transcript

Speaker 1:
[00:00] This system is not set up for people to experience each other and for your doctor to experience you. We just don't even have time. So we don't get reimbursed by insurance for the amount of time that we're spending reading about this, thinking about you, calling you back, reviewing your labs, sitting and hearing your story. We get paid for how many people we saw that day. That does not lend itself to dealing with these kinds of issues and talking about stuff and recognizing patterns. It just doesn't.

Speaker 2:
[00:43] The views and opinions expressed on unPAUSED are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis or treatment. One of the things I've learned after years in medicine and talking to women in midlife is this. The system doesn't give them the time, space or respect to be truly known. And yet, the problem is often framed as that women just don't know their bodies. My guest today deeply understands this. Dr. Suzanne Gilbert-Lenz has spent her career caring for women across every life stage, but especially in midlife, where complexity is the rule, not the exception. She's a clinician, an educator, an integrative medicine expert, and now the Chief Clinical Officer of Monarch, a membership-based health care practice designed to restore something modern medicine has almost completely stripped away, time, relationship, and trust between women and their clinicians. This conversation is important because the current health care system is failing on two fronts at once. It's failing women who need care that is nuanced, layered, and deeply human. And it's failing clinicians who are increasingly trapped in rushed visits, administrative burden, and productivity metrics that reward procedures over listening. The only groups consistently benefiting from this system are insurance companies and large corporations. Meanwhile, physicians experience what we now call moral injury, the distress of knowing how to care for patients but being structurally prevented from doing so. And the patients are paying the price. I'm so excited that Suzanne is here and we can talk about the hard questions about what good healthcare really looks like and who we are willing to fight for. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to unPAUSED, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. If your skin or your nervous system feels a little overwhelmed lately, this may be your sign to simplify. Primally Pure's Blue Tansy products are designed to calm stressed skin using real, biocompatible ingredients that work with your body, not against it. Blue Tansy is a calming blue antioxidant that helps soothe inflammation, redness, and irritation, which is especially beneficial for sensitive skin or for those people whose products tend to overwhelm rather than help their skin. Primally Pure's Soothing Collection incorporates this ingredient across face and body, from their effective deodorant to the soothing serum and body oil, creating a cohesive and calming routine. They've become go-tos for our team with Simplicity Matters Most. Use code UNPAUSED to get 15% off your Primally Pure purchase. That's www.primallypure.com. And use code UNPAUSED at checkout for 15% off your order. This podcast is sponsored by Midi Health, the first virtual clinic created for women by women for the treatment of menopause. Don't let anyone tell you, menopause is something you have to suffer through alone. Midi can help. Visit joinmidid.com to learn more. So Suzanne, welcome to unPAUSED.

Speaker 1:
[04:32] Thank you for having me.

Speaker 2:
[04:33] We talk a lot about health span on this podcast. Yes. And on, God, on social media. I don't know if we're being fed the same stuff.

Speaker 1:
[04:39] I'm sure.

Speaker 2:
[04:40] But it is through a very male lens.

Speaker 1:
[04:44] Yes, the whole biohacking and...

Speaker 2:
[04:46] It's exhausting.

Speaker 1:
[04:47] Yeah.

Speaker 2:
[04:48] But how do you define health span for women?

Speaker 1:
[04:50] Well, I mean, I'm going to say something that I know you know, and I'm sure you've talked about many times on the podcast. I love the word health span as opposed to lifespan for obvious reasons, because being alive but not doing well and not thriving.

Speaker 2:
[05:03] No, thank you.

Speaker 1:
[05:04] No, I think we all know how we feel about that. Nobody wants that. And we know that women live much longer than men and in much poorer health. So, this idea of health span is unlocking that vitality, unlocking the opportunities, the inflection points that we have and they are numerous. It's not like it's ever over, by the way. It's not like you missed the boat at 70. It would be better if you're working on it at 20.

Speaker 2:
[05:29] Look, I saw an influencer the other day who's got probably a PhD, I think it was a PhD and she was talking about osteoporosis. She's like kind of coming down on the osteoporosis movement and all the talk about it because you've reached your maximum bone density at 30. We need to be talking to 25-year-olds. She's not wrong.

