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Unscripted: But wait, there's more!
46 Plays24 days ago
Join our hosts Dr. Dumebi Okocha, Dr. Samiza Palmer, and Student Doctor Chinasa Anokwuru as they recap our recent RTL topics regarding cancel culture, medfluencing, and more! You don't want to miss this conversation!
To share your thoughts on our discussion or if you have any questions to ask our hosts, email podcast@snma.org for a chance to be featured on the show!
Disclaimer: The opinions and views expressed on our podcast do not reflect the official stance of the Student National Medical Association.
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Transcript
Introduction to 'Unscripted' Podcast
00:00:00
Speaker
The views expressed on this podcast represent only those of the hosts and do not represent the views of the Student National Medical Association. Hi y'all, welcome to Unscripted.
00:00:11
Speaker
This is a series where we take our most high yield run the list conversation a step further. Our goal for each episode is to uncover our personal takes of previously discussed topics while highlighting diverse viewpoints that may be representative of our listeners.
00:00:26
Speaker
So sit back, relax and get ready as we your hosts take you through our thoughts on some very trending topics.
Controversy in Dermatology Advice
00:00:51
Speaker
everybody it's dr dumebi here we also have dr samisza and student dr chanasa here and we are unscripted hello guys how are yall doing hi everybody All right.
00:01:07
Speaker
um So one of our first topics that was kind of trending all over TikTok that I personally, I mean, I'm not personally offended because I've already chosen my specialty, but it was this dermatology resident coming on TikTok, trying to give some advice to medical students trying to match into dermatology. And one of the facts that she gave, or not facts, one of the advice topics that she gave was that if you have, quote, if you have acne, you need to fix that.
00:01:35
Speaker
um because it's distracting. And if you're a doctor in a skin profession, you should have good skin in order to treat patients with their skin conditions.
00:01:47
Speaker
um The dermatology field, because I saw lots of takes on this, were both in agreeance and then also like completely against it. Um, I even have some friends in dermatology and they even had like some polarizing opinions on it as well.
00:02:04
Speaker
Um, so I just want to know you guys, like, what did you think? How was her take on this? What's your take on it? And how could she, she got a lot of backlash. So I guess how could she have said it better?
00:02:18
Speaker
Yeah, I mean, i was also on the run the list episode where we talked about this, but yeah, I mean i finally like looked through the whole video and just like the way she brings it up is so abrupt.
00:02:33
Speaker
Like, it's like, oh, like, if you have acne, like, one, you can't have it, or two, you need to be working on that. Like, what do you mean? Like, they need to be working on their face. Like, it's just mad rude how she puts it.
00:02:45
Speaker
um But what I will say is that...
Hidden Curriculum in Medicine
00:02:49
Speaker
I think that in general, in medicine, there's a hidden curriculum. And she kind of did the taboo thing of talking about probably what's spoken about behind closed doors, which somebody might have brought up before around her. That person doesn't have, quote unquote, good looking skin. Maybe they don't need to be in this program.
00:03:09
Speaker
Now, whether or not she should have espoused it as like end all be all, advice for applicants o I don't think so but she's probably speaking to like unspoken things that people usually don't talk about however I think you know putting yourself on a public forum and saying these are the steps that you need to like be like a good candidate for a specialty that's supposed to like fix skin problems not just hope they're not there um i think that's a crazy take for sure
00:03:43
Speaker
I mean, on that note, then I guess, is she doing
Cancel Culture in Healthcare
00:03:46
Speaker
us a favor? Is she helping us out? You know, like Derm is very competitive and she's like, Hey, well, you better be working on your skin if you want to. I can't believe I just said that. No, the video was just, it was just ridiculous to me.
00:04:02
Speaker
But then sat with it a little bit, like you said, Samisa, and I really, really thought about it because there's just a lot of things that I've i've uncovered, I'd say, even in my own journey in medicine, that to your point are a part of the hidden curriculum.
00:04:17
Speaker
um And I mean, if that is and unspoken criteria, then definitely it's problematic. um I guess another thing I was really thinking about was whether she was speaking to the business aspect of dermatology in the sense that it's sort of ah cosic ah like a cosmetic business in a ah in a sense, like plastic surgery.
00:04:40
Speaker
So perhaps to have a thriving... practice uh you know in this profession you need to have good skin to attract whoever you're attracting as your clientele um but needless to say i feel like the message overall the delivery of it was was um the delivery of it i would say was just a little sour Piss poor is how i'd put I put it. I was thinking about like my journey in gynecology, right?
00:05:13
Speaker
So I guess I'll get personal. And i think a lot of people like kind of talk about this. Like people have like heavy menstrual periods or they have like painful periods and stuff like that. And it wasn't until my – OBGYN clerkship as a third year med student that I realized like, oh, I don't have to deal with heavy menstrual. I just just thought it was like kind of like a part of life, you know, just having heavy menstrual periods. Right.
00:05:38
Speaker
yeah And it wasn't until I started studying for myself. learning about different birth control options, which ones are better for amenorrhea, which ones are better for acne, and know and finding the right birth control for me that I'm able to
Personal Connections to Medical Specialties
00:05:51
Speaker
skip periods when I want don't have to like deal with like heavy menstrual periods.
