eight, they just have two separate loops that don't interact, right? So the blood goes to the lungs and comes back and keeps going to the lungs. And then the blood goes to the body and comes back and keeps going. And as you might imagine, that doesn't work because you're not getting oxygen, right? Yeah, Kind of important. Now, kids have in their fetal circulation, a connection between the two sides of their heart. And so there's enough blood mixing, just by having a hole there. That it allows them to survive for a day or two until it closes. And then they haven't. I mean, then they die. So There was a, I believe he was a colonel actually. I'm not mistaken, he was an army surgeon who created a procedure where he could go into the heart and force that hole to stay open. And he actually created the little tissue baffle that preferentially increased the mixing. And I believe that was called the muster procedure. And so these kids went from a life expectancy of one day to a life expectancy of about 40 years.
Right. Which is pretty good. That's crazy.
Yeah. Um, the issue there,
I was thinking, like, a couple weeks, I just live long after we can flip these valves around or something.
I mean, the bodies are remarkably resilient. Wow, it's incredible, right. Um, but they didn't have normal lifespans. Right. And the theory was that if we could actually switch the arteries back, we could get these kids to live a normal lifespan instead of dying in their 40s. In order to do that, you had to be able to bypass the heart and you had to actually operate, you couldn't just go in and open a hole that was already half there anyway, and just kind of keep it open, right? You had to actually operate on the heart and cut the valve, or cut the aorta, cut the pulmonary artery, and sew them back on. And people tried for 70 years Wow, many, many surgeons tried over the years. And you needed a heart lung bypass machine. Right. Um, and various versions were tried, like having a chimpanzee do the pumping. So like just hook into their circulatory system or a pig or whatever, and cross clamp it and all kinds of things were tried. And the prevailing wisdom was that the heart was too delicate to operate on, it just could not be done. We've tried this for 70 years.
And we have a procedure that lengthens the lifespan from a day to 40 years. So every kid that you operate on, you're depriving them of 40 years of life because they're gonna die. Right? Because your procedure doesn't work, right? And, then just heart and his team, actually, were able to create a heart lung bypass machine, and did the first successful transplant, right, and we're able to reverse the arteries. Now, the interesting thing is this is he started doing this, he had one success after a string of failures. And by the way, these guys, you're talking about doctors, like, these guys are fucking hard core, they scheduled, it still gives me chills, they schedule the surgeries twice a day, so the families could comfort each other. That was, that was the logic, we always like, it was like, these guys are probably going to die, we know that they're going to die. And we're going to schedule them twice a day so that the families can comfort each other that I mean, it's stupid, right? And then he had his first success. And then he had a second one. But out of the first 10, his success rate was like two out of 10. Right?
But out of the first 25, it was like 12 out of 25 out of the first 100. So he's getting better and better with this procedure as he's doing it, right. But if you look at that first 10 Eight out of those 10 kids died, the muster procedure was well established, they could have all lived to age 40. Right, right. Um, but he just persisted. And all of our heart lung bypass machines now are based on that set of knowledge, the ability to do cardiac bypass, grasp for heart disease, our ability to do aortic valve repair, all of our heart surgery is derived from this guy killing kits. Like, right.
And yeah, and so I mean, that's what I'm talking about the courage to, and of course, like, if you're one of the parents of the kids that died, this is a horrific story, and
everybody looking on, we've tried this for 70 years and haven't been able to do it. What the hell are you doing?
Right? Right. You're savage. You're a mad person. And so when you wrote your paper about it, what was your argument? Like,What was basically your position?
So my position is this is that the problem with evidence based medicine at its core, is that it reinforces the status quo, right? The best that evidence based medicine can do is to imagine you have a bell curve of all doctors doing slightly different things. We all have slightly different preferences, styles, whatever. And if everybody or the more people that adopt evidence based medicine, the narrower and taller the bell curve will get. Right. But that's on both ends. Yes, you have fewer doctors doing wacky things that don't work. But you also have your doctors doing wacky things that end up working. And the problem is that your outcomes probably look better right now. And from a legal standpoint, a risk standpoint, all of those things. It probably looks better right now. But you're also killing innovation that drives things forward.
Yeah, so what would that say, what's a way that it can look different? Because I mean, I see why some people lean towards evidence based stuff, you want to do things that work and try to do no harm and things like that. So what would be a counter to that?
Um, so I've talked about this, even with colleagues. I don't think you get to pick which side of the bell curve you want, or you only get to pick how far you are from the mean. And that's the unfortunate thing is that like that guy, could, he could have been wrong, and just kill kids.
Right? And there probably have been people that we don't talk about exactly right at all.
Who did exactly that? Yeah. And so that's the unfortunate thing is that in your lifetime, you probably don't get to know which side of the bell, which side of the average you were on, you only know how far away from average you were. Right, right. And that's how much risk you want to take on how much legal risk you want to take on, and how much you believe in what you're doing. What I'm doing has no evidence behind it, because I'm making it up. As I go, this kind of wellness based kind of dream based goal based view of health and fitness and medicine. I've never heard of it, you know, the way I do it, and I haven't, and I'm making it up largely as I go along. And so I had, we were talking a little earlier, I had a patient recently who kind of joined the practice, and I had a phenomenal conversation with him. That was exactly what I always dreamed the practice would be about is, hey, this person is able to articulate their biggest dreams, were able to tie that into rapid feedback right now, what are we going to do this week, next week to make those big dreams come true?
And now my brain is going overtime, trying to figure out well, how do I do that with all my patients? How do I make a connection, something went right in that conversation? And it wasn't going right at first. The first, when I asked him, Hey, what are your health goals? He said something about fitness or whatever, something vague, that didn't really mean anything, right? And I was like, that doesn't really mean. Right, I was able to provide the correct set of challenges, and he was able to provide the correct set of articulation. I was able to find the right question to ask when I got this response. And how do I replicate that?
