บทถอดความฉบับเต็มของ The Shocking Truth About Healthcare Costs No One Tells You

far beyond when nature or God would want them to be. And I couldn't think of many other reasons other than profit, especially because for many of them, it was clearly obvious the person was not going to survive. So the pandemic plus that really, I was like, I don't know how much longer I can stay working in this system and being part of the problem. or at least in my mind, the problem. And so I wrote a book during that period and I wrote the book mostly as catharsis for me. It was almost like a giant journal entry at first. was kind of, it was pretty angry. I was hurt by the system. I had always championed it and I was upset that it was not what I thought it was. And then I rewrote it multiple times, had multiple beta readers, and then ended up publishing a much nicer, better version with some solutions. So I'm very proud of that book now. And then as the years have gone by, I just, you know, the corporatization of everything medicine has just stolen things from people, from patients, from their caregivers. And so I started Broken and Brave Health, which is a caregiver support business where I basically am like your RN in your pocket. You have access to me. You can call me. I can help you help your loved one through any medical issue that's going on. You know, come up with questions for the doctors. You know, know AI can do stuff like that, but a lot of people are very medically complicated. so having my inside knowledge of exactly what to ask or exactly what to say can be really helpful. @the_optimized_np: you the nail on the head for that as well, as far as healthcare. Like there was a huge duality for me too. we go to school, we want to help people, but at the same time, you have to stop and ask yourself, especially in the ICU, are we hurting people? Do these people really want this? These tubes, these lines. It's it's difficult because you you're like, are we doing this for them? Are we doing this for the family? Are we doing this for the hospital? But what do they want? And they can't tell us. it's a really bad feeling to say, what am I doing? You know, what is all this? It's really eye-opening. And the ICU for me was the biggest eye-opener for all of that. And I think COVID really changed a lot of people's perspectives on healthcare. It was, it was eye-opening. I've never seen so many people get burnt out at one time. And, you know, this is the thing. A lot of people think that PTSD, you can only get it in military combat. Tiffany Smith: I @the_optimized_np: You can get PTSD from a variety of things. I cannot tell you how many people have significant PTSD, nurses, CNAs, EVS, family members, because of the things that we do and the things that we see. And so when you had that moment of clarity, was it a specific situation or was it slowly increasing to that point over time? Tiffany Smith: both. definitely over the course of a couple of years, more and more was seeing evidence that the system was very broken. I felt very lied to and I really

did not like that. And I also saw very smart, like physicians and nurses and nurse practitioners ignore what they knew and just did what they were told. And like a specific incidence I remember, I had read multiple things about remdesivir, which is what they use to treat COVID. And I saw with my eyes, it kill people's kidneys, which then can kill you and frequently did as a matter of fact. And I remember asking a pharmacist on the ICU, like, hey, why are we using this drug when it's clearly doing more harm than good? And their answer was, we've been trying to get it off of our formulary for months, but no one is listening because the CDC says that this is what we have to give people. And I said, so even though there's clearly clinical evidence that this drug is hurting people and or killing them, or at least leading to their death along with other things, they're still. giving it, like it's still required. And they were like, yeah, there's nothing we can do. And the doctors said the same thing about the drug. And I was floored by that, floored. Why would you not as a practitioner be like, no, I'm not giving that, especially to at-risk people? And they just did. And I will never forget that. @the_optimized_np: I mean, not even a practitioner, just as a human with, you know, conscious thought. It's it's just saying, if this thing's causing harm, why are we doing it? It just doesn't make any sense. But the thing is, is in healthcare, it's fear-based medicine, right? It's fear-based. We're we're so scared of litigation. We're just essentially puppets. We're all going down protocols, algorithms. It's so conveyor belt medicine and so many people get hurt. It's it's the saddest thing I've ever seen because the people making the calls. Tiffany Smith: devil hate. @the_optimized_np: Are the people that are the most disconnected from the bedside? Me and you, Tiffany, we saw it. We saw firsthand the devastation of protocol-based medicine. But you know what? It's dictated by pharmaceutical lobbying, it's dictated by finances, profit margins. These are what dictate your health care. And I I think it's absolutely unethical. I am gonna say, I am seeing a shift in the paradigm where people are. able to get more information online. All