Speaker 1:
[05:47] Right. But that doesn't mean that we never-

Speaker 2:
[05:48] It's never too late.

Speaker 1:
[05:49] No, 100%. So listen, I even look, and I'm a person who's been a fitness person my whole life, but I'm at risk for osteoporosis for a number of reasons. I'm a small person. I had breast cancer, whatever, blah, blah, all the different things. And this is a good example. I doubled down in the last year on really getting to the heavy weights and not just talking the talk, but walking the walk. I've been on hormones now for almost two years.

Speaker 2:
[06:17] OK, wait, you know people's heads just exploded.

Speaker 1:
[06:19] Oh, because we didn't talk because I'm a breast cancer survivor who's on hormones.

Speaker 2:
[06:22] You know, I forget that about you from time to time.

Speaker 1:
[06:24] Because it's not my whole personality.

Speaker 2:
[06:26] You're in the thick of it. It's your whole personality. But go back to that, because I think we have several pre-virus survivors, people in the world of having to deal with the potential of having had breast cancer or pre-cancer cells and all the things. Because you rarely talk about it.

Speaker 1:
[06:41] I mean, I do sometimes, but I mean, I don't know, I don't focus on it a lot. I mean, that's a whole story in and of itself. But when you talk about healthspan, that's a great example. So I was diagnosed with breast cancer at 47. And of course, it was devastating and traumatizing and all sorts of things. And it changed my life forever. Now, in the end, I am grateful for it, because it forced me to really look at like who I was and how I wanted to live. But you could take that diagnosis and say, okay, your lifespan is, it may be shortened. So what is going to be my healthspan? What, how do I want to live my life? It's not just like taking hormones and lifting weights. And whatever biohacking thing we're talking about for women, because I think you and I are on the same page, that dealing and managing our menopause appropriately, which is something that we have to decide for ourselves in consultation, is 100% going to impact your healthspan. And I'm not saying I didn't have those moments, I did. But it's also joy. It's also curiosity. It's also what do I have in front of me right now? How do I want to live right now? And how does that set me up for so many other opportunities? Because when you are open to yourself, this is where I get really into the philosophy of stuff. When you're open to you, your authentic self, and who you want to be, and you're expressing that, wow, you draw the right friends, you draw different opportunities, you see your world differently. To me, that's vitality. That's healthspan.

Speaker 2:
[08:16] What I see is that women, the medical system is set up to force this breast cancer diagnosis or potential breast care diagnosis to be their whole personality.

Speaker 1:
[08:28] Because it's all about what you can no longer do.

Speaker 2:
[08:30] Because everything is an exclusion of that. You can or cannot because there's a potential that one cell may become, you know, and the whole rest of their body, their lives, their happiness, their fulfillment, their sex life is ignored.

Speaker 1:
[08:42] The only thing that exists is the breast cancer diagnosis. This is a human being. And I will say that some of it's just my personality. I'm an optimist. Some of it is what I had done to work on healing myself, you know. I had been doing yoga and meditation for, I don't know, about 10 years before my diagnosis. And I will never forget going into the MRI. I had the biopsy that I had, you know, breast cancer. Now I had to go into the MRI and see like where else is it? What is going on? And I got into that MRI machine and it is so overwhelming. You're literally surrounded and knowing like, okay, my fate is right. And I said, no, your mantra to get through this, very uncomfortable experiences, this is not who I am. This is happening to me. That's literally what I just, that's what popped into my brain. And that's what I did. And I did that for 45 effing minutes in that machine. Oh my God.

Speaker 2:
[09:44] If anybody's had an MRI, that's what it sounds like.

Speaker 1:
[09:46] It's not fun.

Speaker 2:
[09:48] Yeah.

Speaker 1:
[09:48] And that's what I said to myself. I said, you know what? You're not gonna wallow in self-pity. You get some time to be sad. And I was freaked out. My kids were so freaked out. Oh my God. And I said, no, you're not gonna adopt this as who you are. That was my decision. Yeah.

Speaker 2:
[10:04] You've talked about perimenopause.