00:05:56
Speaker
um So I feel like a lot of times when people choose a specialty, it's because sometimes it relates to them personally. So I think sometimes people choose dermatology because they had crazy acne and dermatology, they grew up, like they fell in love with the specialty because it saved them, right? Like they found the tips and tricks for them.
00:06:15
Speaker
So I think writing someone off of a specialty because of a current struggle that they're facing, I think it's just doing, um, a misservice for the community. I think a better way of how she could have said it is, you know, acne is an insecurity for many different people.
00:06:32
Speaker
And I know this as a derm resident who probably either struggled with acne or whatever. So like preface it by saying like I'm not trying to like Be rude. And I understand the struggle. Here are some cost effective ways to help control your acne in medical school in general, whether you're sub eye or not.
00:06:49
Speaker
And she could just look at some things that med students can try, like spironolactone, like different face washes, whatever they do, like birth control, whatever they do to control acne, like on a budget.
00:07:02
Speaker
I don't think she had to say it like during this kind of like anxiety provoking time of match season where people are submitting applications and stuff. And um i think it was just overall in poor taste.
00:07:14
Speaker
um I think you can I think the best doctors are the people that have. struggled and like have been through things that their patients have gone through you know and i mean whether that's like for me so especially like you know patients with abnormal pap smears and like oh i've had a leap so like i can tell you like what i experienced during my leap or i you know have had any i have never had an immunology biopsy but like you know like i've had this so like i can tell you about this you know and speak to it and So I think I would hope that she wasn't trying to be mean. I think she was trying to like be controversial and like try to eat up or whatever, but like she didn't land properly.
00:07:56
Speaker
And I feel bad that she was kind of like bullied off TikTok. I mean, she didn't have many followers anyway, but like she was kind of like harassed off of TikTok. But think it was for the best for her career. The dig was crazy. Yeah. Even PDs were like on TikTok talking about like my program does not reflect TikTok.
00:08:11
Speaker
Blah, blah, blah, blah, blah. So I was like, you better just go back to your dermatology. No medfluencing for you. no let it go. I mean, I think it's even dehumanizing itself because does it mean as doctors we are excluded from different pathologies? Medical conditions, right? Like we can't have diabetes. being like We can't have anything. You know, you you just you can beat you get the cholesterol, type whatever it is, just like anyone else.
00:08:37
Speaker
So it was just really baffling to me. And acne itself. is such a multifactorial condition. yeah i think being in medical school on its own is probably a pre-existing risk factor for acne, given the level of stress.
00:08:52
Speaker
So um it just really sounded,
00:08:57
Speaker
just came up very unempathetic to just make such... And some people don't care about their acne. Like we can also just like some people literally don't care. Like there's some dentists who have yellow teeth, but they don't care that they have yellow teeth. It's part of their their, you know, persona, whatever. So like some people generally don't care that they have acne.
00:09:17
Speaker
And I think that's all right. You know what i mean? Yeah, and I mean, there's, you know, just like she's saying, like, take care of it. But one of our best treatments for acne is, like, Accutane. And that in and of itself has, like, a lot of risks.
00:09:32
Speaker
If you are thinking of any sort of, like, ah family planning, like, you literally actually can't. Like, you have to take a pledge to not get pregnant. because Yeah, again and have, like, two forms of birth control.
00:09:44
Speaker
Mm-hmm. Exactly. So it's just like you're saying take care of it, but you don't know what people's lives are. And she kind of even says like, oh, I know as a student, it's hard to like have time to get your skin together.
00:09:56
Speaker
So then why would you put out this basically like I don't even know. Like it it was just, it was just so bizarre. She didn't eat. Unfortunately. Yeah. i agree Not even a nibble.
00:10:10
Speaker
Yeah. i haven't seen My PCP. Okay. And then you're talking about dermatology where the way is like a year for a year to infinity.
00:10:20
Speaker
I just laughed when I watched the video because she said, okay, well, just make sure you're working on it. But how? That part, we don't even really just... How fixed her own. That's the issue, too. mean, I don't know. And was like, good luck. And now you can't even find her account.
00:10:36
Speaker
Yeah. It's crazy. Yep. How the table's turned. Whoops. My, my, my. And they're all putting crazy things like... you know, if you look like you have filler, if you, you know don't wear your engagement ring. Like I was like, said, that's just what you are. You're a hater. We're going to notice.
00:10:57
Speaker
Yeah. She's like, we're going to, we're going to notice. I was like, why are you not noticing like the pathology at hand? Why are you worried about your med student, what they choose to rock? I encourage all my med students to wear their red wings. It's a, it's like a conversation starter. Like, Oh, I like your ring. I like your ring too. Like, why can't they like,
00:11:14
Speaker
It's like this improvisation of medical students. like you can't, you have to look so humble and so like hungry for it. It's weird. i don't know. Yeah, no, and she was like, yeah, maybe you were a banker before you decided to go back to medicine, but, like, don't bring that here.
