WEBVTT
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Welcome to Pack and Forth, the official podcast of the Physician Association of California.
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We're here to protect the future of private practice.
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This show is for independent physicians, policymakers, and patients.
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Really anyone who cares about high-quality health care.
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We explore the issues shaping independent medicine in California, from policy debates to office administration and innovation.
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Let's dive in.
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Welcome back, everyone, to another episode of Pack and Forth.
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This is Matt Robinson, the CEO of the Physician Association of California, joined by my co-host, Alan Young, VP of Cobalt Public Affairs.
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How are you?
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Always great to be here.
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Thanks, Matt.
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Alan, who do we have today?
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Today we're joined by Dr.
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Haley McNear, an OBGYN and partner at Sacramento Women's Health.
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The office, based in Sacramento, is committed to delivering inclusive, evidence-based care for women at every stage of life.
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Dr.
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McNear, welcome to Pack and Forth.
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Thank you for having me.
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So, Dr.
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McNear, again, thank you for taking the time today.
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I uh heard you had somewhat of a busy long day.
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Uh, I wanna want to talk a little bit about it.
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Oh, yes, we just had an operating room day today, and we um had a very uh large uterus that needed to come out.
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So it was a very uh we ran a little late, but uh we did accomplish that laparoscopically, so the patient will go home today and do really well.
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So we're we're proud of that.
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But it was a long day.
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Well, again, we very much appreciate you taking the time.
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Uh uh I mean it's it's it's great knowing that you're uh able to spend the time with us, with our audience, and so forth.
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We got some uh good topics going today.
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So, Alan, you want to start it off here?
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Yeah, thank you, Matt.
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Our main topic today is misinformation in healthcare and how to address it.
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Before we talk about the negatives, Dr.
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Meneer, I want to actually play devil's advocate and ask when, if ever, is there a benefit to a patient doing their own research and coming in just uh, yeah, I've I've read about this and uh I'm up to speed on it.
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Does that is that ever beneficial?
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Um, I mean, definitely.
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Like I think in general, um the more educated and aware a patient is of what their options are and what works for them, the better the discussion can be.
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Um, you know, the there's always been a variation in what a patient comes into the office wanting to hear.
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Sometimes they already know what they want and they're just looking for you to facilitate that.
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Sometimes they have no idea what their options are and they want you to go through everything.
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And I think um it's definitely there's more information out there, but I don't know that it's necessarily too much different, I guess.
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Like we've always had a mix of a mix of um patient education needs.
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And I think one of the main your main jobs as a doctor is to figure out where the patient is at and just meet them there.
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So, I mean, like with that said, though, Dr.
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McNair, I mean, you said, you know, this is typically like a very positive thing.
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Are is there ever time or like ever moments, like certain publications, so forth, where you know this is actually problematic, burdensome, right?
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Where this person is just adamant, whatever they read, right?
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You know, that they're they're the doctor, or you know, they have a they have a friend, a cousin whose best friends, whose sister's a doctor, and they told them this, you know, any anything like it in that regard where you know this is actually like somewhat of you know a barrier to what you're trying to do, you know, with you being the physician delivering delivering the care?
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Um, I mean, yes, I think uh there's always gonna be times where you may not agree with what a patient wants to do.
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Um, but I think, you know, when you're training, one of the main things that you have to keep in mind is like patient autonomy.
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So sometimes it's very easy to get extremely frustrated with uh someone who maybe you think isn't isn't looking at the whole picture or is getting bad advice or wouldn't do what you would do.
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But at the end of the day, like I'm a consultant and they are coming to see me for my opinion.
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Um, and I, you know, the whatever outcome they have is ultimately kind of up to them.
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So there's a little bit of like, I'm gonna educate the best I can and try to correct anything, any like, you know, um fallacies or like things that I'm like, well, really, that's not a correct fact.
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But at the end of the day, like people get to decide what happens to their own bodies.
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So I you kind of have to like let go a little bit.
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Totally.
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And you know what?
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I mean, that's like something you know I hear all the time, uh, whether it's you, uh other physicians, like in all specialties, right?
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Especially within private practice, like having that autonomy, that that that physician-patient relationship, like that direct relationship.
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I mean, no middleman, but that's like something that's off obviously, you know, very important because it's the physician wanting to have those real conversations with those patients, right?
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And it is it does make it actually that you know that more authentic, where you are talking through, or as you said, right?
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You're consulting through um in in many ways.
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So you did just touch though upon something and just you know, interested in this because uh uh you know, obviously you're you're very well versed, like very well experienced.
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Is there though any I would say, you know, myths in a way, like myths out there that you see with your patients?
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If there's one thing in particular that you could debunk with the patients uh that you know you see, like what would that myth be?
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You know, I actually think the myth that bothers me the most is that your doctor is that you you should have to fight with your doctor for what you want.
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Like, we get a lot of women who are told on TikTok or Instagram or whatever, your doctor wasn't trained in this and they don't know what they're doing.
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And so you have to come in and tell them, like, no, you have to do this.
