Transcript
Speaker: Everything on the podcast is for entertainment purposes only.
Speaker: Nothing I say is meant to treat or diagnose, or it's not even advice for you to follow.
Speaker: So remember when you're listening to the podcast, I am a doctor.
Speaker: I'm just not your doctor.
Speaker: This is On Call with Dr. Dave, and today we're talking with Dr. Drew.
Speaker: Dr. Drew is an internal medicine doctor, so internal medicine doctors go to medical school, then they train in internal medicine.
Speaker: A lot of what they're training is inpatient medicine, so taking care of people in the hospital, but they also take care of people outside the hospital.
Speaker: internal medicine doctor sometimes people do both sometimes people are just inpatient or outpatient and dr drew sounds like you do outpatient right now and i just want to jump into some of your stories hear a little bit about you what you do we don't mention specific locations where you practice but just like the generic setup of what your day-to-day is
Speaker: Yeah, yeah, I wish we would change the name of internal medicine.
Speaker: It's really confusing for people.
Speaker: I'm here for adults, the grandmas and the grandpas, the sick, complicated patients.
Speaker: Those are, that's my bread and butter.
Speaker: That's what I see all day, every day.
Speaker: I was in training in the hospital primarily.
Speaker: After that, I was with a group for a few years.
Speaker: I just branched off and started my own real small clinic.
Speaker: It's just me there.
Speaker: I got two exam rooms and I just, you know, people come in and tell me about all sorts of different things they have going on, chronic disease, basically.
Speaker: I've never really thought about the name internal medicine, just because it's just something I always knew about what's external medicine.
Speaker: Derm, but in internal medicine, I think you probably see a bunch of skin, lumps, bumps, lesions as well.
Speaker: But I guess maybe it started because it was internal to the hospital system.
Speaker: I don't know.
Speaker: I don't know where that name came from.
Speaker: Yeah.
Speaker: It's just like you said, historically it was, you're an internist, you're in the hospital, you're living there.
Speaker: You're the one, the backbone of the hospital.
Speaker: That's where it came from.
Speaker: It really just needs to change.
Speaker: Yeah.
Speaker: That makes sense though.
Speaker: Like now that you say internist, I'm like, oh yeah, okay.
Speaker: Yeah, that makes sense.
Speaker: But I've never even thought about the name before.
Speaker: That's interesting.
Speaker: Now in your day-to-day clinic, you're taking care of, like you said, mostly adults and you're interacting with that population that the difference of family medicine, I think is they will do pediatrics and geriatrics and they'll sometimes they'll deliver babies, but you're specific more to adult population.
Speaker: Yeah.
Speaker: Yep.
Speaker: Now, when you think back over your career, when we asked you to come on, we asked you to think about a couple of stories that you said you had a couple of stories to share with us.
Speaker: We'll just jump right into those.
Speaker: Yeah.
Speaker: So again, internal medicine, we established these, I tell people right up front, I'm going to take care of you until you die.
Speaker: So it's, that's the plan.
Speaker: It's going to be a long-term relationship and things sometimes get messy at the end.
Speaker: Anyway, so the first story was very early after I started working after residency, I had a patient, middle-aged guy.
Speaker: He had plenty of problems, controlled diabetes and kidney disease and some things, and was not in the habit of seeing doctors on a schedule, as you would like to see with patients like this.
Speaker: He'd come real hit and miss.
Speaker: So the first time he saw me, he laid out a bunch of stuff and I said, okay, let's start with a few things and then have you come back.
Speaker: So I got routine blood work on him.
Speaker: Yeah, his kidney function was really pretty bad.
Speaker: And some of his potassium was high and said different things.
Speaker: And so I called him, I said, Hey, it's not great.
Speaker: Let's adjust your meds.
Speaker: Let's follow up.
Speaker: And again, at that time I'd been mostly in the hospital.
Speaker: So I was used to this kind of stuff.
Speaker: About two days later, one or two days later, he ended up going to the hospital, the emergency room and in pretty short order was on dialysis.
Speaker: And then he was upset with me because of what happened, which looking back, I tell this story because like it hints at the beginning, sometimes doctors, we do things that we wish looking back, ah, I probably should manage that a little bit differently.
Speaker: So it's good for patients to hear that.
Speaker: that we know that we make mistakes.
Speaker: We, it's not a career that's very forgiving of mistakes.
Speaker: Nobody wants to experience adverse outcomes for their health of anything.
Speaker: He ended up being okay.
Speaker: I didn't see him after that.
Speaker: Like I said, he was upset and he moved on.