Speaker 1:
[10:06] Yes, I have.

Speaker 2:
[10:06] Before, it was like even a word that the internet knew how to say. I feel like, and I'd love to hear your opinion, that perimenopause is kind of where menopause was three years ago.

Speaker 1:
[10:16] Yeah, I agree. People are starting to really understand like it's not about that final menstrual period only. It's about the decade that you spend leading to that, that people don't realize is happening.

Speaker 2:
[10:31] What do you think women should be doing during that decade?

Speaker 1:
[10:34] Well, first of all, we have to be talking about it more so that younger women and younger men, they have women in their lives, understand the experience. It's like a very prolonged puberty, and it can be quite discombobulating and very disconcerting, and people feel not like themselves. We know we talk about this. When I talk to patients and I teach about it, if I were to characterize it in one term, I'd say it's a loss of resilience on all levels, emotional, spiritual, psychological, physical. It's really rough. So if we don't prepare ourselves and our patients and our colleagues for this experience, people are going to be searching for a solution that may not fit what the actual issue is. And I'm not calling it a problem on purpose. I'm not saying it's not problematic, but let's also can we reframe this? This is physiology. So if we understand it as an expected shift in physiology, and we treat it as such, we have more appropriate opportunities to intervene in a more precision manner. What is your personal history? What are your goals? What's your family history? What are your risk factors? What are your data points? We have to kind of combine it, the art and the science of medicine in here. And women are going to have to advocate for themselves because they're ahead of the medical community on this. They just are. We know this because you and I have been seeing people for a very long time who are now on polypharmacy, antidepressants.

Speaker 2:
[12:11] Polypharmacy, for our listeners, is on multiple medications. So it is not unusual to have a woman in perimenopause who's been given sleeping pills for her insomnia. She's been giving anti-anxiety meds. She's been giving antidepressants. She's on something for her fibromyalgia, something for her irritable bladder.

Speaker 1:
[12:28] Her fibromyalgia, which I'm going to go ahead and say is just perimenopause.

Speaker 2:
[12:31] Musculoskeletal syndrome of menopause, yeah.

Speaker 1:
[12:34] All sorts of weird, you know, random diagnoses, which may or may not be accurate. It's also a time where, because of this loss of resilience, we see things that are big risks that get uncovered if we're looking. So again, it is on, unfortunately, it's on us as women to understand enough to ask the right questions and to also understand that we might be, I'm going to use an old analogy. If you go to the hardware store looking for milk, you can keep going back to the hardware store and you are never going to find milk there. So you might be going to a clinician who just does not understand it, does not grasp it for whatever reason, and it's going to have to be time to move on. Yeah.

Speaker 2:
[13:24] So you were practicing obstetrics until very recently. So there's something we get a ton of questions on. And I just read the statistic last year that women now over 40, more women over 40 are having babies than under 20. That was the first time in history we've seen that switch. And so talk to me. Now, I stopped doing OB. I was doing emergency care only since 2018. So I stopped my full OB practice in 2018, so almost 10 years ago. And I was aging along with my patients. I was starting to see it, but I didn't know enough about perimenopause to recognize it. So, like, so many questions about the shift from postpartum directly into perimenopause. What does that look like? And women are, like, heads are exploding right now.

Speaker 1:
[14:12] Well, I will say that I feel like I owe an apology to many of my patients. Oh, sweet. Girl.

Speaker 2:
[14:18] Same.

Speaker 1:
[14:18] Because I didn't really get it myself. And here I was, like, doing OB for a long time. I was really had entered into the menopause space quite early through my actually my breast cancer experience. I was seeing all these young breast cancer survivors and they were going through menopause early. That's actually how I started in menopause. So now I, you know, I'm in Los Angeles. A lot of women have babies over 40. I had a lot of women in perimenopause getting pregnant and having young children. And we were telling them, like, look, you're 42 with a two year old, you know? Of course you're tired.

Speaker 2:
[14:56] Yeah. It's just so much harder.