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This is what I learned on my and um the reason that most of the time this is sort of being um those two reasons this is kind of being perpetuated online.
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One is that the less a p somebody trusts their own doctor, the more they're likely to take the advice of this person online who is typically trying to sell something: a program, a supplement, a uh a consult, a, you know, so the less you rely on your other sources of information and expertise, the more you're gonna trust this person.
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And then the other piece of that is um, you know, there are women especially have felt very dismissed in the medical community in the past.
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So there is a piece of this that you have to really understand.
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Like, there are a lot of patients that, you know, have had say extremely painful periods for years and years, and they were always just told, like, suck it up, you're being a baby, like you're fine, and then comes to find out like 10 years later they get diagnosed with endometriosis, something like that, you know.
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So I do think that there's a mix of like the death of expertise a little bit.
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Like we um you your doctor doesn't wasn't trained in this and doesn't know, which isn't true.
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Um, or uh, and um feeling like they have to fight to be heard.
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And so you have to sort of separate those two things out.
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Like, hey, I am listening to you, I hear you, but also this supplement is not going to fix this, or I don't think this lab test is gonna help us.
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So I don't really want to order it.
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Like, you know, at the end of the day, this is not a McDonald's.
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Like, it's my job to provide good care, and that means ordering the tests that I think are appropriate and, you know, offering treatment options that I think are appropriate.
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And at the end of the day, if they don't like that, like you're welcome to get another opinion, you know.
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We're gonna touch on best practices uh later.
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One thing I want to talk to you about is specifically the topic of menopause information.
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Now, Matt and I are a couple of bros, right?
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But we're both married guys.
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And uh uh, you know, in in with my wife, her friend group, one thing that's different now than I think than 10, 20 years ago is they're being inundated with a lot of information on Instagram about paramenopause.
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And I'm curious, just what's your experience on this topic and the conversations you have with patients?
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If you could see my uh residency training group chat, um, this this has been a hot, a hot topic.
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Um, you know, it's really interesting.
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Like I would say two to three years ago, I probably never heard the word perimenopause come out of anyone's mouth in my office.
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Nobody.
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And now it's like I have 35-year-olds coming into my office and being like, I want to get ready for perimenopause.
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I'm really worried.
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And I think um, you know, you can actually, one of my friends actually looked at the you can look at Google search terms and see the how they change over time, and you can actually see, like maybe two, three years ago, perimenopause just goes like this, and then in the last year, it's like wild how much people are searching for this.
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And I do think that it's extremely valuable that we're talking about menopause and perimenopause.
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And I do think a lot of people have a lot of really bothersome symptoms, and I'm all for talking about them and understanding them and treating them.
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But it's a very predatory market.
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Almost all of those accounts are selling something, a supplement, a book, a weighted vest, uh, you know, and they're making people really anxious.
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Like, it's kind of crazy to me how worried everyone is that they're gonna not do something right and then have a really bad outcome.
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And I have to remind them that perimenopause and menopause is not a disease, it's a life stage.
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And so, like, there is no urgency to this, like, we have to do everything right or my bones are gonna turn to dust and I'm gonna shrivel up like an old prune and die.
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It's like, okay, calm down.
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Like, there really is this, like, I do, I just think it's contributing to a lot of anxiety people have.
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I do think the world in general is just making people anxious these days.
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And one thing people feel like they might be able to control is their health and how they feel.
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So, I mean, that is one of the big myths too, that we're being that patients are coming in and they're being told on the internet your doctor didn't learn about menopause.
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They got one lecture in in training, and they that's why you need to go online to MIDI health or um, you know, order this supplement or buy this book or you know, pay for this training program.
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And the reality is that we are trained in menopause, and people who have a specific interest in it or want to know more get continued training.
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Like it's um, you know, doctors are lifelong learners, and so we we spend all a lot of time investing in finding out more and learning more and kind of riding this wave along with our patients.
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So it's been um it's been a uh an overwhelming journey a little bit, the perimenopause uh boom, shall we say?
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I don't know.
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Um I mean, I myself am a 43-year-old woman, so like I'm like I'm here with you, but it's just I don't know that it's as um as urgent as the internet makes it seem to people.
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And I feel I feel like it uh sad that women feel really like worried that they're gonna do it wrong, you know?
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It's just another thing for women to have to worry about.
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I don't know.
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Well, yeah, it's it's it's funny you were you were just talking like kind of like like the the Google boom and evolution and like so forth, like how like terms have changed and so forth.
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So I actually just saw a recent report, uh, Dr.
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McNair, where uh I think it was like w through open AI, I believe, where 25% now of all the consumers um that are on open AI asking questions actually relate specifically to healthcare questions, whether that's in public health, diseases, insurance coverage, you name it.
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But that is just absolutely just you know astonishing, right?
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Where I mean, you know, people are wanting to learn about certain things, right?
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And they're actually you know somewhat putting trust in open AI um uh over the physician themselves, right?
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Who has been trained, has the expertise and so forth.
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So um how how do you find that you know with you know your balancing act, right?
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Because you know, you're you're doing best practices with the patient when you're consulting them.