Speaker: And, but that, I remember that was a moment where I, a growing moment where you have to mature a little bit.
Speaker: And even though I had already done a lot of residency training, you're on your own and
Speaker: You're the guy in practice.
Speaker: So that was, that's the first story.
Speaker: On that story, just looking back, it sounds like just somebody listening to it.
Speaker: It sounds like you did the regular workup.
Speaker: You got some labs, you recommended adjusting the medicines.
Speaker: And then two days later, he's in the ER.
Speaker: Looking back, do you think there's something you could have done that would have prevented that?
Speaker: Yeah, just curious.
Speaker: It sounds like you did the right stuff.
Speaker: Yeah, looking back, I probably would have just said, hey, go to the hospital, get taken care of, come back and see me afterwards.
Speaker: The outcome would not have been any different.
Speaker: But a lot of my job is managing people and their feelings and their people are more than just their health, right?
Speaker: So you have to understand where they're coming from and
Speaker: what they want to see and how they want it done.
Speaker: And I would have had a better relationship with him and better long-term care if I would have just said, you know what, just go to the hospital, come see me after.
Speaker: He would have been fine with that.
Speaker: For some reason, I felt like I needed to take care of it and not send him to the hospital, but that was just not the way to think about it.
Speaker: Yeah, that makes sense because a lot of times too, like I do think so often that I say the same things to people over and over again.
Speaker: But every once in a while you'll forget to tell somebody, hey, you will have a bunch of swelling with this.
Speaker: And then if they don't tell them and they call you like, I'm really swollen, what's going on?
Speaker: But if you tell them beforehand and they just know to expect it and then they're happy with you.
Speaker: It's not really that they
Speaker: get they care that they're swollen or puffy or they're bruised like if you set the expectations up then almost no matter what happens as long as you tell them this is what's going to happen then they usually are pretty happy with you as a doctor and if you forget to tell them something even if it's something that's not even a big deal looking back they tend to be a little more frustrated that they were surprised by something so maybe this guy was you know if you told him hey based on these labs you go to the hospital
Speaker: then the expectations were met.
Speaker: You said, based on this, you need to go to the hospital.
Speaker: And he was probably a little upset to go to the ER.
Speaker: Like you said, people are more than just their health.
Speaker: And so I would imagine that maybe a lot of being a provider that's there through the course of somebody's whole life, especially an end stage life, that the expectation has to be
Speaker: either set in advance or that you learn that on the job, like that nuance of reading people to be able to provide them a little bit more peace of mind, I guess, rather than just take care of their health.
Speaker: Yeah, yeah, exactly.
Speaker: You got, you got to know, it's not just small talk when you say, oh, where are you from?
Speaker: And you have family and you have to understand what their priorities are.
Speaker: You have to understand how much they want to spend time on their health and, you know, how much testing they would be willing to do.
Speaker: And some people just don't want to take medications at all.
Speaker: So then you have to be able to work with that.
Speaker: Yeah.
Speaker: Yeah.
Speaker: It's interesting to think about just like getting to know the patients, getting to know what they value because yeah, it's not a one size fits all.
Speaker: That's why when we talk about AI or like what's going on and what's going to happen with AI, I think some of the, especially primary care doctors are going to be really protected from that because people don't want
Speaker: something to be completely formulaic.
Speaker: They want to have some feedback.
Speaker: They want to have some say in how they're treated.
Speaker: And if the AI system gives the very best answer that's possible based on analyzing thousands of research papers in the split second, that patient may not follow that because it's just this recommendation from an unfeeling computer.
Speaker: And if it's like, what's important to you, how do I value you?
Speaker: And then these are the tests that will get you to your goals.
Speaker: I do think that humanistic nature and that connection is going to get us through any of those things.
Speaker: Because people aren't formulating.
Speaker: No, they're not formulating.
Speaker: You have sample sizes of people that can be analyzed.
Speaker: But when push comes to shove, it's one person with one unique upbringing and set of circumstances, instead of traumas and thought patterns and feelings and reactions and also priorities of what in their health they even prioritize.
Speaker: So I think that's probably right.
Speaker: And it's unfortunate that the first interaction you had with this patient was that one, because I'm guessing if you'd established the baseline relationship with him first,
Speaker: you probably would have been able to weather any of that or he probably would have stuck with you if you knew that you cared and you're there for him.
Speaker: It's just unfortunate the first time you two interacted with something that he ended up going to the hospital for and he moved on with life, but hopefully he found somebody that he gets along with well and has a good relationship with.
Speaker: And then what's the other story?
Speaker: So the other story is in essence linked to the first, even though it's a completely different patient, but flip side of the first.