this information's online. People can be educated. People are asking questions, the right questions. People are able to start advocating for themselves, which is huge. But it's people like you that actually let them know, hey guys, it's okay to question a broken system. so segueing off of that, why don't you tell us a little bit about your book? Tiffany Smith: Yeah, I was just gonna say almost everything you just said is in my book. So I have, it's written in two parts. The first part is kind of a day in a life of a nurse because I don't think a lot of people know what it's like to be on the floor as a nurse. And it's just kind of literally from the moment I wake up until the moment I go to bed and what it's like, and it was for during COVID time. And I definitely have PTSD from that by the way. And then, @the_optimized_np: Go figure. Tiffany Smith: The second part is separated into all of the parts of healthcare that are problematic, which is all of them. So I have an entire COVID chapter. I have an entire chapter on the insurance, on big pharma, and just the damage that these big groups of corporate people are doing to human beings and their lives. And I do think that the internet is the best thing that could have ever happened to healthcare because people like you or I who have been inside of it have seen the damage and are now trying to get out of it. I don't wanna be part of this anymore. And so that's kind of what the book was designed to do was to open up people's eyes that were in the system, like for nurses. but also for people who are not because I don't know that it's super common knowledge for a lot of folks and they just keep getting taken advantage of. @the_optimized_np: Absolutely. Yeah. People only know what they're told, right? You don't know what you don't know. And unfortunately, no one tells you, well, guess what? You have the ability to make decisions for your health, right? A lot of people don't know. You can pay cash for most imaging, most tests, most surgeries. Cash pay is always an option too. You don't have to go through insurance. when you were making the book, were you floored by some of the statistics you were seeing as far as how much money these hospitals are making and how much money they're making off sick and hurting people. Tiffany Smith: for sure because here's what my impression, especially before COVID, was that every healthcare facility was struggling pretty much. Like I knew that pharma and insurance companies were trillion dollar companies or whatever and made tons of money. But for sure I thought that hospitals, hospital groups, physician groups were constantly having to fight for every dollar that they made. And that is actually true for some rural hospitals. I will say that. There are some rural hospitals that truly just are struggling. I worked for one of them. I know that for a fact because they just don't have the volume. But the bigger hospitals, these big conglomerates, it's truly disgusting. I have a section in the book that talks about being given a bag of saline. So you're given a bag of saline, which is to help hydrate you when you're in the hospital. Almost every person who goes into the hospital is given a bag of fluids at some point, whether you're on an observation just in the ER or admitted into the hospital. And the cost of an saline bag to make is like $1.80. And that includes the bag it's in. And that's from where they actually produce it. By the time it is charged to you and during your hospital stay, there are hospitals and businesses that charge upwards of $400,000. $5 for a bag of saline. Okay, and I literally like this is in my book. There's citations you can see I I was like What are you talking about? I

was so shocked by that I could not believe it and then the stories of people being like yeah I got a bill for $900,000 from the hospital and I called them and I was like I need an itemized receipt. What do you mean this? @the_optimized_np: Whoa. Tiffany Smith: four days hospital stay cost a million dollars. And then by the time they got the itemized receipt 30 days later, it was down to like 80 grand. Like what are you, what? Like, so it just seems so fraudulent. Like I don't get it. And the amount of money is unbelievable that's going on. It's unbelievable. @the_optimized_np: Wow. Mm-hmm. criminal criminal, you know, and I would see two types of death in the ICU. I would see physical death and financial death because it is so incredibly expensive. Unnecessarily expensive. And you have to say, even if I make it out of this, what am I going to do? Because it's just so much cost for unnecessary things. The saline bag, that was a great example. Tylenol, ibuprofen, things you get over the counter Guess what? We've got a 2,000% markup now because it's given in a healthcare setting. Now, you talked about the rural hospitals. How long do you think it's going to be until we have a massive monopoly on hospital systems? And these small rural hospitals are just going to be gone. Tiffany Smith: It's already happening. It's already happening. It happened in my town. It happened actually in the last two towns I've lived in. They get taken over by corporate agencies and they're no longer the small, every doctor knows every patient, you know, type of situation. It becomes this