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How are you in in a way having to explain to them at certain times where hey, I you know, I I'm not saying I should tell you exactly what you need to do, but hey, I'm the knowledgeable one here, I'm the expert.
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Um, like in a in a very diplom in a very diplomatic way.
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Yeah, I think um I think some of this is reassurance.
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Like, yes, I I do have education in this.
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Um, one of the benefits of private practice, I would say, is that the majority of my patients I have a long-term relationship with.
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And so a lot of them actually do come to my office.
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Hey, I read this online.
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What do you think about that?
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And I really appreciate that because I do think they feel like they can trust us.
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And I know this is the same for my colleagues.
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Like, um, do I need to be doing this?
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Am I missing something?
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Like, is there some, you know, I I think, um, and I'm grateful when that happens.
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I I think it's important to explain to patients, like, what does the data actually show us?
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Like, what do we actually know?
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Um, and sometimes I pull up papers for them.
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I'm like, hey, here's the current guidelines on testosterone use in women.
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Like, here's what we actually know.
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Um, because, and a lot of that does not make for nice clickbait.
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Like, it's it's always interesting to me when people say they they are doing their own research because it is hard to read a medical paper.
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There's a lot of statistical information in there.
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There's a lot of like study design that gives nuance to like, is this actually like something we're now gonna do for everyone?
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Or is this just an interesting piece of information that's gonna require, you know, more long-term follow-up for us to really know?
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Like, you know, is it appropriate to use hormone therapy for dementia prevention?
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You know, we don't know.
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There's some really interesting information out there about the brain and hormones, and but it's not that level of evidence is not there for like we should put everyone on hormones so they don't have dementia.
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Like, that's just not where we're at.
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But that's not how information is presented online.
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So I think sometimes just explaining to patients like the nuance and like, hey, you know, I practice medicine with these sets of guidelines, like I'm willing to, you know, talk to you about your symptoms and stuff, but that's just not what we're doing right now.
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Um, and I feel like most patients really respect a balanced discussion.
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I do think there are definitely those people who just show up and want you to do what they want.
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And it's like, okay, well, I'm either gonna do it or I'm not, and then you're welcome to go somewhere else.
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But I think um our field in general is really struggling with a lot of uh health inundation right now, and a and um a lot of it is just like predatory money making online, you know, like a lot of those accounts are just making money, getting clicks.
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Like it's it's kind of hard because I can see why people get sort of swindled is the wrong word, but like sucked in, you know.
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Well, you know, I it's um look, I'm I'm I'm a lifelong uh Sacramentan, you know, what went away to school, but you know, can came back here in Sacramento.
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You know, my wife, same thing, lifelong Sacramentan, went, you know, down to Southern California, came back.
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I mean, I can tell you though, um, and like like kudos to you.
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Kudos, uh, kudos to your partner, um, you know, Dr.
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Rooney and I and your other partners uh, you know, within your practice.
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It is amazing though, like what you just talked about, like, you know, your pride within, you know, being in private practice, independent physician.
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My wife, her friends, all of them, like they talk about you and your practice.
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Like, I mean, that is like the the best, right?
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Because I think it is because of like the credibility um and like you know, the energy, the time that you're able to spend with them.
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Um, you know, you're not on the clock.
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Um, you know, you're able to get have those intimate conversations with them.
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And you know, you have you have people who do have trust in you to say, hey, look at this.
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Um, you know, Dr.
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McNair, is this do you believe in this?
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Uh uh yes or no.
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So I think that speaks a lot to you.
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So like on that, you know, kind of want to end like in this part here, um uh Dr.
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McNair.
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No, you're 43 years old, still very young.
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Um, um I won't say how old I am, but uh uh you're looking way younger than I am.
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Uh so from you know, from med school, from residency and so forth, and like like very early on in your career to now, I mean, you obviously building trust, building a rapport with your patients is key.
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Anything that you can share, right?
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I mean, with specifically right, you know, our physician audience that may be listening, not just our patients, but you know, physicians as well.
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Like, what is something that you know you have learned or that's been helpful?
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How have you evolved in a way, especially you know, with information on the internet or whatever it may be over the years where you think you're, you know, in you're actually earning trust in a more effective and efficient and better manner now than you may have been um, you know, say 10 years ago.
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Um, I I actually think it kind of goes back to what we were talking about first.
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It it's um you can't get frustrated with somebody if they're just uh at a different place, right?
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So I think I used to feel really uh like if I could just uh say it in the right way, then the patient would do what I thought was best, which is kind of true, but also um I think true respect comes from recognizing that like I can give you my best opinion, but I also respect your decision to do what you want to do.
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And um, I think patients appreciate that because it's not about me at the end of the day.
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It's not about my agenda.
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It's like I you came to me, I'm a consultant, and um, you know, I'm gonna give you my best advice and what I think is best, but um you're free to do whatever you want, but not in an adversarial way, but in a little bit more of like, you know, hey, you are the boss of your own body.
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No one knows you better than you.
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And I'm I don't know you better than you.
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And so that sort of um feeling of like, you know, I trust you to do what's best for you, and you trust me to give you my best advice.