Speaker: So this was a guy who had a life full of difficult things, history of cancer, radiation and chemotherapy treatment when he was younger.
Speaker: As a result of that, he had to, lots of times, years after radiation, he ended up with scar tissue.
Speaker: He had a bad infection.
Speaker: He was a guy who was very familiar with doctors and being in the hospital.
Speaker: And some people just get, they understand what's involved, right?
Speaker: He had several long hospital stays.
Speaker: And I saw him usually at least twice a year, one for routine checkup and another time for, you know, something that was going on that was
Speaker: affecting him.
Speaker: So he had lymphoma, and so he had radiation to his chest and a lot of cardinal disease and esophageal disease related to his various treatments.
Speaker: And so he was prone to aspirating.
Speaker: His secretions would just go to his lungs and he would get pneumonia or cough or things like that.
Speaker: And this was just recently actually.
Speaker: So he came in and really did not look very well.
Speaker: Was having trouble eating, was losing weight.
Speaker: And I looked at him and he was breathing very quickly, about 25 times a minute, which if you see somebody breathing that way, it's very notable.
Speaker: His blood pressure I could barely detect even with my manual measurement.
Speaker: His oxygen was borderline.
Speaker: And I tend to get patients who I can work with people who want to try different things, not always the regular process.
Speaker: But I said, hey, I think you need to go to the hospital.
Speaker: And he said, I don't want to go.
Speaker: He knew, he says, once I go there, I'm always there for a week or two.
Speaker: Once I get in there, I'm stuck and it's horrible.
Speaker: And I said, no, you're not doing well.
Speaker: I think you have pneumonia and I can't give you what you need.
Speaker: You need IV fluids.
Speaker: He was like, I'm not going.
Speaker: It was difficult.
Speaker: I said, okay, let's compromise.
Speaker: So there are services that'll come to your house and give you IV fluids.
Speaker: I said, you need to go get a blood test right now.
Speaker: I'll give you some antibiotics and I'll see you tomorrow.
Speaker: Okay, fine.
Speaker: And I said, please call if anything happens.
Speaker: So he came back the next day.
Speaker: Had some IV fluids.
Speaker: Said he felt a little better, but I didn't believe him.
Speaker: He was just trying to stay out of the hospital.
Speaker: He was like, yeah, doc, I feel great.
Speaker: Yeah, I get it.
Speaker: So the same thing the second day, close follow-up.
Speaker: And okay, fine.
Speaker: Long discussion.
Speaker: It's been there for a while.
Speaker: He's there with his wife.
Speaker: So he leaves.
Speaker: And the other thing, you've probably found this to be true as well, it's hard is
Speaker: You have these cases and then, okay, got to see the next patient, right?
Speaker: So like, you just got to move on.
Speaker: And sometimes the next patient, they want to joke around and whatever.
Speaker: And then the next patient's cancer and they, you don't really have time to, to process things.
Speaker: And I think that's why you're making this podcast is because we all have these situations where we can't have the opportunity to deal with the emotional aspect of medicine.
Speaker: Exactly.
Speaker: So anyway, I got a call that night from the ER and they said he was dead on arrival.
Speaker: They called 911, took him in and they couldn't resuscitate him.
Speaker: And that was tough.
Speaker: Just cause you never want to lose a patient and the whole situation.
Speaker: And so of course on the surface, anybody who looks at this says, you messed up.
Speaker: Well, what were you doing better?
Speaker: But I try to be pretty upright with people.
Speaker: So I was like, I got to call his wife.
Speaker: This is a hard situation, but I have to talk to her cause
Speaker: just because everything and so i called her and i said hey what do you say i just say talk to the er i'm sorry and she says you know what no regrets like we did exactly what he wanted to do she says we we always said that you were the best doctor that you ever had even that day that before he died
Speaker: grateful that Dr. Hall is working with me and everything.
Speaker: Like I said, in a way similar to the first case, but in this case, they were, we have a good relationship.
Speaker: And like I said, you don't want to lose somebody, but they really, in this case, he knew what he was choosing.
Speaker: And she was convinced as his wife that
Speaker: even though he passed it, that was what he wanted.
Speaker: He didn't want to, he was done with these long hospital visits and he had been declining for a while.
Speaker: I think he would have lived a few more years if he would have got to the hospital quickly, but,
Speaker: Anyway, so just, you know, every case is unique and complex and just a lot of thoughts, a lot of feelings that go into these things and it's medicine.
Speaker: Yeah, I can hear the compassion in your voice and how much that stuck with you.
Speaker: But listening to it, I think you're right, though, and I think his wife is right.