Speaker 1:
[14:58] I mean, which is true. But like one of the reasons it's true is they're in perimenopause and nobody knows it. So I own apology. But I think that once I started realizing like, oh, wait a second, this is something more than that. Why is nobody talking about this? This is enormously important because it's affecting not only people's fertility, but it's affecting their postpartum experience. They're having a much more difficult time with sleep disruption, with mood disorders. I mean, we know that a pregnancy-

Speaker 2:
[15:27] Baby's sleeping through the night, but mama isn't.

Speaker 1:
[15:29] Exactly. Yeah. And like all this anxiety and is it really postpartum anxiety or is it really perimenopausal, PMDD that's showing up, you know, severe mood disorders. All these things that we know that are happening in the perimenopausal population, it's like on steroids if you've just had a baby. And it's really this confluence of a lot of unpredictable hormonal fluctuations, right? You're going from this really high level, really steady state of estrogen and progesterone and it is just dropping precipitously postpartum. And it's plummeted you into an era where you're not even going to be going back to regular cycling necessarily anyways. So you're about to experience high highs, low lows and you just you feel like a truck hit you. I mean, these are women that really deserve our attention. Yeah.

Speaker 2:
[16:19] And I there's almost no papers on it. I rarely see it in the academic literature. I haven't really seen it. I see it on social because again, women are around the social water cooler and finally talking about it. Oh my God, that was me. And but I think we owe that population, we owe women thousands of years of research. Of course, of course. But they are particularly because they're becoming more and more common now. And we're not preparing them for this.

Speaker 1:
[16:45] No, and this is people's lived experiences.

Speaker 2:
[16:46] They're so vulnerable.

Speaker 1:
[16:47] Yeah, very much so. And again, this is a really big opportunity to understand, like to support them through it so that they understand the impact that this could have on the rest of their life and on their health, rather than, again, I don't want to sound anti-medicine. I use medicine, I prescribe medicine, it is not, there's not, this is like a not a pill for every ill situation, like everybody does not need to be medicated, they need to be supported, or they need to understand what the medicine is for and why we're using it, rather than just like, I have seven minutes to see you and I don't have time to unpack this, which, as you know, I have a lot of compassion for our colleagues that are living in that system.

Speaker 2:
[17:27] Yeah, we lived in it, you know, for decades.

Speaker 1:
[17:29] For many decades, many decades. But you know, if you don't have the time, and there's no literature on it, and it's not being pushed in the guidelines, it doesn't exist.

Speaker 2:
[17:39] It doesn't exist. We don't have time to make it exist. If you're looking for your next drama obsession, I've got one for you. From the producers of The Crown comes Brit Box's brand new original series, The Lady, inspired by a true story of a royal scandal. It follows Jane Andrews, a working-class woman plucked from obscurity and appointed to the highly coveted role of royal dresser to the Duchess of York at Buckingham Palace. But after rising to the heights of British high society, everything starts to unravel, spiraling into obsession, suspicion, and murder. This is a story of class, ambition, and the allure of royalty. Starring award-winning actress Natalie Dormer and Mia McKenna Bruce. Don't miss The Lady, streaming March 18th, only on BritBox. Watch with a free trial at britbox.com.

Speaker 3:
[18:40] Hi, my name is Lloyd Lockridge, and I'm the host of a new podcast from Audacy called Family Lore. In this podcast, I'm going to have people on to tell unusual and sometimes far-fetched stories about their families.

Speaker 2:
[18:51] I've heard my whole life that she invented the margarita.

Speaker 3:
[18:54] And then we're going to investigate those stories and find out how much of it is true.

Speaker 2:
[18:58] He gets a patent one month before the Wright brothers.

Speaker 3:
[19:00] Oh my God. Please follow and listen to Family Lore, an Audacy podcast available now on Apple Podcasts, Spotify, or wherever you get your shows.