Yeah, I mean, you love when that happens, you know, you're just everything kind of clicks right into place. And yeah, how do you? I mean, how do you find it, is it literally just random? Or did that? How do you find more guys like that or gals, more patients like that?
I think I don't like to think it's random. I like to think that everybody has their lever. And I had to ask what I think is almost the same question. At least four times with him. But the fourth time it clicked, it made the Connect that it was the same, it's sort of the same question, but it's phrased differently. So one of the ways I said is like, what would it be? What is your concept of success? That's one version, right? He'd already sold his company for several million dollars. But one of the ways I asked the question is, if you had millions of dollars in the bank, what would you do with the rest of your life? Another one that finally clicked for him is I said, Look, you imagine you're 150, you're on your deathbed. And you're looking back and you're like, you know, I really killed it in the first part of my life. Because I had my career. I built this amazing business. And then, in the second part of my life, I killed it again, because I
What was that? Right, you had him fill in the gap.
I had him fill in the gap. And that clicked for him. And I think part of algorithms using this is trying to consciously build a database of the I don't know how many versions there are. Maybe there's 100 versions of that question. And if I have a database that I know all 100 versions of that question, and I can, maybe it takes 20 office visits to get through all 100. Right. But I will find the one that resonates with this person. And we'll get that set of information.
Yeah, it's interesting. You and I have talked about apps before, but wouldn't it be cool if you there was just like an app for your practice and app to ask the question of the day, and sure, there were 365 questions that got out what you needed to, you know, so by after their first year of being your patient, you finally collected all the data? Yeah. And so, it'd be you rather than have them cuz I think I remember you told me one time, how, most doctors, you come in, you see him for 15 minutes, but you probably spend more time with their nurse or someone of their medical assistants or something. Yeah, you actually spend a significant amount of time with your patients.
Yeah, all my visits are an hour at least, I book a minimum of half hour between visits, in case they run over. So I'm never late for the next person. And if I have time, like this guy, it was the last appointment of the day. Um, we talked for like, three hours to get to the information, right? It was just like, Okay, this conversation is going well, let's keep going like, we'll build on it. Right? Yeah.
And I think, of course, think about like, that's a magical situation, because a lot of times now, we're so conditioned, even as someone who believes in what you're doing, you know, I make my doctor's appointment. And I'm like, I can't be there. 30 minutes, what do I mean? Like, and I don't have and then I didn't schedule more than 30 minutes. And if it starts running over, I'm thinking about all the other things. So, educating your people saying, like, No, this is different. And you might want to take half a day or whatever.
That’s probably my biggest marketing problem, in some ways, is what I'm doing, I think, and I think my patients would agree is so different. That until you do it, you actually can't know how different Can you describe it? Because even if that is just what you pointed out, it's not necessarily occurred to me. But yeah, I was perfectly I mean, you know, some went down, we were kind of almost sitting in the dark, I didn't want to turn on the fluorescent light and whatever. But we kept talking until, like, 730, or something before we called it or whatever, we kind of came to a plan, you know, we didn't call it until we came to a plan. And then we did. And I said, Great, I'll put this together, we'll create our spreadsheet. We've laid out these feedback loop factors. And, we said we're going to check in every two weeks on these nine topics. Right? And awesome. Okay, great. Like, but we didn't stop till we got there. Now, if he had been earlier in the day, and we didn't have that time, that's fine. But I still had an hour, hour and a half. And we said, Okay, we didn't quite get there today. Let's think about it some more. Let's meet up again next week. And let's keep at it, and just that idea of persisting until you get where you're going? I don't know. Yeah, I don't see that in medicine. Very much.
No, definitely not, it's like, they said, I think doctors are unfortunately, put in a position of, hey, this is what I can bill for. This is what the insurance company's gonna pay me for. And, because of your type of practice, you don't really have to worry about that as much, probably, I'm guessing.
Oh, yeah, insurance at all. And so it's weird how much? It's weird how freeing that is, and I didn't even know how freeing it was until I did it. Here's some odd bits of information. Um, the messaging app signal. Yes. Most secure messenger app in existence currently, is not HIPAA compliant. Why is it actually secure for HIPAA? HIPAA actually requires there to be an auditable data trail. In order to assure that it was encrypted because HIPAA was written before the concept of end to end encryption really kind of took off right by technology has changed. Yep. So now you can't use signals for patient communication if you're HIPAA compliant. Because there's no log, right? I'm not taking insurance. I technically am not a HIPAA covered entity. So I can actually use more advanced technology that is not allowable under HIPAA, if it is better for patients, because I don't actually have to follow HIPAA, right.
Because of bill insurance, it's that kind of stuff, the notes I write, we're taught to write notes in a particular way. I came to realize, well, a lot of this stuff was just for billing insurance. It's not actually medically relevant, right. It's not important to Anyone no one cares about this. You know? I mean, I sat down for a three hour conversation, what did I write in my note? Right? I drew a diagram of hey, this is what we came to. This is what he thinks is important. This is how we're going to measure it. These nine factors check in every two weeks. Signature. Right. It's a diet like Yeah, totally. That's my note is a diagram because it was the content of our that's the core. That was an exam? I mean, he was breathing. You know, he wasn't he wasn't in distress.
Yeah. You didn't do his blood pressure. Did you want that? Yeah.
I had done it. I had done it. He had seen me like two days before. Okay. But I, for sure, hadn't become abnormal in two days.
Right? He was. So I'm curious, also with these, with these enquiries that you do you know, these interviews that you're doing with your, with your client, you call them patients, clients, members? I call them old. People. Do you have a plan that you try to present to them? Is there somewhat of an already preconceived structure to that like, like you mentioned, there's principles of your that was the Aussie? You and one of them? What had something to do with mind, body and soul or something like that? So are there certain areas that you're trying to work towards?