Speaker: He...
Speaker: You have the conversation with them.
Speaker: Like the right book answer is to transfer them to the hospital.
Speaker: And yet we're dealing with people that have their own wants, feelings, they're autonomous beings.
Speaker: We've learned about that in medical school.
Speaker: The old style was the very patriarchal male doctor coming in and saying, this is what we're doing.
Speaker: Right.
Speaker: And it shifted.
Speaker: That's not how people want their medicine delivered.
Speaker: People want to have a say in that one guy.
Speaker: It's sad, but I do agree with you or him that you talked to him, you gave him his options.
Speaker: It's not your job to force people to comply with the best recommendation.
Speaker: You had a conversation, you let him know the risks, you let him know that was your recommendation to the hospital.
Speaker: And he said, no.
Speaker: And instead of just saying, if you don't listen to me, then I'm not going to work with you.
Speaker: You said, okay.
Speaker: I gave you my recommendation, but I'm going to try to still help you the best way I can.
Speaker: So I think that's a beautiful story about somebody having autonomy.
Speaker: over their own healthcare and a doctor caring enough to have that conversation.
Speaker: Cause you could have just said, Hey, that's against my advice.
Speaker: Sign this form saying that you're not listening to my advice.
Speaker: The AMA will release me from any liability, but I'm calling the ambulance or you have to leave.
Speaker: You could have just been like very hard line about it.
Speaker: And like, that's not the way it would have.
Speaker: gone down.
Speaker: I just think it's a beautiful story because it ended in sadness, but it's really what we strive to do.
Speaker: We really strive to inform our patients and let them make choices.
Speaker: And yes, we have more information about the disease process, but we don't have more information about their lives and their wants and wishes.
Speaker: I think we do our best to educate.
Speaker: And then we work with the patient to come up with a treatment plan that makes sense from medicine, but also respects their wishes.
Speaker: Yeah.
Speaker: I think it's something that people don't understand about healthcare workers is they, this kind of stuff happens and you think about it, you remember it, you carry it to your next interactions.
Speaker: And I'm not 100% certain that you guys aren't trained to
Speaker: Know when your decision stops and when the patience begins, because it's not that you're trying to be forceful.
Speaker: It's just, I want to help you so much.
Speaker: And I know that this is going to help you.
Speaker: Do you please, will you take this help?
Speaker: but that autonomy of the patient starts and i get why this guy did not want to go to the hospital i've had family members choose the same where they didn't want to be there even if it meant that it was going to be their last day and and so i think talking about this kind of stuff helps and it's just because you care so damn much
Speaker: Yeah.
Speaker: It's really a privilege to be a doctor.
Speaker: I remember hearing that when I was applying to medical school and I was like, yeah, whatever.
Speaker: It's more than a job and that kind of stuff.
Speaker: But it is that way.
Speaker: You have kids and it's the same sort of thing.
Speaker: They make their own decisions, but you still...
Speaker: You're still interested in what's going on.
Speaker: You can't just say, oh, you made your decision.
Speaker: You suffer your own consequences because they're your kids.
Speaker: So it's not that much in medicine, but it's a little bit of that feeling of no matter what happens, you're always concerned about the patient basically.
Speaker: Yeah.
Speaker: We just interviewed a kid not too long ago where he's, this is the only, he's a med student.
Speaker: This is the only profession where you can provide care for someone like a parent who cares for a child and how special that was to him and how he felt the same privilege.
Speaker: Yeah.
Speaker: And unfortunately, just like parents, sometimes you have wayward children.
Speaker: Sometimes you have children that don't listen.
Speaker: And sometimes you have kids that are really obedient and do everything.
Speaker: And same thing with patients.
Speaker: We have patients that listen to everything we say and some people that don't.
Speaker: And just in the last week, I've had a patient that didn't listen to any of my pre-op instructions, none of my post-op instructions, and is now dealing with a kind of self-induced complication that didn't need to happen.
Speaker: It's just because she didn't do anything that I told her to do.
Speaker: Yeah.
Speaker: Yeah.
Speaker: And then somebody else showed up today and she's a week out from surgery and she already looks amazing because she'd listened to everything and she, her husband's taking care of her and he's like, your sheep said to do this every two hours.
Speaker: So I set a timer and I have this and I told her, oh, it's your time for your drops.
Speaker: And I did the drop right when I was supposed to.
Speaker: And that's just...
Speaker: I like your parent analogy.
Speaker: I've never really thought about that in medicine, but I do that analogy because I do care a lot about these people and yet I can't force them to do anything.