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And that's really the therapeutic relationship, right?
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Like, and sometimes um, you know, they come back to you later and they're like, you know, I tried that and it just didn't work.
00:19:01.200 --> 00:19:02.559
And you're like, oh, okay, cool.
00:19:02.640 --> 00:19:05.759
Let's try this other thing that I also thought was better from the first time, you know.
00:19:05.920 --> 00:19:09.519
So it's just you have to let people have their own experience.
00:19:09.680 --> 00:19:18.799
Like one of my um most helpful thoughts that I use when I get frustrated with a patient is I can let people be wrong.
00:19:19.119 --> 00:19:25.839
And and that is it, it works in a lot of places in life, but you know, I think especially during COVID, that was really tough.
00:19:26.079 --> 00:19:35.279
Um, you know, uh like I can't imagine what our poor pediatrician colleagues are going through right now with vaccine drama and like there's a lot of stuff.
00:19:35.359 --> 00:19:46.640
Uh obviously we advocate for what we think is right, and we, you know, um do our very best to know as much as we can and be as up to date and communicate effectively.
00:19:46.799 --> 00:19:52.799
But at the end of the day, like I have to let people be wrong if that's what they want to do.
00:19:53.200 --> 00:19:59.599
So I I think that a little bit of that more relaxed attitude is helpful because nobody likes to be fought with.
00:19:59.680 --> 00:20:07.039
And I think um, when as soon as you feel like you're fighting with your doctor, that trust is gone, and then that relationship is ruptured.
00:20:07.200 --> 00:20:10.640
So um it works for spouses too.
00:20:12.000 --> 00:20:12.799
Noted.
00:20:13.039 --> 00:20:14.000
Hey, thank you.
00:20:14.079 --> 00:20:15.680
Uh thank you so much, uh, Dr.
00:20:15.759 --> 00:20:16.880
McNair, for taking the time.
00:20:16.960 --> 00:20:18.079
And I know you've had a long day.
00:20:18.160 --> 00:20:23.039
I want to make sure you're able to enjoy a nice dinner, get some sleep before another busy day tomorrow.
00:20:23.119 --> 00:20:25.359
But uh again, very much appreciate all that you do.
00:20:25.519 --> 00:20:26.559
Um, so again, thank you so much.
00:20:26.799 --> 00:20:28.240
29 patients tomorrow.
00:20:28.480 --> 00:20:29.440
Oh boy.
00:20:30.480 --> 00:20:30.799
All right.
00:20:30.880 --> 00:20:32.400
Well, we'll let you get some sleep.
00:20:32.480 --> 00:20:33.279
Thank you so much.
00:20:33.519 --> 00:20:34.079
You're welcome.
00:20:34.160 --> 00:20:34.720
Thank you guys.
00:20:34.880 --> 00:20:36.880
I really appreciate all you do for private practice.
00:20:36.960 --> 00:20:37.920
It means a lot to us.
00:20:38.000 --> 00:20:40.880
There's not that many of us left, and we need all the help we can get.
00:20:41.119 --> 00:20:41.599
We're on it.
00:20:41.680 --> 00:20:42.160
We're on it.
00:20:42.319 --> 00:20:43.119
Thank you.
00:00:00.080 --> 00:00:05.200
Welcome to Pack and Forth, the official podcast of the Physician Association of California.
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We're here to protect the future of private practice.
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This show is for independent physicians, policymakers, and patients.
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Really anyone who cares about high-quality health care.
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We explore the issues shaping independent medicine in California, from policy debates to office administration and innovation.
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Let's dive in.
00:00:23.519 --> 00:00:27.359
Welcome back, everyone, to another episode of Pack and Forth.
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This is Matt Robinson, the CEO of the Physician Association of California, joined by my co-host, Alan Young, VP of Cobalt Public Affairs.
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How are you?
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Always great to be here.
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Thanks, Matt.
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Alan, who do we have today?
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Today we're joined by Dr.
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Haley McNear, an OBGYN and partner at Sacramento Women's Health.
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The office, based in Sacramento, is committed to delivering inclusive, evidence-based care for women at every stage of life.
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Dr.
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McNear, welcome to Pack and Forth.
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Thank you for having me.
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So, Dr.
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McNear, again, thank you for taking the time today.
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I uh heard you had somewhat of a busy long day.
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Uh, I wanna want to talk a little bit about it.
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Oh, yes, we just had an operating room day today, and we um had a very uh large uterus that needed to come out.
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So it was a very uh we ran a little late, but uh we did accomplish that laparoscopically, so the patient will go home today and do really well.
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So we're we're proud of that.
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But it was a long day.
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Well, again, we very much appreciate you taking the time.
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Uh uh I mean it's it's it's great knowing that you're uh able to spend the time with us, with our audience, and so forth.
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We got some uh good topics going today.
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So, Alan, you want to start it off here?
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Yeah, thank you, Matt.
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Our main topic today is misinformation in healthcare and how to address it.
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Before we talk about the negatives, Dr.