huge. corporatization, one knows anybody, the telehealth, know, these people that are totally removed from these small areas. Like, sure, we offer a neurologist, but like, do you? Because they're over a computer, you're having someone who's not a neurologist do the actual physical workup. I don't, like, it's just not the same. And before it was, it was just so different. they are, rural hospitals are already disappearing. There's, way less now than even five years ago. @the_optimized_np: Yeah, and rural I think rural hospitals are amazing. I I did some of my NP clinic holes in Eads in East, Colorado. I population maybe thousand. It was so small. And the hospital also doubled as the primary care facility, also tripled as the nursing home. So you knew everyone and everything was within walking distance. And it's just a different feel, but it's different medicine because these are farm related incidents. These trucking related incidents. rural medicine is its own specialty. And it's being able to do things without resources because you don't have all the fancy tools, the fancy equipment out there. You've really got to work on your clinical skills. And so telehealth, I think, is amazing at getting more health care to people in more difficult areas. But on the other end, as far as the provider goes, there are certain things. There's a sp there's really a specific intricacy of human connection and touch that you lose no matter how clear the picture is, you're going to lose that touch. So as far as your book goes, who would you say is the best demographic to read this book? Tiffany Smith: I think anybody who is caught up in the system, regardless of how it is, whether you're a practitioner of any kind, or if you are a caregiver, or if you are a patient, and I know that's kind of everybody, but I would say that the primary demographic is probably healthcare workers. And the reason for that is because I think a lot of them are still championing a broken system. And I know that they probably have like bits and pieces of things that are messed up within the system, but I don't know that they understand the true depth of it. But I have several non-medical people who have read the book who were astonished to learn all of the things that were in it. And were especially, you know, they thought it was so crazy what a nurse goes through during a shift. And it's not just nurses, know, it's doctors and everybody, but I had to write, I am a nurse. So I wrote it from the nurse's perspective, but yeah, so I think that, you know, there's something in there for everybody, but it was written truly to bring awareness to what was going on behind the walls of hospitals and medical facilities. @the_optimized_np: It. I think that's perfect because from a nurse's perspective, you're seeing it from both ends. You're that gap between the person who's making the orders, they're following the directions from up above. You're also seeing all the people on the ground suffering, boots on the ground, right? You're at the bedside, you're interacting with the patient more than anyone else. And so you're actually seeing where we're losing human touch and we're sacrificing humanity for profits. You we mean we see it. We saw it firsthand. And so was the business a branch of this book? Is that what prompted you to create your new business? Tiffany Smith: Yeah, I think writing the book and then the aftermath of it and continuing to work in corporate medicine and now really paying attention to all of the details of the messed up-ness that was going on around me, I realized that I had made a mistake by writing off caregivers. I think in much of my career, I was very patient-focused, which I think is good. That's what I should be doing. But I think that caregivers are left to the dust a lot of times. They are in the room constantly. They are trying to advocate. They are trying to ask questions. And while I most of the time liked it when there were visitors and when family was present, unless, of course, they were being abusive, but most of the time I liked that because they helped. know, they would come in and tell me that they needed something or whatever. But I don't think that I ever really took enough time with them to teach them how to take care of their loved one. I just would come in with discharge paperwork and I would say, all right, they need to follow up with this

doctor, this doctor, this doctor. These are the medication changes. Do you have questions? And of course there's questions. Of course they don't really understand what's going on. And then things like, well, hey, I have two kids and I work full time. How am I supposed to go to a doctor's appointment that's two and a half hours away from my house three times a week? How am I supposed to make that work? What does it look like if they don't do this? You know, I just didn't give them options. I just went through the paperwork and I was like, good luck, have a great day. And I think that that is a giant failure of our system because caregivers are sometimes dying before the people that they're taking care of because caregiving is so stressful. There's a few physicians out there that are saying that they think that being a caregiver should be a diagnosis because it's so stressful. You can have so many health issues of your own and the