00:11:30
Speaker
like um I was like, I was rocking my Michael Kors during my clerkship. Call it what you want, but I've never been a beggar. So i I like my Michael Kors, and I was wearing it, no one clocked it. Like, no one cares about me. Like, if you're that busy as a resident, maybe you're just not busy enough.
00:11:47
Speaker
Maybe need go to fellowship. Maybe that's what it is. Like, you're just maybe not that busy, that you're worried about what other – people are wearing on their body and what bag they choose to or like if they get lip filler or I don't know.
00:11:59
Speaker
Yeah. it was It just went in so many different directions in such a short time frame. Like, just why are we talking about that? And at the end of it, she's like, yeah, this was mostly related to women, but I'm going to come back with a part to tell you what the men cannot do, like shouldn't do either. I said, I was like, oh, yeah.
00:12:16
Speaker
we you up right there Or where you just stop there. why don't you just hold it right there and freeze, okay?
Denzel Washington on Cancel Culture
00:12:25
Speaker
But like I said, you know, she's... She learned her lesson.
00:12:32
Speaker
She's been effectively, quote-unquote, canceled. So speaking of cancelling, let's talk a little bit more about cancel culture and its effect on mental health.
00:12:44
Speaker
Now, we were just talking about this girl that got cancelled and, you know, ah hope and all praise her and hopefully that she's doing okay. But back to the topic at hand, one of the topics that we talked about was Denzel Washington actually And his recent thoughts about cancel culture when he was doing a press interview for his new movie with Spike Lee called Highest to Lowest.
00:13:07
Speaker
And he was quoted as saying, I don't care who's following who. You can't lead and follow at the same time. And you can't follow and lead at the same time. I don't follow anybody. I follow the heavenly spirit.
00:13:20
Speaker
I follow God. and don't follow man. I have faith in God. I have hope in man. But look around. It ain't working out so well. And, know, he kind of goes on and on about i just, like, what are we doing? Why do we have this sort of mentality and pop and just, like, general culture now?
00:13:38
Speaker
And as we all know, there are big impacts to being, like, canceled um and, like, it having mental health repercussions. So I guess, like, you know, for you guys, what do you think, especially given the fact of, like, the topic that we just spoke about, what do you think are some of the potential impacts on cancel culture, specifically in healthcare trainees, and how do you think that we should sort of approach that moving forward?
00:14:09
Speaker
I do think we are too quick. really like how you framed your initial. Oh, go ahead, Tawini.
00:14:15
Speaker
Sorry. I do think that, you know, we are too quick as a society to cancel people. I think sometimes like when, you know, ah TikTok video pops up and then it's like not in everyone's favor, you can only explain yourself so much in a video, you know? So...
00:14:33
Speaker
people just take that you know clip, cancel you, propagate stuff. People are doing duets and everything to your TikTok, and then they're canceling you from that. you know So I do think we are too quick to cancel.
00:14:46
Speaker
um And I think people should have more of like an independent mindset. And I think not everything is so black and white either. There'll be some times where I'm like, I agree with this, but I also agree with what the other side has to say.
00:14:59
Speaker
But I think sometimes society doesn't always leave room for gray it's like either you're a radical this or a radical that um and if you're not on one side of the other then you're canceled so i just keep my mouth shut on a lot different i mean some things are right and wrong but there's some things that are just like i don't really have an opinion and i think it's okay not to have an opinion on something so
00:15:24
Speaker
chanassa i feel like you're about to say something too right before do maybe Yeah, was going to say that, I mean, in this day and age, everyone has a microphone and you know everyone has a device, which does come with its own peril.
00:15:40
Speaker
um I do really believe that we should embrace diversity of opinions. I mean, I don't believe in hate speech or anything like that, but I just feel like we are too quick to, i think we're just quick to dismiss opinions that don't align with ours.
00:15:58
Speaker
And the reality is that we're we're just not all the same people and it's okay um to have different opinions. So i I feel like we've just become so extreme and finding in a way that embraces that difference or a way that that promotes healthy communication.
00:16:19
Speaker
i hear you, but also this is what I think kind of deal would probably help off society a lot. Yeah, I'm probably on the opposite side of this conversation in terms of sometimes some of y'all need to be canceled. Oh, for sure. Yeah.
00:16:36
Speaker
um And i think that
00:16:44
Speaker
I think now cancel culture has come of has kind of become a buzzword where people are like, oh, like y'all are too quick to cancel people, y'all too quick to cancel people. But some of y'all need to be controlled.
00:16:56
Speaker
Some of y'all have very chaotic opinions. And the only way that you're getting policed is if everybody's like, yo, that's a little wild. Like you probably shouldn't say that. AKA my girl from the earlier topic.
00:17:10
Speaker
If nobody was like, oh, like maybe that's a little wild that you're talking about your students like this. She probably would have kept doing it. She wanted to do a part two. So I swear I was to say, maybe she doesn't need to be off of the internet completely.
00:17:28
Speaker
However, sometimes
TikTok and Diversity in Wellness Spaces
00:17:30
Speaker
there are people that live in their own societal bubbles and they don't see outside of their own communities or see outside of their own upbringing, whatever is their sphere of influence.