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Meneer, I want to actually play devil's advocate and ask when, if ever, is there a benefit to a patient doing their own research and coming in just uh, yeah, I've I've read about this and uh I'm up to speed on it.
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Does that is that ever beneficial?
00:02:07.519 --> 00:02:08.719
Um, I mean, definitely.
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Like I think in general, um the more educated and aware a patient is of what their options are and what works for them, the better the discussion can be.
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Um, you know, the there's always been a variation in what a patient comes into the office wanting to hear.
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Sometimes they already know what they want and they're just looking for you to facilitate that.
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Sometimes they have no idea what their options are and they want you to go through everything.
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And I think um it's definitely there's more information out there, but I don't know that it's necessarily too much different, I guess.
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Like we've always had a mix of a mix of um patient education needs.
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And I think one of the main your main jobs as a doctor is to figure out where the patient is at and just meet them there.
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So, I mean, like with that said, though, Dr.
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McNair, I mean, you said, you know, this is typically like a very positive thing.
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Are is there ever time or like ever moments, like certain publications, so forth, where you know this is actually problematic, burdensome, right?
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Where this person is just adamant, whatever they read, right?
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You know, that they're they're the doctor, or you know, they have a they have a friend, a cousin whose best friends, whose sister's a doctor, and they told them this, you know, any anything like it in that regard where you know this is actually like somewhat of you know a barrier to what you're trying to do, you know, with you being the physician delivering delivering the care?
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Um, I mean, yes, I think uh there's always gonna be times where you may not agree with what a patient wants to do.
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Um, but I think, you know, when you're training, one of the main things that you have to keep in mind is like patient autonomy.
00:03:58.800 --> 00:04:09.039
So sometimes it's very easy to get extremely frustrated with uh someone who maybe you think isn't isn't looking at the whole picture or is getting bad advice or wouldn't do what you would do.
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But at the end of the day, like I'm a consultant and they are coming to see me for my opinion.
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Um, and I, you know, the whatever outcome they have is ultimately kind of up to them.
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So there's a little bit of like, I'm gonna educate the best I can and try to correct anything, any like, you know, um fallacies or like things that I'm like, well, really, that's not a correct fact.
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But at the end of the day, like people get to decide what happens to their own bodies.
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So I you kind of have to like let go a little bit.
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Totally.
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And you know what?
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I mean, that's like something you know I hear all the time, uh, whether it's you, uh other physicians, like in all specialties, right?
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Especially within private practice, like having that autonomy, that that that physician-patient relationship, like that direct relationship.
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I mean, no middleman, but that's like something that's off obviously, you know, very important because it's the physician wanting to have those real conversations with those patients, right?
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And it is it does make it actually that you know that more authentic, where you are talking through, or as you said, right?
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You're consulting through um in in many ways.
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So you did just touch though upon something and just you know, interested in this because uh uh you know, obviously you're you're very well versed, like very well experienced.
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Is there though any I would say, you know, myths in a way, like myths out there that you see with your patients?
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If there's one thing in particular that you could debunk with the patients uh that you know you see, like what would that myth be?
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You know, I actually think the myth that bothers me the most is that your doctor is that you you should have to fight with your doctor for what you want.
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Like, we get a lot of women who are told on TikTok or Instagram or whatever, your doctor wasn't trained in this and they don't know what they're doing.
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And so you have to come in and tell them, like, no, you have to do this.
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This is what I learned on my and um the reason that most of the time this is sort of being um those two reasons this is kind of being perpetuated online.
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One is that the less a p somebody trusts their own doctor, the more they're likely to take the advice of this person online who is typically trying to sell something: a program, a supplement, a uh a consult, a, you know, so the less you rely on your other sources of information and expertise, the more you're gonna trust this person.
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And then the other piece of that is um, you know, there are women especially have felt very dismissed in the medical community in the past.
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So there is a piece of this that you have to really understand.
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Like, there are a lot of patients that, you know, have had say extremely painful periods for years and years, and they were always just told, like, suck it up, you're being a baby, like you're fine, and then comes to find out like 10 years later they get diagnosed with endometriosis, something like that, you know.
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So I do think that there's a mix of like the death of expertise a little bit.
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Like we um you your doctor doesn't wasn't trained in this and doesn't know, which isn't true.
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Um, or uh, and um feeling like they have to fight to be heard.
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And so you have to sort of separate those two things out.
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Like, hey, I am listening to you, I hear you, but also this supplement is not going to fix this, or I don't think this lab test is gonna help us.
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So I don't really want to order it.
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Like, you know, at the end of the day, this is not a McDonald's.
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Like, it's my job to provide good care, and that means ordering the tests that I think are appropriate and, you know, offering treatment options that I think are appropriate.
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And at the end of the day, if they don't like that, like you're welcome to get another opinion, you know.
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We're gonna touch on best practices uh later.
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One thing I want to talk to you about is specifically the topic of menopause information.
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Now, Matt and I are a couple of bros, right?
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But we're both married guys.
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And uh uh, you know, in in with my wife, her friend group, one thing that's different now than I think than 10, 20 years ago is they're being inundated with a lot of information on Instagram about paramenopause.