Speaker 2:
[19:11] Many of you know I've spent my career pushing for better medical standards for women. Midi Health is on that same mission, delivering the kind of care women have always deserved. For too long, women have been told to just deal with perimenopause and menopause symptoms. Your labs are normal. This is just a part of aging. Eat less, work out more. That approach failed us, and it's exactly why both my work and Midi's exist. Midlife and menopause aren't the beginning of the end. They're a critical window of opportunity. But education is only half the battle. Women need access to clinicians who actually understand the science of female aging. That's the gap Midi was built to close. Midi is focused on health span, not just lifespan. That means looking at your metabolic health, bone density, cardiovascular risk, and cognitive function. It's the kind of proactive, evidence-based care I've always believed women deserve. And it's exactly what Midi delivers. And here's what matters most. Women in all 50 states can access this care, covered by insurance, with clinicians trained in the latest menopause and longevity science. Because your zip code should never determine your access to quality menopause care. Book your virtual visit today at joinmidi.com. That's joinmidi.com. Why is time, why has it become such a critical and endangered resource, especially for women and women's health care?

Speaker 1:
[20:51] You know, if you look at the systems under which we are trained, the systems in which we work, we're navigating something that really isn't set up for humans. It's set up for shareholders. It's set up for reimbursement structures. It's set up for workflows. Not necessarily for the excellent, connected practice of clinical medicine. That requires that we talk to each other, that we as clinicians have the bandwidth to listen and then to apply our knowledge. If we are being forced to work for RVUs...

Speaker 2:
[21:34] What's an RVU?

Speaker 1:
[21:35] It's a Relative Value Unit. Okay, even just that. It sounds like you're working in a factory.

Speaker 2:
[21:42] That is how our time is valued. It is called a Relative Value Unit. And it is decided by a room full of crusty dusty, mostly male, mostly surgeons who decide...

Speaker 1:
[21:57] The relative value of our work.

Speaker 2:
[21:59] The relative value of your work is.

Speaker 1:
[22:01] So the work of the mind is not reimbursed.

Speaker 2:
[22:05] No, only the work of the hands.

Speaker 1:
[22:07] Yeah, and look, I'm a surgeon and I did a lot of procedures. And I mean, I did them for the right reason. Believe me, I wasn't making enough money to be doing surgery on you just to make... Trust me, I was losing money in the office. That's a whole other thing. So the system is... It's not a whole other thing. It's related. The system is not set up for people to experience each other and for your doctor to experience you. We just don't even have time. So we don't get reimbursed by insurance for the amount of time that we're spending reading about this, thinking about you, calling you back, reviewing your labs, sitting and hearing your story. We get paid for how many people we saw that day. That does not lend itself to dealing with these kinds of issues and talking about stuff and recognizing patterns, you know? It just doesn't.

Speaker 2:
[22:56] And also, when you even look at procedures, procedures, if you look at equivalent procedures done on women versus the equivalent procedure done on men, because we have, especially in urology, right? We have autologous body parts. So the clitoris is the equivalent to the head of the penis. So if you look at these procedures, men are reimbursed like three to five times higher for the equivalent procedure. I remember learning, because when you work for a corporation, they are controlled by this model of as many patients that you can see in the clinical setting and do as many procedures as you can, and that's where the money is made. They are a slave to the same system, the same reimbursement system. And it is heartbreaking. So nine months of care for Obi, over a dozen visits usually, and then, God forbid, she has some condition that needs to bring her in, ultrasounds, and then delivery, which might take five minutes, might take 50 hours, you know.

Speaker 1:
[23:54] And you have two patients.

Speaker 2:
[23:55] And you might, yeah.

Speaker 1:
[23:56] You're responsible for two humans. Or maybe three or four, depending on how many there are in there.

Speaker 2:
[24:02] And when you look at what the reimbursement rates were for that.

Speaker 1:
[24:05] It's insanity.

Speaker 2:
[24:05] Versus you break your leg and you go to orthopedic surgeon and they put a pin in it, and, you know, which is a complicated procedure and, you know.

Speaker 1:
[24:13] Yeah.

Speaker 2:
[24:14] But the reimbursement is like 10 to 1.

Speaker 1:
[24:16] But tell me you don't care about women's lives, you know. It's like, wow.

Speaker 2:
[24:20] Yeah.

Speaker 1:
[24:20] I did it as long as I did because I loved doing it. I loved my patients so much. And then I just got tired and old.

Speaker 2:
[24:26] And I did.