Isn't there an algorithm that's in the back of my head sort of vaguely so I think. Health obstacles again, so the principle is the natural state of the body is healthy. Right? So if you're not having as much health as you want, there's an obstacle in the way in some sense. I think those obstacles fall into five categories. One is congenital and genetic issues, stuff you were born with cognitive, relational. That was the sort of thing I call the internal category, spiritual issues. External, so behavior, environment, habits, that kind of stuff, traumas and holdovers scars, whether physical or emotional. And then the fourth, last category is what I call acute issues. And I put all of the regular medicine there. So right, like stuff that will kill you before we can talk about anything else. Right, right. So I mean, if you're diabetic and have completely uncontrolled sugars, well, we need to get control of that beforehand. Yes, you should also work on behaviors and cognition, if you're depressed or addicted to food or whatever, whatever is going on. But we also do need to probably prescribe medicine and make sure that we get these things under control so that you don't have damage while those behavior changes are hopefully having their effect. But those are my five categories in the back of my head.
Yeah. And so and then so does there like in that particular case, the example that you shared, it was like you drew a diagram or graph or something? Is there an Is there a normal structured plan that you might issue them where they all look different, depending on the person or some people get the diagram like that guy did? And then something?
He and I made that up together, right? At the moment? Yeah. Like, and now I'm thinking this part of the excitement is, hey, that was awesome. I think that again, do I need to be doing that with everybody? Right? So now at that moment of success, you start saying, Well, can I be algorithmic? Is that or is that something he needed? And not everybody needs it? So I'm going to have all my patients in one by one, and we're gonna say, Hey, would it be useful to start doing this? And? If it's not. And we'll try and figure it out. And we'll kind of go from there.
Yeah, I mean, that's the fun of I mean, that's the fun of the and that's why I feel I do feel badly for other doctors and stuff, who were hampered by, maybe not even having their own practice, they work in someone else's practice. And it's all a very regimented structure, where you have this opportunity to be entrepreneurial and creative. And, do stuff that and that's why I mean, that's why I own I could just go be a trainer at someone else's gym, or I could do a lot of other things. But, it fascinates me to create something that might work for a lot of people. I mean, the Athlete Progression Guide is a good example, for me five years of tinkering and ideating and throwing it away because I couldn't deal with it anymore. Yeah. And it just evolves. And the hope is that yeah, this is going to serve some people and this is going to make a difference, you know?
Yeah, I think that's the dream. I think that that builders spirit, that idea of wanting to create, to put something out in the world and have it take form and I'll say, you know, I've certainly run into many physicians who don't necessarily have that in the same way and provide amazing service for what they do, of course. I think the other challenge realistically There's an emotional aspect and a pragmatic aspect. The emotional aspect is, I'm single, I don't have any, I have a wife, kids depending on me, right. And I fly out to the border to take jobs to pay for the practice that doesn't have enough patience. And yeah, I graduated 2011 And sort of the practice then and I've had to iterate it and change it, and it's failed and crashed and you know, pulled it back out of the ashes and all that stuff. And yeah, I don't think I could have done that if I had kids.
Yeah, that's interesting, too. You see, this works for you right now, as it is now. But for this the reasons that you stated, but yeah, good examples. Would you have stayed three hours with the guy if you had to be home? To eat dinner with the kids or something? Or I don't know if that's even? Yeah, no, assumptions?
No, it is, I think that's something that I definitely feel has passed me by in my life in some ways, you know, just pet my 40th birthday recently, and so, thank you. But yeah, it's definitely something that kind of didn't quite never quite gelled in a way that I wish it wouldn't still look forward to hopefully, maybe someday having I think it will take a and this is a little bit old school, and maybe not PC in some ways, but I think it does take a particular spouse for that to happen. Um, I feel like there were reading diaries or stories about older doctors and their wives, I think their wives felt very much a part of what they were doing is that is that she was a part of the medical team, because she was making sure his personal life was taken care of, so he could stay an extra three hours. And when he got home, everything was lined up. Because he was going to be exhausted. Right? And that was part of the care that she provided to the community through supporting him, right. And there's kind of like, there's ideas like that. And I imagine military or in other areas where the support organism, the support, part of the organization is still part of the organization. And I feel that mission and purpose in what they're doing
very much in the military. You mentioned the military, and I hadn't really thought about that to the second you said it, but in the military, they've got what they've called, like Family Readiness groups, and the you know, the, the family is part of the unit, and because when all of us get sent overseas, if things aren't okay, back home, and if things are, there then things aren't okay, over there. And so obviously, people learned along with someone, some general or something learned a long time ago that we have to incorporate them, or things, aren't it this, this ecosystem isn't going to work isn't going to work? So yeah, so I've seen that I always wonder about that. Because, yeah, people who go out there and do great things, like you always wonder about their family see what's behind the scenes that we don't see, like, is it kind of a train rat? Oh, sure. Has Dave, a lot of times it is they've had to stomp on, or they've been divorced five times? Because no one could, I always wonder about that,
lot of times it is, but there are also those who, by all reports, at least, actually managed to kind of have it all right. And, and a lot of times, it's not down to them, it's down to the other half of that team should. And, and, and maybe to the degree that they allow that other person, it goes back to what we're talking about kind of intimacy and vulnerability is allowing that other piece person to be a part of what you're building and say, Hey, I'm staying for three hours, but we're doing this gather. There's also that sense of community. And I think that's something else. Well, you know, I was very honored, actually, one of my patients invited me to his house warming party. And I went, and it was fascinating, because doctors aren't typically a part of patients lives in that way.
Right. Yeah. And that, that's cool. Yeah,
it was sort of it made me think about my grandfather and kind of like practicing in smaller town medicine and this and that, where you are more a part of the community. And something that I would like to incorporate more and always dreamed of was, hey, yeah, okay. We have these members in the clinic. But but in an ideal world, that could be a community, a community that's kind of dedicated to dedicated to pursuing dreams and building up. There are privacy issues there and there's all kinds of you know, stuff you could trip on, but you can work through that stuff. It didn't come up at the party, you know, I mean, we had multiple patients there. And nobody asked me any medical questions and nobody you know, back full and it just didn't come up. I didn't have to draw any firm lines or anything, it was just cool to let people share and, and it gave me insight even even, you know, one of the guys is coming in now. And I've been kind of brainstorming how we're going to have that conversation and you know, how the appointments gonna go and I know what he's dealing with. And he kind of gave me a heads up. But it's also informed by what I learned about his background, when he was just talking and just being a person. Yeah,
I mean, getting to see I mean, I can only imagine being a doctor and getting to be welcomed into somebody's home to see what their habits are like and how they live and what they believe and what their coach. I mean, it has to be nothing but benefit to be able to serve that person.