00:17:42
Speaker
And it is not until they hear the opinions of other people. And honestly, sometimes it could be the majority of people's opinions that they're like, oh, maybe i was a little off base.
00:17:56
Speaker
um I do think it can go too far. I do think that it can kind of go in the opposite direction too, where you have opinions that um kind of silence, you know, people that are on the margins and they become louder and they don't let other voices speak.
00:18:14
Speaker
But I think that in general, Like social media, I guess, has allowed people that usually wouldn't...
00:18:26
Speaker
um that usually wouldn't ah have gotten reprimanded. i think it lets them have some sort of public, like, oh, like you need to pump the brakes before you say things. So I understand that sometimes it can go too far, but I do think it has a place because I think that there's sometimes where people may or may not know that they're doing things that are offensive and they need to reel it in.
00:18:54
Speaker
You know on TikTok right now with Pilates by Raven, that girl who was talking, you know she was on Love is Blind. She's the one that was married or like engaged to SK.
00:19:06
Speaker
And she does Pilates. and Is she South Asian? No, she's not South Asian. She was the one that was like mixed And SK was like from Ghana or something like that. ended up. Oh, oh yeah. Yeah. Yeah. So like, she's currently getting canceled right now because she said Pilates is like a bodega bag and it's not accessible and it's not diverse.
00:19:28
Speaker
And it doesn't need to be diverse because it's not for everybody. So now all these people in the Pilates community are canceling her saying that, what do you mean? Pilates is not diverse. Pilates was made for Pilates was made for prisoners. That's where it originated from. And y'all gentrified it.
00:19:43
Speaker
um she compared Pilates to a bodega bag and said, when you go to the bodega store, do you um do you see diversity there? No. So like, why would you see diversity in Pilates? I'm like, Pilates, ain't that just bricks and springs? You lost me from the bodega part.
00:19:59
Speaker
Right. Like, that's crazy. Yeah, and I'm like, it's Bricks and Springs. Like, I'm confused about the exclusivity of it all. Like, it's homemade devices doing homemade stretches. Like, I'm not really understanding.
00:20:12
Speaker
But she made it seem... Like, now people in the Pilates community are canceling her because she's, like, not very divert. Like, she... She's trying to make it inaccessible. and Inaccessible because it's not supposed to be accessible. It's not supposed to be diverse.
00:20:24
Speaker
So one, it was kind of like, oh, you're confusing diversity with exclusivity. like You're saying that like diverse backgrounds can't afford this, which is not true. They were talking about more of like a socioeconomic diversity, but she was bringing up you know other types diversity that no one really was talking about like that's not no one said she put her foot in her mouth and she's in diversity so i'm a little confused what she's talking about but she didn't take an africana class in college clearly definitely not she's a little confused classism and racism does not equal yeah and so she got a little confused trying to eat they can be intersecting so i can see it
00:21:04
Speaker
They can intersect, and I feel like... But she's literally the intersection, and she missed it by a lot. like Like, she's a black girl in Pilates. Parallel. like She's, like, literally the intersection, and she, like, myical she missed her turn completely. She's in a different state now. Like, she lost her weight. Like, a thousand miles in the wrong direction.
00:21:26
Speaker
She hasn't made an apology video yet, so i'm assuming she's, like, standing on it, but... The poor Pilates community is shambles right now over what she said because they're like, how dare you?
00:21:37
Speaker
We include everyone in Pilates and blah, blah, blah. So, yeah. That's the most recent cancellation of notes.
00:21:48
Speaker
Yeah, see, we got to reel people in. i' I'm sorry. Go ahead. Go ahead, Shanasa. Where is the opportunity to actually have that conversation? Because I feel like if it's if the internet is this place where you you're you're just canceled, then I feel like we're going to get to a place where people don't even voice their opinions anymore because it's almost policed.
00:22:11
Speaker
In that case, people are problematic. because i like They shouldn't. Can I just say this real quick?
00:22:23
Speaker
We love saying people are canceled. We really do. People come back like cockroaches every day. There hasn't been somebody that was canceled for real.
00:22:34
Speaker
Jobs, all these things. Like it's, I mean, it's just problematic. I don't know. Okay. Let me say so there hasn't really, really, really been a celebrity. i don't know about lay people. There hasn't really been a celebrity that was canceled that low key didn't make a comeback.
00:22:48
Speaker
Literally people still talk about. Hasn't come back in a long time. Where is Tiffany Haddish?
Mental Health and Public Perception
00:22:56
Speaker
It's only a couple that it works on. It's only a couple. I stand on that. he Even the podcast.
00:23:03
Speaker
I Googled her. They couldn't even find her. They're talking about Tiffany Haddish. I was like, wait minute. Hold on. That name sounds familiar. Exactly. Like, it's so crazy. It really only works for randoms. Like, it's its sometimes there's just a little recipe that goes into it, and then next thing you know, poof, you never hear from them again.