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And I'm curious, just what's your experience on this topic and the conversations you have with patients?
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If you could see my uh residency training group chat, um, this this has been a hot, a hot topic.
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Um, you know, it's really interesting.
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Like I would say two to three years ago, I probably never heard the word perimenopause come out of anyone's mouth in my office.
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Nobody.
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And now it's like I have 35-year-olds coming into my office and being like, I want to get ready for perimenopause.
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I'm really worried.
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And I think um, you know, you can actually, one of my friends actually looked at the you can look at Google search terms and see the how they change over time, and you can actually see, like maybe two, three years ago, perimenopause just goes like this, and then in the last year, it's like wild how much people are searching for this.
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And I do think that it's extremely valuable that we're talking about menopause and perimenopause.
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And I do think a lot of people have a lot of really bothersome symptoms, and I'm all for talking about them and understanding them and treating them.
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But it's a very predatory market.
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Almost all of those accounts are selling something, a supplement, a book, a weighted vest, uh, you know, and they're making people really anxious.
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Like, it's kind of crazy to me how worried everyone is that they're gonna not do something right and then have a really bad outcome.
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And I have to remind them that perimenopause and menopause is not a disease, it's a life stage.
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And so, like, there is no urgency to this, like, we have to do everything right or my bones are gonna turn to dust and I'm gonna shrivel up like an old prune and die.
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It's like, okay, calm down.
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Like, there really is this, like, I do, I just think it's contributing to a lot of anxiety people have.
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I do think the world in general is just making people anxious these days.
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And one thing people feel like they might be able to control is their health and how they feel.
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So, I mean, that is one of the big myths too, that we're being that patients are coming in and they're being told on the internet your doctor didn't learn about menopause.
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They got one lecture in in training, and they that's why you need to go online to MIDI health or um, you know, order this supplement or buy this book or you know, pay for this training program.
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And the reality is that we are trained in menopause, and people who have a specific interest in it or want to know more get continued training.
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Like it's um, you know, doctors are lifelong learners, and so we we spend all a lot of time investing in finding out more and learning more and kind of riding this wave along with our patients.
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So it's been um it's been a uh an overwhelming journey a little bit, the perimenopause uh boom, shall we say?
00:11:10.399 --> 00:11:10.960
I don't know.
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Um I mean, I myself am a 43-year-old woman, so like I'm like I'm here with you, but it's just I don't know that it's as um as urgent as the internet makes it seem to people.
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And I feel I feel like it uh sad that women feel really like worried that they're gonna do it wrong, you know?
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It's just another thing for women to have to worry about.
00:11:32.399 --> 00:11:32.960
I don't know.
00:11:33.279 --> 00:11:41.279
Well, yeah, it's it's it's funny you were you were just talking like kind of like like the the Google boom and evolution and like so forth, like how like terms have changed and so forth.
00:11:41.360 --> 00:11:44.399
So I actually just saw a recent report, uh, Dr.
00:11:44.480 --> 00:12:04.720
McNair, where uh I think it was like w through open AI, I believe, where 25% now of all the consumers um that are on open AI asking questions actually relate specifically to healthcare questions, whether that's in public health, diseases, insurance coverage, you name it.
00:12:04.879 --> 00:12:08.159
But that is just absolutely just you know astonishing, right?
00:12:08.320 --> 00:12:11.440
Where I mean, you know, people are wanting to learn about certain things, right?
00:12:11.519 --> 00:12:19.440
And they're actually you know somewhat putting trust in open AI um uh over the physician themselves, right?
00:12:19.519 --> 00:12:23.360
Who has been trained, has the expertise and so forth.
00:12:23.519 --> 00:12:28.080
So um how how do you find that you know with you know your balancing act, right?
00:12:28.159 --> 00:12:32.639
Because you know, you're you're doing best practices with the patient when you're consulting them.
00:12:32.799 --> 00:12:46.320
How are you in in a way having to explain to them at certain times where hey, I you know, I I'm not saying I should tell you exactly what you need to do, but hey, I'm the knowledgeable one here, I'm the expert.
00:12:46.480 --> 00:12:49.679
Um, like in a in a very diplom in a very diplomatic way.
00:12:50.080 --> 00:12:53.919
Yeah, I think um I think some of this is reassurance.
00:12:54.000 --> 00:12:56.720
Like, yes, I I do have education in this.
00:12:56.799 --> 00:13:02.240
Um, one of the benefits of private practice, I would say, is that the majority of my patients I have a long-term relationship with.
00:13:02.320 --> 00:13:04.480
And so a lot of them actually do come to my office.
00:13:04.720 --> 00:13:05.759
Hey, I read this online.
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What do you think about that?
00:13:07.200 --> 00:13:11.360
And I really appreciate that because I do think they feel like they can trust us.
00:13:11.440 --> 00:13:13.279
And I know this is the same for my colleagues.
00:13:13.440 --> 00:13:15.679
Like, um, do I need to be doing this?
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Am I missing something?