I mean, I certainly think so. And I don't know, the pandemics also been an interesting experience. For me early in the pandemic, it's it's faded out now. I'm a little bit and something that I imagined he was also getting the military to some degree the idea of being thanked for your service. Yes, yes. Um, I had never had that, in my career until the pandemic branch really interesting. And it actually was really emotional about it. Like, I actually got really teared up teary eyed, like I was in a small town, kind of height of the pandemic pre vaccine. It was really a scary time for a lager or whatever. And I had worked my shift and I ordered a steak from whatever little small local steak house or whatever, and went out to pick it up. And I picked it up, and they were dropping it off to the cars, no going inside or whatever. And they dropped it off. And they said, it's on us. And I was like, Dude, this has never happened. That has never happened. And you know, I mean, it just scrubs talks about this great show. But yeah, you know, back in the day in the 60s, or whatever, like, you know, doctors were a part of the community. And, you know, barbarism gives you a free haircut, if you came in your white coat, and you know, this and that. And there were and now, most of those things we see are not there's no like sour apples is just an observation. Sure, it's nurses, first responders, police, and doctors aren't a part of that group
anymore saying I never really thought about that. But yeah, yeah. I mean, I see that part of
that is the salary differential. Right. Certainly we make more money. And don't feel sorry for this. Yeah, yeah, totally. I think that I think there's a fairness to that. I think, I don't know
if there's a way we already talked about how money doesn't really mean anything.
Yeah, it doesn't in the deepest analysis, but it does. It does matter. In terms of like, yeah, and it's a matter of whether you're considering it in terms of like, the monetary value of the haircut, or the steak, right? Or are you considering the community value of the steak? Those are different? Sure. And, yeah, the monetary value, it doesn't make that much of a, it probably is more of a difference too. And I even objected, I was like, Dude, it's a pandemic. You're a restaurant, like, let me pay, like, I at least have work. Yeah, you know, um, and they were very firm. They wouldn't take it. And, but that was kind of the thing is that made a bigger difference their bottom line than it did mine. I can afford the steak, right. But as a community building, I mean, yeah, I definitely. I still feel tied to the town. Right? Like, I was there for a week, but like, God, fucking remember that. You know,
I mean, I have to say that, I mean, because I can relate, because that because I am in the military, and I'm often in my uniform, and I'll go eat lunch somewhere. And it happens a lot that people will just hate your beer. Someone paid for your meal. No, yeah. And it's always such a humbling thing. You know, especially like, I haven't been to combat and so many years, you know, I mean, I just, I, you know, that was like, I think the last time I deployed was, like, oh three or something like that. It's been so long,
that kind of thing fades though.
I mean, like me, like, again, like, feeling weird about it. But But I think it's such a cool thing for people to be finally, especially I guess, it took a pandemic for people to recognize, recognize that how you're on the frontlines? Sure.
Yeah. I think I think that's, you know, thankfully, it's a product of medicine being in this day and age pretty, pretty successful overall. You know, we've always been on the front lines in terms of, you know, we take we have patients come in with TB, and sure how to go and take care of them. You know, TB is far more infectious than than COVID. Right. And we do you know, we flew Yeah, but you know, I, I remember in residency is 2009, we, you know, the swine flu that year, kind of went through the whole nation. That was an early pandemic, right, not nearly as fatal as COVID but but still pretty. pretty serious. And yeah, it hit me. Never I'll never forget this. It hit me about 430 In the afternoon, the night that I was on call. And we already had so many residents out with the flu, that there was no one to call. There was no one to take the shift. Like, and so I literally like I put a mask on and slathered myself in alcohol to the elbow. And like went and admitted patients and then went back to the call room and like the shivered there, and then like, look up and like saw the next one went back and shivered. Um, and so yeah, I mean, physicians have been a part of that. But I think it's easy to forget, until something kind of doesn't work. And I've often said COVID COVID has been for physicians to incredibly humbling because it's back to Civil War medicine, pre antibiotic era, we're used to being able to pull people back from the brink of death unless you have like, unless you have like, eight organ systems that don't work, you know, um, but, and the one and in my career, the people that died. Sounds weird to say, but the people that died without my permission, like, not because we withdrew care, not because we were trying whatever, no, because we knew, like, Oh, God, you know, this guy's got stage four cancer, and there's just whatever. But the ones that you know, that just died, you know, young guy had something didn't go right. Suddenly his lungs filled with fluid and he died. And like, I still remember that case, because it was not what we expect. And COVID That's every day, you know, 36 year old guy comes in, maybe has diabetes, obesity, whatever, one or two risk factors, but overall young, pretty healthy, and just dies. And there's nothing we can do. It's we just watched them. And
yeah, yeah, see, it's just how me and just doing how many cases of that have happened. It's not just like one Yeah. Yeah, I kind of on that same subject you had sent me you had written up a whole thing on Coronavirus, like what works and what doesn't work. And I thought it was such it was so helpful. Yeah, and I you know, just for people listening, it was kind of like, here's some of the treatments that are out there. It was just such a how I would I hold certain professionals up to a certain standard of objective, you know, just assessment of things and like doing the homework and, and I thought it was just really well written. It's like, you know, here's, here's the, here are the facts, or here's the data and so so one thank you for I mean, that must have taken you for how long did it take you to write that? This was about Coronavirus for everyone listening. It was
interested river rock dot pro slash COVID.