00:23:24
Speaker
But honestly, mm-mm. DaBaby's still big in Charlotte a little bit. He still the does what he needs to do, DaBaby we're talking about. But yeah he got I don't know Even the worst himself, Robert Kelly. People bring him up. there They're trying to bring back that video of him in, like, Ethiopia or something, like a TikTok sound. they keep using it in jokes. America. So. hello
00:23:52
Speaker
I don't like them, but. Like, it's crazy. So i don't know. i i Like I said, I think I'm on the opposite side of the opinion. Yes, I do think that there should be a limit to cancel culture. But I do think there is a place for, you know, calling people out, you know, in a way that could or could not be helpful. What about the mental implications of all of this?
00:24:16
Speaker
Yeah, that is. If you apologize, I'll let it go. They're like, you know, they're sorry. Like, they didn't know. They read up on stuff. They educated themselves. They went on CNN and did an apology tour.
00:24:26
Speaker
probably are me like a sigh like Yeah, that's when I think it goes too far. If there's, like, genuine remorse and change, like, and y'all are still like, I hate you. That's crazy. Yeah, like, then that means something's wrong with you. Yeah.
00:24:41
Speaker
Like, let it go. Or just, like, you know, you don't have to hate them. Just don't. Unsubscribe. I followed my uncle the other day. Like, he was just doing too much. So, I did what I had to do. Unsubscribe. What unc do? What unc do, dude? You know, in Nigeria, like, you don't just be posting nonsense. Like, you know what's going on. Like, you don't know what's going on here in U.S. You don't.
00:25:02
Speaker
Was it WhatsApp? No, it was Facebook. What are you talking don't what you're talking about. Go pay your school fees, man. know what you're talking about. I'm dead. have to just unfollow him.
00:25:13
Speaker
It's okay, though. Much love, but i just can't subscribe. Sorry to the Mabie's uncle.
00:25:24
Speaker
Well, I guess, yeah. I mean, at the end of the day, we just have to think about what what works for us, I guess, what works for our own sanity. I do agree with you, Samisa.
00:25:36
Speaker
um i wanted to push the boundaries a little bit, but I think there's a place in calling people out and checking them, you know? but I think we also have to have to balance a space for healthy conversation a space for making those changes, having accountability and, and then, you know, adjusting behavior according to accordingly.
00:25:56
Speaker
Exactly. And no cyber bullying. This is not what I'm advocating for. Let me be very clear. You can call people out and not attack them. Yep. Jesus did it. So can you.
00:26:07
Speaker
Oh, Oh, Oh, lord
00:26:15
Speaker
But speaking about just mental wellness in general, y'all, I don't even know what's going on in our society anymore.
Ethical Challenges in Therapy Boundaries
00:26:23
Speaker
But y'all probably heard about this lady, Madam Kendra Tilti. I apologize if I'm not saying it well. That's crazy.
00:26:33
Speaker
She... But, you know, Madame Kim on TikTok and was detailing this journey she had as a therapist and how she claimed that the therapist was aware that she was falling in love ah with with him and continued the relationship.
00:26:50
Speaker
um And it's just interesting to see that her experience like sparked controversy. Some people, especially the psychiatry world and profession, started coming online and sharing your perspective on whether they thought that there was anything wrong in a doctor's practice.
00:27:08
Speaker
um I don't know what she was expecting to come out of her detailing that journey. Personally, when I was thinking about her experience, I feel like one of the questions that came to me was that, I mean, how did she know for sure? Because i don't really recall anywhere where she...
00:27:26
Speaker
She mentions explicitly asking you know him directly. So for all I care, this could all be in her head. ah but That's just me. So I want to know what you guys think about this situation.
00:27:40
Speaker
Yeah, she was dead wrong for that. like And the thing about it is healthcare professionals don't get caught up in this stuff like because HIPAA is still a thing. he couldn't yeah The that's really annoying about it is that she was saying all this nonsense that didn't happen. It was all in her head.
00:27:58
Speaker
yeah she's you know And she knows it's not true. Everyone's like, oh, she's schizophrenic. and like I don't diagnose people. I don't know. Yeah. left that long time ago. i don't even know what that the DSM five criteria is anymore for that.
00:28:11
Speaker
But what I do know is that she knows exactly what she was doing. She knew exactly what she was doing. She's going alive, saying nonsense. And then you know what the doctor can't even do. The doctor can't even defend themselves because it's HIPAA, but she was exposing him saying all, you know, like it's supposed to his name, where he worked, all this stuff, but we cannot do the same.
00:28:30
Speaker
And that is where I have the problem. Because imagine it like if one of your patients comes out there and you're like, I think they're talking about me. Then they say your name. Then they're detailing your conversation. They're revealing their own HIPAA.
00:28:42
Speaker
And you can't even defend yourself. defend you know what you have to do? Doctors, young doctors out there, you have to get your lawyer and you have to saddle up. Because like people like that need to be like canceled. Like what Samiza was saying. They need to be canceled.
00:28:54
Speaker
That's crazy. I would sue her. I would sue her pants off. I don't care what type of... illness you think you may have, whether it's in the genome or not, in your hippocampus. I don't know where it is. But what I do know, she crossed a boundary. She crossed a boundary. She's over here using words that have never been used before.