Speaker 1:
[24:27] It couldn't be up anymore.

Speaker 2:
[24:28] I really had a, you know, we're going to talk about this some more, but I had a moral crisis when I was like deciding to leave the traditional reimbursement system. Because that's what I was brought up in. But actually at the very beginning of like medical school, it wasn't that bad. And in residency, we all operated under a charity system.

Speaker 1:
[24:50] Uh-huh. Yeah.

Speaker 2:
[24:51] So we took everybody. We saw everyone in the state would just write checks, right? That stopped by the time I became faculty. And we were turning people away who we could cure their disease. We could cure their cancer. They were having stage one endometrial, turning them away because they didn't have insurance and couldn't find coverage from their county or whatever. And I wanted to die as faculty signing off on that chart. But the hospital was like, unless it's an emergency, we're not going to do it.

Speaker 1:
[25:26] That's not why we signed up to take care of human beings.

Speaker 2:
[25:31] Had she had her cancer five years ago, we would have done it and not thought twice about it, you know, at a teaching institution.

Speaker 1:
[25:37] Yeah, I had a similar... I mean, I think we trained at the same time. I had a very similar experience because I started at a county hospital in medical school, so literally all comers. And I mean, it was wild and I learned a ton. I'm so grateful to those patients. And then I went to Cedars-Sinai Medical Center, which is sure it's, you know, hospital to the stars. But also at the time, we took all comers. I mean, obviously through the emergency room, it's a federal violation not to accept anybody, but it was not an emergency, but we took everybody. And we had one of the reasons it was such a great training program is that we had an enormous number of patients who were either indigent or were coming in through like emergency Medi-Cal. And that all shifted.

Speaker 2:
[26:15] Especially, we had this pregnancy is different. Yes, yes. We could get anything covered in pregnancy, but I'm talking about like the GYN, gynecologic stuff.

Speaker 1:
[26:23] Yeah, it all shifted and that was very scary and sad.

Speaker 2:
[26:26] It was horrible. So horrible.

Speaker 1:
[26:28] Yeah.

Speaker 2:
[26:28] So when I was 25 weeks pregnant, I was a second-year resident and all my girlfriends had had their babies or were about to deliver and I was walking around my brother-in-law and his wife had come to visit and we're Galveston and it's old streets, cobblestones, and I'm walking in these cute little wedges, like trying to be cute at 25 weeks. And I twist my ankle stepping up on a curb and I kind of stumbled back. My brother-in-law caught me like basket catch under the arms and I remembered this like stabbing pain in my foot, like this sharp like, so I couldn't walk on it. I couldn't bear weight. They bring me home. Of course, we call our friend, the orthopedic surgeon resident, he comes over, he's like, yeah, it's probably broken. You need to go to the ER. Okay. I'm in a ton of pain and I can feel my tummy getting tight.

Speaker 1:
[27:15] Oh, wow.

Speaker 2:
[27:16] And we go to the ED and they all freak out because I'm pregnant and ortho comes and they're like, oh, she's pregnant. Right. So they get the monitor, I'm contracting. And they're like, are you in pain? And I was too scared to tell anyone how much I was hurting because I thought they would label me as a drug seeker or whining.

Speaker 1:
[27:37] Whoa. Do you think that was because of your own experiences as a resident and how people treated women coming in with pain?

Speaker 2:
[27:43] And we were taught you need to minimize your symptoms.

Speaker 1:
[27:46] Wow.

Speaker 2:
[27:47] Yeah. I had a-

Speaker 1:
[27:48] Oh my God.

Speaker 2:
[27:49] Roan in my foot that had snapped in two. The pain was so severe, I was in preterm labor.

Speaker 1:
[27:55] Oh my God.

Speaker 2:
[27:55] And I was too scared to admit it. Because I was worried I would get labeled as a drug seeker.