00:13:16.960 --> 00:13:21.600
Like, is there some, you know, I I think, um, and I'm grateful when that happens.
00:13:21.759 --> 00:13:29.600
I I think it's important to explain to patients, like, what does the data actually show us?
00:13:29.759 --> 00:13:31.759
Like, what do we actually know?
00:13:32.159 --> 00:13:35.440
Um, and sometimes I pull up papers for them.
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I'm like, hey, here's the current guidelines on testosterone use in women.
00:13:39.679 --> 00:13:41.519
Like, here's what we actually know.
00:13:41.679 --> 00:13:45.679
Um, because, and a lot of that does not make for nice clickbait.
00:13:45.840 --> 00:13:54.799
Like, it's it's always interesting to me when people say they they are doing their own research because it is hard to read a medical paper.
00:13:55.039 --> 00:13:57.919
There's a lot of statistical information in there.
00:13:58.080 --> 00:14:05.360
There's a lot of like study design that gives nuance to like, is this actually like something we're now gonna do for everyone?
00:14:05.519 --> 00:14:11.600
Or is this just an interesting piece of information that's gonna require, you know, more long-term follow-up for us to really know?
00:14:11.679 --> 00:14:16.799
Like, you know, is it appropriate to use hormone therapy for dementia prevention?
00:14:16.960 --> 00:14:17.759
You know, we don't know.
00:14:17.919 --> 00:14:27.679
There's some really interesting information out there about the brain and hormones, and but it's not that level of evidence is not there for like we should put everyone on hormones so they don't have dementia.
00:14:27.759 --> 00:14:29.039
Like, that's just not where we're at.
00:14:29.200 --> 00:14:32.000
But that's not how information is presented online.
00:14:32.320 --> 00:14:46.639
So I think sometimes just explaining to patients like the nuance and like, hey, you know, I practice medicine with these sets of guidelines, like I'm willing to, you know, talk to you about your symptoms and stuff, but that's just not what we're doing right now.
00:14:46.879 --> 00:14:51.840
Um, and I feel like most patients really respect a balanced discussion.
00:14:52.000 --> 00:14:56.799
I do think there are definitely those people who just show up and want you to do what they want.
00:14:56.960 --> 00:15:01.919
And it's like, okay, well, I'm either gonna do it or I'm not, and then you're welcome to go somewhere else.
00:15:02.159 --> 00:15:20.399
But I think um our field in general is really struggling with a lot of uh health inundation right now, and a and um a lot of it is just like predatory money making online, you know, like a lot of those accounts are just making money, getting clicks.
00:15:20.559 --> 00:15:28.320
Like it's it's kind of hard because I can see why people get sort of swindled is the wrong word, but like sucked in, you know.
00:15:28.799 --> 00:15:37.360
Well, you know, I it's um look, I'm I'm I'm a lifelong uh Sacramentan, you know, what went away to school, but you know, can came back here in Sacramento.
00:15:37.600 --> 00:15:42.240
You know, my wife, same thing, lifelong Sacramentan, went, you know, down to Southern California, came back.
00:15:42.399 --> 00:15:45.440
I mean, I can tell you though, um, and like like kudos to you.
00:15:45.840 --> 00:15:48.480
Kudos, uh, kudos to your partner, um, you know, Dr.
00:15:48.559 --> 00:15:51.600
Rooney and I and your other partners uh, you know, within your practice.
00:15:51.919 --> 00:15:58.000
It is amazing though, like what you just talked about, like, you know, your pride within, you know, being in private practice, independent physician.
00:15:58.799 --> 00:16:03.360
My wife, her friends, all of them, like they talk about you and your practice.
00:16:03.440 --> 00:16:05.679
Like, I mean, that is like the the best, right?
00:16:05.840 --> 00:16:12.080
Because I think it is because of like the credibility um and like you know, the energy, the time that you're able to spend with them.
00:16:12.240 --> 00:16:13.919
Um, you know, you're not on the clock.
00:16:14.000 --> 00:16:18.080
Um, you know, you're able to get have those intimate conversations with them.
00:16:18.240 --> 00:16:22.480
And you know, you have you have people who do have trust in you to say, hey, look at this.
00:16:22.559 --> 00:16:23.440
Um, you know, Dr.
00:16:23.519 --> 00:16:25.519
McNair, is this do you believe in this?
00:16:25.679 --> 00:16:27.200
Uh uh yes or no.
00:16:27.360 --> 00:16:28.960
So I think that speaks a lot to you.
00:16:29.120 --> 00:16:33.679
So like on that, you know, kind of want to end like in this part here, um uh Dr.
00:16:33.840 --> 00:16:34.240
McNair.
00:16:34.559 --> 00:16:36.960
No, you're 43 years old, still very young.
00:16:37.200 --> 00:16:42.559
Um, um I won't say how old I am, but uh uh you're looking way younger than I am.
00:16:42.960 --> 00:16:56.159
Uh so from you know, from med school, from residency and so forth, and like like very early on in your career to now, I mean, you obviously building trust, building a rapport with your patients is key.
00:16:56.799 --> 00:16:58.559
Anything that you can share, right?