00:29:10
Speaker
I don't know. DSM-5, I'm not sure. What I do know is that she's weaponizing her mental illness for incompetence and That's what I think it is. I don't know what her mental illness is, but she's making it seem like he was preying on her when he was just being a good psychiatrist. And she couldn't even, the thing about it is that she had no insight to how she was because even things that she was saying wasn't even in her favor. i and You know what I mean? Like you didn't even flip the story to being your favorite. My mental status exam, she said the insight was poor.
00:29:45
Speaker
was very poor. It was lackadastical even. Like I...
00:29:51
Speaker
um Yeah, you know, i just, it's baffling to me, honestly. But again, but again i Yeah, I don't know. when i When I saw the story, I thought it was very chaotic. I feel like it's all of like the long-form TikTok stories that happen. like you know People just tell like these crazy stories over like and insane amount of videos.
00:30:19
Speaker
And I guess this one kind of like hit a little different because you know obviously it deals with like a community that we're a part of. But yeah, I don't know. In this situation, I guess it's different because...
00:30:35
Speaker
Plus or minus this is like you know her her her mental illness, like talking and whether or not like she's in control of like these delusions that she's clearly having, versus like how many times in the hospital like are you put in sort of like a compromising position in a patient.
00:30:54
Speaker
like hits on you? Like, what do you do? So I think from that perspective, it was interesting to see, I guess, flipped for me because obviously I'm a woman and like to see it kind of put on a man was a little different.
00:31:09
Speaker
But either way, it just shows that When you are dealing with patients, no matter the specialty, but especially in something like psych, like you have to be very clear yeah about like how you speak to your patients and sort of like the level of familiarity and boundaries.
00:31:28
Speaker
Because you what you do not want is to get that message misconstrued at all. Right. even in GYN, have your chaperone. Don't play around. Don't think, Oh, I'm a lady. This is a lady. I'm going to do a exam. You better have your chaperone. Yeah. That is true. Cause people will play in your face.
00:31:47
Speaker
You thought it was a lovely encounter. You did her pat smear. Nice. You know, you're on the news. I'm just saying like, you have to be careful. You do have to be careful. Like, you have to protect yourself, protect your license, um have witnesses, document everything.
00:32:02
Speaker
um I guess, how do you avoid being cold? He wasn't cold at all. Like she just took it all the wrong way. Like she built a proper rapport and she went overboard with it, you know? So, um,
00:32:15
Speaker
Always, yeah. Have your chaperones in the room, cover yourself, document your stuff, have your MA, nurse, wherever. um And if you feel like, you know, the patient's acting a bit, you know, whatever, you have to two chaperones. Make sure your med student's in the room. Make sure another MA's in the know what i mean? Like cover yourself because um especially as a physician and like sensitive specialties, you want to make sure that you're doing the right thing.
00:32:41
Speaker
People will see you doing the right thing. And then patients know that they can't try you in those regards because you have all your documentation to back it up. But then I think that's the thing about this case that's just so murky. Right. And I agree with everything that you said. In fact, I remember doing an OSCE and we had to do rectal exams and stuff. I was like, yeah, never mind.
00:33:02
Speaker
ah Euro, GYN, everything below the chest is not going to work for me. i We're not doing that at all. I did a DRE today. Yeah, that's the thing that's so tricky. This is psych.
00:33:15
Speaker
we We do want the patient to be able to feel like we're being empathetic. We're listening to them and and you know stuff like
Loneliness and Doctor-Patient Relationships
00:33:22
Speaker
that. So I guess like how else would you have even... i just feel like it's not really crystal clear, right?
00:33:30
Speaker
Because it's not like you just bring a chaperone due to the privacy constraints that occurs in these type of kind like conversations. yeah I think when speakings to the in one speaking about the psych setting, perhaps, um I feel like it's just a little bit more gray.
00:33:49
Speaker
And a part of me just wonders if this case showcases how lonely we even are in general, like just a broader picture of how how loneliness is a problem in the West. um you know, how socially isolated we are. And to the, to the extent that the only kind of connection that we, we feel is, is one that we have with a health professional.
00:34:14
Speaker
That's a little bit of a bar. Dang, that's kind of sad. but It's kind sad. Yeah. And I think I just want to highlight Dumebi's point about documentation.
00:34:27
Speaker
Like, I think that's one of the biggest lessons I'm learning or i guess feeling intern year. Like, obviously your notes matter. Like, as soon as you start writing notes as a med student, but I'm now really feeling the weight of I signed this note, my name's on it.
00:34:46
Speaker
What did I put in here? Right. And right now I'm like at the VA and for real, you can't change a note once you sign it. Once that thing is signed at the VA, just know that it's been sent to the president. It's gone. It's been sent to the president on his desk.
00:35:03
Speaker
It's at 1600 Pennsylvania. Like you cannot get that thing back. That thing is the only addendum literally means addendum. It's just a blank sheet that is also attached.
00:35:21
Speaker
What did you have to add to this note that you already put in every typo? Make sure it's correct. Epic, maybe even Cerner, they'll let you do a little edit.