River Rock dot pro slash COVID. It was right up there. Yeah, right there.
So, yeah. It took me probably a week to put together of writing, I don't know, three, four hours a day. A lot of it. And that's fast. But a lot of it was I already knew the data. You know, I've been studying this for a while.
Yeah. So. So was that spurred by Yo, what was your motivation for like, What are y'all that were my patient
told me to do? Oh, what do your patients want? Yeah, they were like, well, they said, Hey, we've got all this great information from you, you have these and we ask you questions. But it'd be really great if you put like a, and they even gave me the title, they said, put together a paper that was just like the current state of COVID. And just kind of keep it up to date. And I was like, That's a great idea. And so I did oh, so when you engage with people that way, they tell you what to do. Yeah.
Which I love again, how often does that happen with anyone else's doctor? Sure, you know, you get kind of input and they actually, you know, they might say, Yeah, that's a great idea, but I'm not going to do it or whatever. I don't have time to do it. So So I love that and I love that you that you put that together.
Yeah, I mean, I think it made me reflect to because as I was writing it, I tried to get and I have a lot I actually have a lot of sympathy. I think that came through in the in the document a lot of sympathy for the anti backs more than most doctors, I think, the anti Vaxxer concept because I think that that's what my practice is a reaction to is the medical establishment has broken trust with the communities they should be serving. And some of that misinformation. Some of that's a well intentioned attempt to control people into being healthier, which is never a good idea, but maybe sounds like a good idea sometimes. And yeah, without, you know, again, very honored by the trust that my patients put in me I had one patient who put it very flat but had but most of them actually operated the same way is, you know, when the vaccine first came out, I was like, ah, you know, it looks pretty safe, but maybe not safe enough for a 40 year old. It's probably, you know, I told my parents to get it right away because they were high risk from natural COVID. But I didn't get it for several months, because my risk was lower. Right. So I needed the vaccine to be proven to be safe enough to know the risk benefit there. And my patient was like, Well, I'm about your age. I'll get it when you get it. And I did, I emailed him, I said, Hey, I got my first dose of vaccine, just so you know. And he went and got the first vaccine. So there's that trust there of like, Hey, you're looking at the data. And he knows that I'm not afraid to buck the establishment. Like I've said the establishments wrong on statins for more than 10 years now. Wrong on aspirin, which is finally I think, hit the news. Yeah, 10 years later. Sadly, the average time to implementation medicine is about 13 years. So the the story now start the study that came out on aspirin being the best first line treatment for an active heart attack. It took 13 years for that to become standard of care. And, unfortunately, medicine. There's a lot of reasons for that good and bad, and you're not going to get that down to incident the way we would like it to be. But 13 years is excessive. That's a long time. Yeah. And so yeah, the idea of aspirin no longer being the ideal, or not being a good preventative. I was aware of the studies in residency that were there were, you know, it was more than 10 years ago, we're finally I'm just now seeing the headlines. But yeah, just kind of crazy. It just, they know that I'm not afraid to buck the establishment, but that I do it on the basis of what I've read, and I can generally say, Hey, this is why I believe what I believe. And if I tell them, hey, I believe this because one of my attendings told me this when I was in residency, and I have no scientific justification word at all, that's what I'll say. That's your turn. Yes, that's what I know. Right? Or that that's what that's how I came to that conclusion. Right? If I have 10 studies backing up the opinion, I'll tell them, then I'm happy to send them the citations. If, you know, however, I put that belief together, I convey it transparently that this is what I think this is why I think it and this is how sturdy of a belief I think that is. A lot of times I tell him, Hey, this is what I think. But that's actually not that sturdy of a belief. So if you disagree with me, I'm not going to I wouldn't blame you. Right,
right at that level. But that's that level of transparency and honesty, that I feel like we all want and often feel like with your eye, you said the trust has been broken in a lot of cases, because we don't feel like we get that well. It's probably just because of the system. Like again, you get 10 to 20 minutes with your doctor. There's no time to build trust in
that. Yeah. And that's that that is the problem is is the the idea of industrializing medical care ignores the human element of trust, is how are you going to build a relationship with a patient in an average is 12 minutes, by the way? No, they
nationalized the average of like, visit FaceTime. Wow. 12
minutes. Yep. And the here's the here's a worst statistic, the average time you get to speak before the doctor interrupts you is 23 seconds. Wow. I mean, how are you gonna know you're gonna build any No way? No way. Right, but, and that's why we overprescribed. That's why despite multiple campaigns, we still get antibiotics for colds, right, we still do things, we still give opiates for back pain, we still do things we know we shouldn't be doing medically. But it's the only thing we can do that will, again, we're serving the relationship to the degree that we can is I don't want you to leave here upset because I want some sort of relationship with you. And the only thing I can do is give you something you want, right, give you what you want. Or think you want, right, in order to preserve the relationship. And that's why we make those medically bad decisions is because we're not able to preserve the relationships without them. It's a really bizarre situation where we're doing these things, right.
I mean, yeah, and I, I get that. I understand why that happens that way. Shifting gears a little bit, like completely. So what's your definition of optimal health? So part of this podcast is about optimal health. Yeah, so I'm on the search, I'm hunting. What is that even?
So this goes back to kind of what we were talking about before, right is is what's what's your definition of an optimal amount of money, but without a goal, right? And define that, right? Yeah. So it is very individual. Optimal Health is always going to vary by the individual. If your dream is to, you know, run a world record time and a marathon or something, you're gonna have a very different view of health because health, your health is going to be the thing that serves that purpose. Right? If your view of success is having a really amazing family life, that's going to be a very a different definition, right? A lot of people default to longevity, or health span, the amount of time that I remain functional and healthy and interactive. And I've been accepting that answer from patients and I'm thinking I'm going to stop. It's not a good, it's not sufficiently useful. But I need to start asking trickier questions like, why should you be allowed to live that long?