stress of being a caregiver of someone who's chronically ill is so severe that it affects every aspect of your life. It can affect your job, your personal relationships, your health. And so I wish that I had done a better job in my career. supporting, educating, and helping caregivers. And while writing the book and seeing all of the failures of the system, I just was like, OK, so I need to do better. And I offer very affordable assistance for caregivers. And everyone keeps saying that I should charge more, but I won't do it at least yet. I just, know, because caregiving is expensive also. So hello. @the_optimized_np: Can be. Tiffany Smith: Yeah, I just want it to be accessible to people. @the_optimized_np: You know, when when I was at the bedside, you know, we would have someone, we'd have family members. And sometimes we would be like, man, they have all this family in there and they're always asking these questions. You know, and you look back and you're like, they were doing exactly what they were supposed to do. Because at the end of the day, when this when this patient leaves, they're gonna be taking care of them. when we discharge them, our mind is on who's coming in the room. It's just a conveyor belt. That's where our mind's at. But we're not thinking, well, I I can barely get that guy to the bathroom. How's the family going through? They're not trained. Here's a gate belt. Good luck. They don't know how to use it. They don't know the proper ways to do this. And there's not enough time in the hospital to educate. That's the biggest problem. There's not enough time. And so what you're doing is you're bridging that gap between, I'm in the hospital. I saw what happened. I didn't learn it. To I'm home now. I need help. I need a professional that can help me actually adequately take care of this person. Because how many times have you seen re just readmissions? Not because of any fault of the caregiver, but they just didn't know what to do. So they're like, they fell again. I'm sorry. I don't know how to help them. they won't eat, they won't do this, they won't do that, because they don't know how. Tiffany Smith: Yeah, I think that that is a huge part of patients not being able to be successful at home and out of these facilities. Caregivers are not professionals. They don't understand the difference between medications. They don't know how to transfer a patient who can't transfer themselves. They don't know, like I've had patients, doing home health has also really opened my eyes to this too. I've had patients like, or caregivers really not understand the severity of how sick these folks are and how it would kill them if they fell. And so it's just not made clear because you literally do not have time as a healthcare practitioner in the hospital to do that. And that's part of why when I was in the hospital doing those discharge instructions, I was like, here's what you need to do, have a great day, bye, because I had to keep going, I didn't have time. And so that is exactly the point of broken and brave health is to have an easily accessible healthcare professional at your fingertips that can answer what may seem like stupid questions. Like, how do I get my mom to sit up without pulling out her shoulder? How do I, you know, like simple things. Hey, I thought that they were on this type of medication. Now they changed it to this. Is that the same thing? Is it something totally different? What do I need to expect with that? We just don't have time to do that in the hospital or in doctor's offices. And the changes are made and they're just expected to do it. their damage is done. People have permanent damage. mean, I've walked into households where they're taking three times the dose of a diuretic. Like, hello, you can die doing that. Yeah. @the_optimized_np: Easily easily. Tiffany Smith: Like within days, okay? It's not like a bit, you know, it's a way bigger deal than people know. And so having the resource of truly a nurse in your pocket where you can contact me and we can walk through things and I can take an hour with you as a nurse and sit with you. And yes, it is more like telehealth because it's over Zoom because I want to be available to everybody, but I'm not giving medical advice, but I'm walking you through the medical advice you've already been given. And I can help guide you with that. And the other piece that I really want to talk about is, you know, I have a lot of family members, especially doing hospice, who tell me, you know, I really thought months ago that we, what are we doing? Why are we doing all of this? I could tell that You know, dad was declining. He wasn't doing well. just, I, and every time I asked and I said, you know, should, what, what are we doing here? To what end? How much longer are we getting him with this? The answer that I kept getting was, well, we have to try everything. We've got to keep trying this. Well, you know, we could get him several more months or several more weeks or whatever the case may be. And these