00:35:32
Speaker
I addend five times in Epic. Addend, and it's just perfect. They can see how many times you addended it, but your note that you want before it's co-signed is good.
00:35:43
Speaker
Yep. I sent my first note in at the VA and I said, oh, hold up. You were serious. I can't change my mind. Okay, okay, okay. Good to know. Good to know. Yep.
00:35:56
Speaker
So goes back to, and I think it's the same thing with the psych patient and this sp psychiatrist. I think they probably know this too, and they're probably told about it a lot. Like everything that goes in that mental status exam, everything that's in their HPI, all of it, assessment, everything. Like you have to write it to a T because there is no other like marker of what you did, right? Besides what you guys spoke about and like medications.
00:36:25
Speaker
So, but I agree with you that in general, there is a problem with loneliness in the country for sure.
00:36:35
Speaker
And that's why maybe she should do things like group therapy so other people can witness to make sure that, you know, it was what it was and it wasn't what it wasn't. Yeah. And she can talk to more people that are struggling with things she's struggling with too.
00:36:51
Speaker
i agree.
00:36:56
Speaker
No.
00:37:05
Speaker
Oh, sorry.
Understanding Uterine Fibroids
00:37:07
Speaker
Okay, and um because I'm a gynecology resident and because this is near and dear to my heart and I geek out over this type of stuff, in one of the Run the List episodes, we talked about uterine fibroids. And for those who don't know, uterine fibroids are a non-cancerous mass that many women experience on their ovaries.
00:37:26
Speaker
um Usually, it's around like the premenopausal time. um There are like four main symptoms of uterine fibroids, including dyspareunia, heavy menstrual bleeding, infertility, and bulk symptoms. Sometimes you have constipation or feel like it's against your bladder or um you feel kind of full or you get um like when you're, you don't eat a little bit and you're like already feeling bloated and distended.
00:37:52
Speaker
And I feel like fibroids are something that we all talk about, but it's,
00:37:59
Speaker
I guess not talked about enough. A lot you are asymptomatic. They have fibroids and it doesn't really bother them. It's an incidental finding on like an ultrasound or a CT that they get. And there are some people that are really debilitated by fibroids. And as a gynecology resident, I've seen it kind of on all the spectrums.
00:38:14
Speaker
And what I've really been learning about during my first and second year in gynecology residency is how do we counsel about treatment of these fibroids? I think a lot of people, like i was talking about in the beginning, like you think, I mean, I don't have fibroids, but people think that they have to live with certain conditions that are treatable.
00:38:32
Speaker
And with fibroids, there are various different treatment options available. And I'm not your doctor. I'm not your gynecologist. I'm not saying what you should do, but I am saying what you can bring up to your gynecologist if these things interest you.
00:38:45
Speaker
um So first you kind of want to know With uterine fibroids, like, do you want to have children in the near future? do you not want to have children in near future? And that can kind of determine your management on the fibroids.
00:38:57
Speaker
And also, what problem is the fibroid causing? So if your issue with the fibroid is that you're having heavy menstrual bleeding, you can do things as even as like birth control or removing the fibroid or you know, there's some like, um, ultrasound guided ablation procedures now for fibroids.
00:39:16
Speaker
Um, so you can still like kind of keep your fertility, but then help remove the fibroid or at least manage the symptoms of the fibroid until you get to menopause. Now, for those who don't want, you know, children in the future, there's the definitive option, like a hysterectomy, but they're also like uterine artery embolizations that you can try.
00:39:33
Speaker
And then also being on a, giiani G-N-R-H agonist, like Lupron or something, um which can be on it for, I think, about six months or so. um So I guess my question to you guys is, I think they learn a decent amount about fibroids, like on our OB-GYN clerkship and things like that.
00:39:51
Speaker
um But I guess, do your family members kind of struggle with fibroids? um Do your patients struggle with fibroids? And I guess our attitudes towards it, like, do we need to be talking about it more? Do treatment options be more available for Black women? And how do you kind of get that word out there to the community?
00:40:08
Speaker
Yeah, um I kind of spoke about this a little bit on the Run the List episode, but I definitely have a personal connection to fibroids. I personally do. Well, I don't think I have them. I never heard nothing. I don't have any of the symptoms that you listed.
00:40:22
Speaker
But my mom had a really bad fibroids when she was pregnant with me, actually. And that was a really difficult pregnancy for her. And honestly, like, it wasn't.
00:40:33
Speaker
I definitely think they, like, advised her to, like, you know, terminate the pregnancy. um So like to me, that's always like something that I think about in terms of like what are those symptoms that she was having prior and like during and like after my pregnancy.
00:40:51
Speaker
I believe she ended up getting a myomectomy if I'm not mistaken. um but ah Yeah, so it's something that I always think about and like you know worry about myself. I think there's definitely other women in my life that have had fibroids, and it's like a constant thing that I've seen throughout my childhood, um people struggling with them. So I think it's always been a like a very common topic in my family, but I think it's because of such a high burden that I've experienced with it personally.
00:41:23
Speaker
um so it's something i' I've always been like really... keen to.