Yeah. Or like, what do you want to do with those years? Yeah, yeah, in my world, I, we always talk about earn your progress. You know, like you want a 500 pound back squat? Well, you're not going to just jump under the barbell and back squat, 500 pounds, you've got to you got to earn it. And so maybe in your case, it's like, what do you want to do to earn your longevity? Or something along those lines? Yeah, I
think there's something along those lines, I think in terms of our vision of optimal health, I think where that goes is what's your what's your ideal version of yourself? What is that picture in your head is who, you know, how does that person behave? What does that I'll do even from a very personal standpoint, I love the show house. I used to watch it a lot. Yeah, I have a very similar character. Indeed, I'm very driven to find answers. I love the puzzle of things. And I'm not as caustic or abrasive. And even though it's medically not realistic, it is personality realistic for me in a lot of ways, but, and I realized, and it helped me get to residency and a lot of ways, what I realized, after I graduated, enjoying that show, spoke to the parts of me that were broken, and gave me sufficient purpose to push through the brokenness in extraordinary circumstances. Right. And that's valuable. But it also became a limiter. And I realized this reading a book from childhood was reverse see, where the ideal that was presented was something I also identified very strongly with, but it was a story about overcoming brokenness. And I remember though, I was like, Look, I have a choice in front of me, I can continue to identify with my brokenness, or I can consider the possibility that that is a crutch that is, is keeping me from growing further. And keeping me safe and saying, Well, this is just how I am. And so yeah, my all that to go to say, My ideal version of myself had to change, I had to go back to an older version, an older ideal that I had maybe as a kid, right? And start aiming higher. Sure.
In that regard. You if let me see if I understand that. Right. So you're saying that accepting a part of your brokenness as it being like, This is who I am. You felt like that was a limiting factor for you just kind of, like, This is who I am. This is how I do things. That was kind of holding you back.
It was Yeah, yeah. It was both right. It was it was, you know, we've talked about, you know, talk about this in fitness is you know, what, got What Got You Here Won't Get You There. Right, right. And that's exactly what it was like that identification with brokenness got me through residency, it got me through crazy circumstances in my personal life that were going on at the same time. And the situation was so absurd, that I had to be absurd in order to kind of get through it. Right. Yeah. And being able to be caustic and cold and kind of, and there's still parts of medicine that like, hey, you know, medicines. Bertel
yeah, there's sometimes No, no room for the emotional response.
Yeah, but that's not everywhere. There is room at other times for the emotional response. And just hanging on to that cold side, because it's easier, or more familiar, maybe became limiting. I, I there was a lack of spiritual growth that I sure was blocking from by saying, hey, you know what, like, I could actually be better than this. Right? Yeah, better than I am.
Well, I love that. I mean, just, you know, just from the perspective of human being a human being, we're in survival mode a lot, you know, and rather than thinking let me beat find ways to become more whole. That's a skill that can be a step can be a scary, scary, scary endeavor. Because what's gotten me through like, you say, what's gotten me to here my survival tactics? Feel safe. They feel like okay, I know these this is like the evil I know.
Yep. It's like any like anything is you can take even mundane examples, right? If your roof is leaking, and the multiple places and you know, you probably should repair the roof, but you don't have time you don't have the money to patch it. If at any point, you actually want to actually fix the roof, which you probably should you have to take patches. All right, that's the first step. But that's scary because the patch is what's holding it together right now.
Yeah, that's a great I mean, that's a great example and I I've kind of gotten used to one of the things I say to myself, is make decisions that give, I want to make decisions that give me more options. Yeah, once that take options away, and when I've kind of lived through my scarcity mindset and through fear, and through survival, that's really it, it's not giving me more options have ways of being, you know, and so I tried to catch myself doing that when, when I can, you know, reverting back, or,
and there are still parts of me that, you know, it's like what you said about options, I have that health side of me. And, yeah, sometimes in the middle of the hospital shift, or whatever, it's crazy, or some insane thing is going on, and you kind of drop into that mode, right? But then I'm also able to let go of it and kind of be more at peace be, you know, a little bit bigger, bigger focus, a bigger picture.
Sure, like having it as a tool in your tool belt, as, as I go through, you know, I, again, I usually don't talk about my military stuff that much, but but in the military, one of the things I like about it is like, I'm not at all an angry person, or a person who's very dramatic, or, you know, but I, I've learned that in certain circumstances, you know, standing up sliding every all the shit off of someone's desk, and getting real loud, creates an effect of some sort. And sometimes in the military like it, you know, having that in my having the ability to be able to do it, even without being angry, it sometimes gets to a desired end state, you know,
I talk about this with my, my, my mom and my sister are both incredibly empathetic and compassionate people, and agreeable, and struggle with the consequences of being that compassionate and agreeable. Absolutely. And so that tilt to lips when my favorite authors, and another one another, one of his sayings is you need to be kind, agreeable 95% of the time, right, 5% of the time, you need to break chairs, people know you're capable. And when they think about interacting with you, they know they're, you're probably going to be nice. But if you're asking them something that if they're asking you something that's particularly problematic, they're going to think twice about whether they're going to get the chair breaking. Right,
right. Yeah. And it's one of the Presidents it might have been Truman said, was it speak softly carry a big stick? Yeah. I don't know who it was either. But Roosevelt, same concept, you know, and it's just nice to be under, you know, again, be choosing it. Yeah, rather than than to be controlled by it.
And I think that's yeah, I think that is the key is, is once it's a tool in your belt, and you're choosing, but if you're just an angry person, then that's also not in either direction. Right? It's not, it's not a choice. Unless you have all the options.
Yeah, I'm a horrible, I have a horrible history of people pleasing. And it's frustrating to me now. Because it's not like I'm a problem all the time, it's at night, it's not a problem, be nice and compromise. And there's certain things that they you know, but But oftentimes, it's it's at the cost of me doing either what I know is right, or what I really wanted to do today, or you know, and so, I've really gotten myself into trouble with that. See,
I'm the opposite actually, is it's not that I'm aggressive or negative, but I very much am comfortable going my own way. And I've struggled throughout my academic career in dealing with any administration. And even even as a physician, like literally, before the pandemic, one of the chief of medicine at one of the places, one of the hospitals I work was like looked at, just don't ever message administration. Just send me whatever you want to send them. And I will, like, you just can't, it doesn't work. Because yeah, I just have no, I just have not that, like not that I curse or anything. Right. But I make my point very firmly,
you're not going to go along to get along. Yeah, yeah.