family members say, what was the point of that? because those several more weeks or those several more months were spent at doctor's offices or spent miserable from side effects of medications. Why was no one honest with us and told us the true ramifications of all of these treatments and drugs? And I don't ever have a good answer. I do not ever have a good answer. I think that that is stealing time from people. And so, I think that with Broken and Brave Health, I can give people true informed consent. Like, hey, if you keep doing this, perfect. This is what you can expect. If you don't do this, this is also what you can expect. Because I don't think that whole, if you don't do this portion is almost ever spoken about. And I think that's a shame. @the_optimized_np: Yeah, I mean it never is. People think time equals success, but the reality is we really just neglect quality. You know, any randomized controlled trial of any medication, the outcomes are time, life expectancy. It's not quality of life. It's not how do you feel? What do you consider to be quality of life and are you achieving it? Or, like you said, doctor's appointment to doctor's appointment, agonizing pain in between. What is that? For me, I wanna live the best life I can. I don't wanna live the longest life I can, the best life I can. And unfortunately, no one is honest with these people, right? And that's a huge benefit to you, is you're actually saying, just because we can do something, doesn't mean we should. Tiffany Smith: Nope. Yes. Yeah, and I'm sure you can attest to this within the ICU. One of the things that I had to step away from the ICU because I kept seeing this was people who were critically ill, maintained on machines, and they were just performing tracheostomies on people. And basically what they would do, So a tracheostomy for anybody who doesn't know is a hole is cut in your neck and a piece of plastic is put down there and it's hooked up to life support. And you pretty much need life support at least at night, always and forever for the rest of your life. Almost always. There are rare instances that you can have this reversed for sure. And I know many, I know several survivors of having a trach and having had it closed. So that does happen. That is a low percent. of people that that happens with. Almost all people who get a tracheostomy end up having to live in a nursing home attached to life support. And what I was seeing was doctors would come into families of people who could not get off life support because they weren't living. So their lungs were not working, their heart was not strong enough or a combination of those or a combination of a bunch of stuff. And they would say, listen, in order for them to stay alive, we're gonna need to do a trach. and family members would be like, well, yeah, of course, like, I don't want them to die. Please do a trach. And there would be no discussion. And I have been in the rooms hundreds of times for this to happen. And I'm sure you have too, where there was no discussion about the long-term ramifications in what life looks like. None. And that is disgusting because then what would happen is @the_optimized_np: None. None. Tiffany Smith: They would be taken down to surgery. They would have a hole cut in their neck, a plastic tube shoved down their breathing tube. They'd be attached to a machine. They'd be in excruciating pain. They would still, by the way, not be living on their own. And then the family would be approached by a case manager who would say, hey, we need to talk about what facility they're gonna go to. And families are like, what do you mean? And they literally did not know that they wouldn't. probably never be able to take that person home again. And never mind, like, can they eat? Can they drink? Like, what are we looking at with actual quality of life? No discussion. Hundreds of times over my 16-year career, I have had to grieve with family members and patients. their expectation of what their life was because a medical procedure was done on them that was not fully explained, the long-term ramifications of it, and they will cry on my shoulders, wet my shoulders with tears and say, if I had known, I never would have done that to them. I never would have signed off on this. I, after that happened so many times, I was like, I have got to get out of here. I cannot watch this anymore. @the_optimized_np: we've become so disconnected. We see people as a disease process and we don't actually understand. this is Kim. She loves to hike. She's a very active person. How is this going to affect Kim's life? We just think, yeah, Kim had sepsis. Kim, has bilateral pneumonia. She needs a breathing tube. Th we see things different. Things become so just dysfunctional in the hospital, the way that things are presented. We see them as a Disease process and we treat them as a disease process, but we never actually have that humanistic thought of, okay, long term, how do you feel about this? What is your quality of life going to be? we talk to everyone but the patient most of the time. I've had the same situation where I've had patients say, I wish I was dead. Like I really do. I wish I would have just died. This isn't the life for me. I've seen incredibly active, gifted athletes in a situation where guess what? They're spending the rest of their life in a nursing home being taken care of. Young men, young women, they don't want that. And they've made it known. So it's sad. But with your service, essentially the caregivers can reach out to you when they have questions or concerns, and you can give them that unbiased feedback on specific things on how to actually help their loved ones. Is that correct? Tiffany Smith: Yeah, and you know, one thing that I've actually been kind of teased for is my openness and honesty. I just tell it how it is. And that is what makes Broken and Brave Health great because people call and I'm able to just tell them, here's part A, part B,