00:41:29
Speaker
i think for me when I think about fibroids we already know that this is very prevalent especially amongst like African-American women I think the question that i always have is why is it still um such a big issue and I would just wonder if there just isn't a lot of just not a lot of intention when it comes to doing research and this like in this field because I feel like when you compare it to you know cardiology and stuff like that um
00:42:01
Speaker
there are like several options. I guess bottom line about, but the bottom line i'm so of what I'm saying is that I feel like there should be a lot more options. And is i don't understand why we're not really investing in doing more research into this issue. And I wonder if it's just because it just affects African-American women more.
00:42:24
Speaker
um I do you know of several people, including my aunts, my friends who just have heavy bleeding. And I just feel like in age of modern medicine, see medicine 2025 for such a common issue, you know, i want to see all the papers.
00:42:43
Speaker
We need more money. We need more research dollars because this is really affecting black women. And that's all have to say. Yeah, I would say that just hit home. Like, it's just a personal, um this is such an issue. A lot of people are just out there. It does affect, in fact, i have i had a close family friend who did the myomectomy, the surgery, um and then she passed away, you know, and she was doing that to prepare prepare for her pregnancy, to increase her success for pregnancy.
00:43:11
Speaker
um I just feel like this should be a call for us to just invest more in in this and such a common issue that that really, really affects Black women.
00:43:24
Speaker
Yeah, for sure. i i think there are a lot of options. Like, i guess from what I've seen in residency, I think people, it's accessibility to the options that are present. I think that's like also a big issue because like there's hysteroscopies, there's myomectomies, there's sonata ablations, there's endometrial ablations.
00:43:45
Speaker
Um, there's, you know, full on hysterectomy, um, birth control options, um, GNRH antagonists, agonists, all those things. I just think it's about like people recognizing that it is a problem, finding a gynecologist who specializes in like minimally invasive gynecologic surgery that's able to do extensive myomectomies while preserving fertility is also like a big thing too.
00:44:09
Speaker
And then also, um like, I think the main thing is like, I mean, everyone can get like a hysterectomy, right? But like, it's just like, I think the main thing is like fertility sparing options for women who suffer from like these multi fibroid uteruses.
00:44:26
Speaker
um I think that's like where we need to put like, more of our time and attention to. And just kind of like screening for that, like even in primary care, like I think it's you know like i don I don't remember my primary career ever asking me like the quality of my periods.
00:44:42
Speaker
You know what i mean? like Never asking me, like are they heavy to you? Are they light to you? And I think doing those screening questions um first, and like kind of assessing like is heavy menstrual bleeding like a problem, you know, for women and then going from there, it's also like super important, like just asking those baseline questions because a lot of people don't even know what fibroids are, you know what I mean? They just know that they bleed through multiple pads a day and they have this cramping and bleeding and then they have bulk symptoms. They don't know how to really describe it.
00:45:12
Speaker
so i mean, I guess without getting too political, um Even when we think about the father of gynecology, right, Dr. Sins, a lot of the research that was done um just done based on experimenting on Black women. So I just feel like there's a distress in general um and that people like Black women just don't see that kind of like healthcare. care Because i did I did spend a lot of time, for example, doing even like breast cancer awareness and promoting that. And a lot of the narrative,
00:45:44
Speaker
that I got just interacting with like communities in Houston and Austin is that they just are not going to go to the doctor. So one, I feel like it could be an opportunity to, you know, really create that trust in the community.
00:45:58
Speaker
Because even if you have those options, but they don't trust the health profession as an institution, because one, you experimented on us when it came to major discoveries in the field of gynecology, then why will I trust you with my uterus today.
00:46:15
Speaker
i mean And then second of all, research itself in general doesn't even represent, it's not very representative of Black women. So even if we have these medications, I beg the question, about who are the research participants. So those medications may not necessarily be as effective um for different groups of people.
00:46:35
Speaker
So I just feel like there just needs to be more work done in general because it's so, so common. um I think we just do better as a field.
00:46:51
Speaker
ah Yeah, I definitely do think that um More research just needs to be done and um research should be representative of the population that it's impacting for sure.
00:47:02
Speaker
um And that's why I encourage, you know, all women go to your gynecologist, speak about your concerns. You never know like which things are benign and which things are not benign. Like things that may seem normal to you and your family may be something different, you know? So I think you know, go to your gynecologist, your family medicine doctor, anyone really.
00:47:24
Speaker
Um, and just talk about your concerns, talk about your periods. Heavy menstrual periods are, you know, subjective. Like I don't weigh your menstrual pads when you tell me your periods are heavy. I have no choice, but just to believe what you say because it's your body, you know, so get those things worked up.
00:47:39
Speaker
Um, you don't have to go full on surgery if you don't want to. They're very like many other options. Sometimes birth control helps the symptoms until you reach menopause and that's totally fine. Um, But I think all options are worth exploring.
00:47:53
Speaker
um And don't take no for an answer. You find a surgeon that can't do it for you, you know, go to another gynecologist who can.
00:48:04
Speaker
Well, thanks so much for tuning in into Unscripted. And be sure to tune in to future conversations I'll be having here on FNMA Presents The Lounge.
00:48:20
Speaker
Bye.