But, you know, the consequence of that is, is I don't build consensus very well in groups or in organizations, I you know, even in personal relationships that can be hard when you know, if the person just doesn't have an ability to compromise Well, that's kind of difficult to deal with
Sure. You know, it takes a special kind of person like you said, like a certain kind of friend to to be accepting of that and understand it and even support it in some ways, which is the other part of the you know, what the the podcast is about, as you know, I say deep human connection, you know, it's something that I really longed for. And I've prevented myself from by being a people pleaser, all those years I was really blocking myself for sure from deep true connection with with other people because I never allowed them it was really a for me a survival tech tactic you know, just go along with whatever you're saying. Just don't throw me to the wayside. Don't throw me in the garbage. Sure, you know, and now being who I am now, it's like I'm okay. Like I understand that when you even when you we don't agree or whatever. Yeah, You can't even throw me away. It's not even possible.
It's funny because in some ways it was the same. It was the same concept I just took. The other tack is like, if I get even the slightest hint that you might throw me in the go, I'm just gonna jump in the garbage like, and just be like, alright, well, we're done.
Right? Yeah, I'm gonna run away. Yeah, I'm gonna run away from you. So you can't even get me into the garbage. Yeah, correct. Yeah. So Right. We're all on the we're all on some side of that coin, I think. Yeah.
I mean, there's benefits. You know, certainly my practice, my willingness to build this practice outside the structure of standard medicine is very much my own recognition that I'm not going to do well in, in the standard administrative system, those things track together. But then there's also the problem of well, I work alone. Right, right. You, you're accepting
the life of the lone wolf, the Sure. Well, I'm curious though, that with your practice, as as you you have these deepened queries with your with your clients, members, patients, whatever we said, we were calling them, do you find there's a level of connection there? Or is it friendly? Transactional? It's like, you're still kind of getting to an ends. Or, of course, there's professionalism. But I mean, like, is it like, in my world as a, there's a huge part of being, you know, a coach to someone a strength coach is somebody that is connection serves, you know, beyond what's happening in the gym?
I don't know, I think the you know, going to his house was really meaningful me, for me, because it kind of broke that barrier, when he invited me to his house warming party and kind of went and experienced a different side of things that that meant a lot to me, because it was breaking that it is still fairly transactional, maybe is a bit harsh, is still pretty directed. I think most of my interactions with my patients, I think my dream for the practice would be to continue kind of breaking that down if they're receptive to the degree that they're receptive at various patients patient, of course,
yeah. Do you think not to cut you off? But do you think people wrong for that with their doctors? Do you think that people want a deeper relationship? I mean, it's very personal thing that people do. I mean, things that I've had to go to a doctor for, sometimes are, you know, me, you know, not just the sniffles? or something, you know, and so, I'm Cure, I don't even know the answer for myself. Do I want that with my doctor?
I think there's, I think, no, not completely. You want How about half? Right? You want enough to feel safe and comfortable and you want trust? Right? But you also want them to be a little bit of a neutral third party stranger, little bit, you know, because if it's a friend, if it's actually a friend, unless it's a super intimate friend, so there's the other side of it, right? Like, my best friend, yeah, there's no middle that middle ground of well, we're friends, and we have a social interaction or whatever. But now I'm a little shy to kind of bring up my, you know, herpes or whatever.
Yeah. But is that the, because I'm wanting to write, I can see the situations in which you maybe don't want to be you don't want your doctor to be your friend, right? Like, you brought up an STD of maybe that could be embarrassing to you, or what I was also thinking about this,
Hey, I, you know, I like to party on the weekends and do these drugs, or do whatever, yeah,
I'm addicted to whatever, you know, we saw, but I'm actually thinking about it being harder for the doctor, in that case, like making, cuz I can see where you might make some ethical decisions for, or what you might do for a friend versus what you would do for a stranger, where you might make certain decisions or whatever.
Maybe I you know, it's funny, this kind of goes along with that personality trait of not going along to get along or whatever, like, and my mom still struggles with this, I think, but I pretty clearly I think, compartmentalize my emotional set for my analysis. Oddly enough, the more I care, actually, in some ways, the more I push the analytic view,
well, that's kind of I was hoping you would say, you know, is that like, no, if we have a really good relationship, like a great relationship, and even we would come, you know, we consider each other friends. You know, my thing is, like, if you're, if you're professional enough, and we care about each other enough, then you really probably would be making maybe even more solid decisions. And so I've always
thought so, you know, medicine has legally and socially has all these ideas of you know, you shouldn't treat family or you shouldn't whatever. I've never really understood that. Or I understand it third party, meaning I understand that some of my colleagues I think, may be sufficiently emotional about family that that they would be impaired in their in their judgment. That's never really rang true to me. And there are norms that I follow just for keeping my license safe. But yeah, I think I would give better I do give better advice to patients when I care. about them. And that's part of the report that I try to build. I probably think about my patients more than they think about me. I'm at some point, a bit player in their lives, right? Whereas they're a big part of my business. Sure, Tom, I come across an article that is related to something one of my patients is facing, I think about hey, what can I learn something? Should I be doing something differently for them? They're always on my mind and that sense, but that's because I have a relationship because I care and because I want to give objective analysis.
And you know them. Yeah. I mean, you you think they come to mind when you see the article, because you have a relationship with the, you know, there's, there's the details about them. And, you know, and so I think I mean, I think that's powerful.