part C of everything you're going through that I know of about the medical community. You make your choice, because it is fine if you want to have a tracheostomy and you want to live no matter what. And I've spoken to a man who was a quadriplegic who told me that he is glad that he stayed alive and stayed in a nursing home because the few times a year that his grandson comes and sees him is worth it for him. That's fantastic. That's my personal worst nightmare to live in a nursing home in a bed and only be able to see my loved ones a few times a year when they come visit me. but that's okay if that's what you want. And so that's what makes my service great is I say, here are all the following options, or I explain things in depth so that people can understand in an open and honest and unbiased way. @the_optimized_np: People need that. People need to be able to talk to a healthcare professional who's been there. And this is the biggest thing, your experience, you've seen it. If you didn't see this, it'd be a whole different situation. But because you've already seen this dysfunction, you know exactly how to combat it I couldn't agree with you more. I'm a huge advocate. Let people make decisions based off their goals. I say it all the time. Optimization. What does that mean? It's different for everyone. Tiffany Smith: Mm-hmm. @the_optimized_np: And you have to tailor it to them, not you, not what you think optimization is, not what people say it is, not a protocol to you because everyone's different. I don't care about anyone but you. And the reality is you should be your biggest advocate too, but you've got to learn how to do it. It's not easy. Even in healthcare, it's difficult to advocate. And imagine someone that's had no training. Tiffany Smith: protocol. @the_optimized_np: never been in healthcare. Now they're trying to stand up to the doctor or the nurse or the case manager. They don't know what to do. Tiffany Smith: yep, that's exactly why I started Broken and Brave. That's exactly why. @the_optimized_np: Yeah, that's an amazing service. Now, Tiffany, how can people find your business? Tiffany Smith: I have a website, it's brokenandbrave.org. And there is a way to do, I have a free consultation. So you can just sign up and totally free. You just input your email address and schedule based on my schedule. There's a little scheduling link and we can just kind of get a general idea of what you need. And then I have a couple of other options once we're past that. We have a one hour sessions where you can just book per hour as you need it. And then I have a package deal that is discounted and that's three one hour sessions that need to be used up within four months. @the_optimized_np: it's on Amazon? Tiffany Smith: Yep, it's on Amazon. It's called Broken and Brave, the fight to heal American healthcare. @the_optimized_np: Perfect. And we're going to have links in the description as well. Now, Tiffany, as a closing statement, what do you want to tell that caregiver out there that's just overwhelmed? They're scared. They don't know where to begin. Tiffany Smith: I think the most important part that you need to realize is that there is help and resources out there. Not just me, but there's other ones. But being a strong professional advocate for yourself and for your loved one that you're caring for are equally important. You being able to do the things that the healthcare practitioners are telling you to do. is just as important as getting them done for the patient. If you can't get somebody to an appointment, it's not gonna happen because you work or whatever, you need to speak up. You don't have to just say, okay, I'll figure it out. Like, no, there are ways to help you figure it out. And remaining professional is another thing that I talk to caregivers a lot about, because it's very emotional. It's so easy to get... angry and raise your voice and upset and that does no one any good. It burns health care practitioners out faster. It does not get you the results that you need. you know, advocating calmly and professionally for yourself and your loved one and feeling empowered when you go to these health care places instead of small. We work on mindset a lot with Broken and Brave too. So. I think that being a caregiver is the most selfless thing that you can do. I think that having support and backup is important. So you should search it out for yourself. @the_optimized_np: Awesome Tiffany. Thank you so much for being with us today. Tiffany Smith: Yeah, thanks for having me. @ the_optimized_np: This is what Optimize looks like in practice. If this episode moved the needle, share it with someone still coasting on normal. That's how we build this. New episodes drop every other week. Subscribe so you don't miss a thing. Questions, feedback, or think you belong on this mic? Reach out at the optimized np at stillcity-trt.com. I'm Jeremiah Velasquez. This is the Optimized NP. Let's Go.