00:16:58.639 --> 00:17:04.319
I mean, with specifically right, you know, our physician audience that may be listening, not just our patients, but you know, physicians as well.
00:17:04.799 --> 00:17:08.880
Like, what is something that you know you have learned or that's been helpful?
00:17:09.200 --> 00:17:26.240
How have you evolved in a way, especially you know, with information on the internet or whatever it may be over the years where you think you're, you know, in you're actually earning trust in a more effective and efficient and better manner now than you may have been um, you know, say 10 years ago.
00:17:27.039 --> 00:17:31.759
Um, I I actually think it kind of goes back to what we were talking about first.
00:17:32.000 --> 00:17:42.400
It it's um you can't get frustrated with somebody if they're just uh at a different place, right?
00:17:42.559 --> 00:18:10.000
So I think I used to feel really uh like if I could just uh say it in the right way, then the patient would do what I thought was best, which is kind of true, but also um I think true respect comes from recognizing that like I can give you my best opinion, but I also respect your decision to do what you want to do.
00:18:10.319 --> 00:18:16.960
And um, I think patients appreciate that because it's not about me at the end of the day.
00:18:17.039 --> 00:18:18.240
It's not about my agenda.
00:18:18.400 --> 00:18:38.559
It's like I you came to me, I'm a consultant, and um, you know, I'm gonna give you my best advice and what I think is best, but um you're free to do whatever you want, but not in an adversarial way, but in a little bit more of like, you know, hey, you are the boss of your own body.
00:18:38.720 --> 00:18:40.319
No one knows you better than you.
00:18:40.480 --> 00:18:42.400
And I'm I don't know you better than you.
00:18:42.559 --> 00:18:51.759
And so that sort of um feeling of like, you know, I trust you to do what's best for you, and you trust me to give you my best advice.
00:18:51.920 --> 00:18:54.480
And that's really the therapeutic relationship, right?
00:18:54.559 --> 00:19:01.119
Like, and sometimes um, you know, they come back to you later and they're like, you know, I tried that and it just didn't work.
00:19:01.200 --> 00:19:02.559
And you're like, oh, okay, cool.
00:19:02.640 --> 00:19:05.759
Let's try this other thing that I also thought was better from the first time, you know.
00:19:05.920 --> 00:19:09.519
So it's just you have to let people have their own experience.
00:19:09.680 --> 00:19:18.799
Like one of my um most helpful thoughts that I use when I get frustrated with a patient is I can let people be wrong.
00:19:19.119 --> 00:19:25.839
And and that is it, it works in a lot of places in life, but you know, I think especially during COVID, that was really tough.
00:19:26.079 --> 00:19:35.279
Um, you know, uh like I can't imagine what our poor pediatrician colleagues are going through right now with vaccine drama and like there's a lot of stuff.
00:19:35.359 --> 00:19:46.640
Uh obviously we advocate for what we think is right, and we, you know, um do our very best to know as much as we can and be as up to date and communicate effectively.
00:19:46.799 --> 00:19:52.799
But at the end of the day, like I have to let people be wrong if that's what they want to do.
00:19:53.200 --> 00:19:59.599
So I I think that a little bit of that more relaxed attitude is helpful because nobody likes to be fought with.
00:19:59.680 --> 00:20:07.039
And I think um, when as soon as you feel like you're fighting with your doctor, that trust is gone, and then that relationship is ruptured.
00:20:07.200 --> 00:20:10.640
So um it works for spouses too.
00:20:12.000 --> 00:20:12.799
Noted.
00:20:13.039 --> 00:20:14.000
Hey, thank you.
00:20:14.079 --> 00:20:15.680
Uh thank you so much, uh, Dr.
00:20:15.759 --> 00:20:16.880
McNair, for taking the time.
00:20:16.960 --> 00:20:18.079
And I know you've had a long day.
00:20:18.160 --> 00:20:23.039
I want to make sure you're able to enjoy a nice dinner, get some sleep before another busy day tomorrow.
00:20:23.119 --> 00:20:25.359
But uh again, very much appreciate all that you do.
00:20:25.519 --> 00:20:26.559
Um, so again, thank you so much.
00:20:26.799 --> 00:20:28.240
29 patients tomorrow.
00:20:28.480 --> 00:20:29.440
Oh boy.
00:20:30.480 --> 00:20:30.799
All right.
00:20:30.880 --> 00:20:32.400
Well, we'll let you get some sleep.
00:20:32.480 --> 00:20:33.279
Thank you so much.
00:20:33.519 --> 00:20:34.079
You're welcome.
00:20:34.160 --> 00:20:34.720
Thank you guys.
00:20:34.880 --> 00:20:36.880
I really appreciate all you do for private practice.
00:20:36.960 --> 00:20:37.920
It means a lot to us.
00:20:38.000 --> 00:20:40.880
There's not that many of us left, and we need all the help we can get.
00:20:41.119 --> 00:20:41.599
We're on it.
00:20:41.680 --> 00:20:42.160
We're on it.
00:20:42.319 --> 00:20:43.119
Thank you.