And my mom was, I don't know, you know, I've got several of my own stories, but the one that comes to mind, I, when I was two, I pulled a hot cup of coffee down on my head, and it gathered in the diaper and burned. burned me. Yeah, in the diaper area. And it was pretty bad. I was in the hospital, and my mom took me home and had to do the dressing changes. And like scrub the area. She is very empathetic, like my pain, her pain, like, yeah, you know, but she did and did what had to be done despite how much it hurt her. She was crying. I was her report. I don't remember it, obviously. But yeah, I think that idea of, of being able to be harsh enough to be compassionate. The other quote that comes into his game, we talked about briefly the sequel to that. He's in a situation where for whatever reason, he his best friend has asked him to help him to help him die. And he's going, he's going to kill his best friend that that night or whatever. And his wife says, you know, I think you have the heart for what you're about to do. And, and he's feeling kind of bitter about it, he goes, what competitive, cold and ruthless, which is no compassionate enough to put the fire to the wound, when that's the only way to heal it. And that, to me is like my, when I am harsh, or when I seem harsh, for me usually is it is a form of compassion. It's me trying to be compassionate, and it may come off.
Yeah, I took when we when I do staff development with the coaches, when you know, one of our values is kindness over everything. And I tell them all the time, don't mistake that for your being Sui. And sometimes the kindest thing that you can do for anybody is to be hard on them to hold them to do something that might kind of be uncomfortable for them right now. But it's out of love and compassion. And knowing that there's a, there's a bigger purpose, you know, for
sure. And with any with any relationship, you know, I mean, not that I'm a bastion of like, successful. I believe a lot of mistakes. But yeah, you know, to be able to say like, if I really care about you, I'm going to tell you, how I perceive it at the very least, and how I perceive what you're doing maybe a mistake, and you can disagree, and we can have that conversation. Sure, but I'm not going to hide from you. Did I think you're making a mistake? Because that would seem to me that would feel fundamentally unloving? Yeah,
it really is. I mean, you know, the, I think the the level that if you're hiding, you know, it's still if you're hiding or lying, or, or withdrawing some sort of something from somebody because Sure, you don't want to hurt them or whatnot. It's not loving, there's there's nothing loving about that to be fair.
I mean, like, it's not like you have to say everything, right, like right away, but like, right, I try very hard not to lie in response to a direct question, even if the answer is somewhat painful. And then I do try somewhat to choose my moments about when to bring up. When is the right time to share her?
There's, there's definitely
like, skill. Yeah. And and my probably my, one of my big failings is I probably wait too long, or I'm a little too well, you've got all these other things going on. I don't want to pile on and, you know, so on and so forth. And so then it can be a long time before I actually bring something up.
I'm not particularly good at that myself. Yeah,
it? I don't know. I feel like there's that there's that survival thing going back to is like, well, I can make do. Right. So it's not exactly what I want. But I also don't want to pile on top of you. And sure, whatever. Sure.
Relationships are just hard. They're just one of the things that wasn't recorded earlier, when we were talking about how you were mentioning there's like a there's studies it's very correlated with, you know, being in a relationship. Sure, sure. live longer and all that stuff. But men
men, oddly enough, not women. Oh,
that's Oh, that's sad.
No, the interesting thing about that, and I think it is their social norms there too. I think women are better at forming intimate relationships with with friends with other women. And remarkable actually some interesting article, not necessarily the military is actually to some degree the exception to that rule, but we don't have good manhood rituals. And we don't have good passages that help us form really deep masculine relationships. Yeah, I
think she that you bring that up because I I have another friend he's a doctor of. He's a chiropractor. Like he's big on the the rite of passage the the ceremonies for men in particular that, you know, ancient, you know, past cultures, ancient cultures had these rituals, other countries sometimes have him and we here in America don't really have anything like that. It's actually the brought that up because I've been thinking about that.
Yeah, it's an interesting that transition into adulthood. And not just adulthood. But but the, the shouldering of responsibility to a purpose. Yeah, um, I think that buddy ship is the word actually, that I've heard used. Buddy Ship. Ship. Yeah,
yeah. And I have to agree that like, again, in the military, we do get some of that because, you know, you go to basic training with or you go to war with or you've done some, you do hard stuff together. And that really bonds you but a lot of folks don't, you know, sometimes team sports is like that, for some people, you know, you know, that that's something that where people build like, lifelong relationships, but I agree with you. And I can say for me, of course, I do have, you know, guy friends or whatever. But, you know, it's, it's not like women do where they kind of like they really come together as like a bit of a pack within the pack, you know?
Yeah. And, and I'm fortunate I recently have made well, one of my friends, decade old, best friend from residency, but recently made another such friend, guy friend, and having two of them in the same city. I've not had that kind of close set of relationships since high school.
Is that been an improvement to your life? Like,
have you heard incredible? Yeah, crazy, absolutely dramatic. It's difficult to overstate. Yeah. How
would you like what would you say? is different? Like, what? Like, why is it different?
That I don't know that it's a qualitative difference? So it's a little bit difficult. Yeah, to you know, it's not quantitative. There are things you can point to, right. If I get turned down for a date, or I go through a breakup or whatever. I'm not just alone in my head. You have singling it out my you know, myself. Yeah. Somebody to bounce the ideas off of somebody I'm comfortable with telling all the details of what went down. Right. No matter how good or bad it makes me look, without your judgment. Yeah, yeah. And wow, that's wonderful. Yeah, I mean, like, hey, you know, whatever the deal is, you know, no matter how extreme, you know, I think if I, whatever, yeah, you know, I got high on cocaine and slapped her. And then she broke up with well, okay, like, Who are you gonna tell that to? Right? You know, like, you know, that's something you really want to put out there, you've got to have someone who you trust and, and I think in our society, we've ended up, you know, therapists, and doctors end up in that role, but we're not suited for it. It's not, you know, there, there can be value in getting a third party trained opinion. So it's not that there's not good work to be done there. But it's not the same work as an intimate relationship with somebody who you can say that to and who will chew you out. But also say, Hey, we're going to put the pieces back together.