Speaker: I can just offer them the best choices and then help guide and be there if they want my help.
Speaker: It's not easy to brush off.
Speaker: Yeah, maybe that'll help some of those difficult interactions in the future.
Speaker: You're just my disobedient little child right now.
Speaker: Now that sounds a little too paternalistic back to the old days of medicine.
Speaker: You tell people, you've mentioned at the beginning that you tell patients, this is going to be a long-term relationship.
Speaker: I'm going to be taking care of you throughout your life.
Speaker: I'm still around.
Speaker: When you pass, I'll be taking care of you.
Speaker: And I tell patients usually the opposite.
Speaker: I tell them, I'm a catch and release doctor.
Speaker: Fix what you have and then you're gone.
Speaker: So the only people I see on a regular basis are people that do regular Botox or filler or come in for some of that regular maintenance stuff.
Speaker: But usually they come in with an issue.
Speaker: I fix that issue and then they're gone.
Speaker: And I just say, I wish you the best.
Speaker: And if you ever need me again, you know where I'm at.
Speaker: And I say, doc, I hope the next time I see you is just in a supermarket someplace.
Speaker: I'm like, that's good enough for me.
Speaker: Have a great life.
Speaker: So two very different kind of professions here.
Speaker: Yep.
Speaker: Yeah.
Speaker: I would imagine that your practice is getting and will continue to get busier and busier as, especially as aging population.
Speaker: I'm just curious if you had one piece of advice to give people like in midlife, as they go into the later, their later years, what is like the biggest thing that they can do to help their health and mobility?
Speaker: So that's, that's, I'm going to answer more than your question.
Speaker: Just, this is what I do.
Speaker: There are things you can do to help yourself.
Speaker: Mostly just don't do something dumb.
Speaker: Don't smoke.
Speaker: So diet and exercise for sure helps.
Speaker: There's lots of stuff you can't control.
Speaker: But I think what I would, the advice that I would give people in midlife is prepare yourself mentally because your body will betray you.
Speaker: Right now you wake up and everything works.
Speaker: You don't think about it.
Speaker: You do everything else that you're worried about.
Speaker: Someday you'll be 70 and 80 and the number of things that can go wrong and will go wrong in your body are almost without number.
Speaker: And there's a big discrepancy between people who can accept that and stay happy.
Speaker: But every day I hear
Speaker: Getting old is the hardest thing I've ever done.
Speaker: This is for the birds, this and that and the other, because you get, you lose your hair, you get cataracts, you get skin cancer, you get, it just, it goes on and on.
Speaker: Every organ system starts to fade away.
Speaker: So I've tried to, I don't know if it's going to help, but I tried to brace myself to, okay, this is going to happen.
Speaker: It's okay.
Speaker: I can still have a good life.
Speaker: It's,
Speaker: Anyway, so you do all those things and hopefully you can make it to 80 and still be really healthy and functional, but things will change.
Speaker: So diet, extra diet, exercise, and a radical acceptance of what is, what will be.
Speaker: So.
Speaker: Yeah, and then if you can't accept what is, you come to me, I make you look 10, 20 years younger.
Speaker: And you lie to yourself.
Speaker: And you at least get to live in denial for a little bit.
Speaker: Yeah.
Speaker: Half my patients just want to be able to not look through like hooded eyelids or I do.
Speaker: Be able to read again.
Speaker: I do trauma reconstructions.
Speaker: I do cancer reconstructions.
Speaker: I do aging, like ectropians, entropians, like all that stuff too.
Speaker: And then, so it's always interesting to see those patients.
Speaker: They have somebody that's smashed their face up in a car accident.
Speaker: Then you have the person like that's next in your clinic that's just like,
Speaker: I want to look younger doc, just whatever you recommend.
Speaker: I'm like, okay.
Speaker: Speaking of your body portraying you, like your eyelids will fall down.
Speaker: Like even your eyelids will fall down.
Speaker: The thing that is supposed to protect your eyes will then at one point block your vision.
Speaker: Drew, thanks for coming on, man.
Speaker: Really appreciate it.
Speaker: I can't do this without people to talk to.
Speaker: I tried initially, I was just going to do a bunch of stories, me talking myself and it was super boring.
Speaker: I need people to talk to.
Speaker: Good to see you guys.
Speaker: Good to talk to you.
Speaker: Well, have a good night, Drew.
Speaker: You guys too.
Speaker: Take care.
Speaker: Hi, this is Dr. Dave.
Speaker: Thank you so much for listening to this week's episode.
Speaker: Please rate, review, and share this episode so that we can continue to get you more stories in the future.