Speaker 1:
[28:00] But that's also like medical training too. I mean, I think, you know, as we get further into our careers, I don't know, I've just gotten more into, I was always introspective, but I'm very introspective now. I have more time to do it. And I think about the stuff that we subjected ourselves to, because I didn't realize like we were that parallel, because I was pregnant in my whole residency also, and sucked it up so hard, because I didn't want people to feel like she got pregnant and she got lazy, and she didn't carry her weight, and we're taking more call because she got pregnant, you know, and whatever. And I was like, oh my God, I was a pregnant intern. At night, you would have to cover the whole house, right? The whole hospital. So I had four pagers on my, I don't even know how I had my, how my scrubs weren't falling off. We look like a clown, right? The scrubs are tied up here. I had the gynoch pager. I had the emergency room. I had labor and delivery. I had the floor and we had those old, remember those humongous, huge ultrasound machines?

Speaker 2:
[28:57] Oh yeah.

Speaker 1:
[28:58] And we were like, I'm pushing them, and I'm pushing it down the hall. And I'm like, oh my God, sciatica. And I mean, what the hell? No normal pregnant woman would do this. And nobody else who worked with a pregnant woman would let her do it. They were fine. I was the intern. She's doing her job. I mean, I would never have complained. It's so crazy. It's so crazy. It's so not normal. Yeah. I don't know. And then, you know, then you come out and of course you're like, if you're, if you're an empathic person, your response would be like, I would never subject anybody else to that. But people are people and they're like, I did it. Why can't she do it? Yeah. And that's how they treat their patients and their colleagues. It's not good. I worry.

Speaker 2:
[29:40] What do you see when a woman finally feels, and I've experienced this in my clinic. Certainly, I had wonderful moments under the old system.

Speaker 1:
[29:50] Yeah, of course. You know, of course.

Speaker 2:
[29:52] I just, you know, it was getting so bad at the end. The moral injury, the administrative burden, you know, the paperwork, the fighting with insurance companies, more people being hired to tell me what to do at the hospital I was at, and just not feeling like this was the best medicine I could practice. And then leaving that system and going into building a new system. I didn't know how to open a medical practice. I'd always been employed my whole life. I showed up with my stethoscope and they gave me a room and I stuck a chart, you know? And I went to work. And so I literally got the Idiot's Guide to Opening a Medical Practice. I didn't know the rules, do we charge taxes? I had to incorporate and do all this stuff. But we decided to do fee-for-service and that worked for us. But for the first time in my career, other than sitting bedside with someone in labor, when I was on my own time and just visiting with a patient, I had a whole hour to spend with a patient and really get to know her. And really understand her goals, her needs, her wants. And I just, within the first month of practice, I just realized I never felt that good consistently. Not everybody had a happy outcome. A lot of survivors would come to me because they had nowhere to go. And I couldn't fix everyone's exact problem. But I could give them the gift of time and give them the gift of my heart and not feel so fractured and having to choose my family over my work. And it was just unbelievably magical. Like what's that been like for you?

Speaker 1:
[31:27] Oh my God. Exactly what you're saying. I mean, that word fracture really resonates with me because my stress level was so high. Like I'm thinking about it now and it gives me a little bit of chest pain. Just like running from room to room or knowing like, oh my God, I'm running over because she's crying and she needs me. I cannot walk out right now. I can't be like, you know, your hand's on the door and you know there's three rooms full. And now that's when the real question emerges. And you're just like, oh my God, no, I can't. I don't feel that at all anymore. But it's really interesting because I remember initially when I started, so I left a 20 plus year career in a very large prestige practice here in Beverly Hills where we had very high volume and did everything and prided ourselves on doing everything. And it just, for me, I just, it wasn't, it wasn't me. It wasn't what I needed to do or what I wanted to do. I wanted to spend the time and I was always running late. And even when I started the new practice, I remember being nervous like, oh my God. I mean, how am I going to, how are we going to fill 45 minutes? Oh my God. It's like so not hard. It's so not hard. You just sit back. You sit back and listen and you get all the information you need and more. You get to really engage. I really knew my patients, I think pretty well considering. And I had patients for decades who stayed with me and children I delivered who then became my patients, multi-generation families. I was connecting, but I was doing it at a big, actually a really huge cost to myself. Yeah, me too. Because I was giving, giving, giving, and I had no time to like relax and think. And also I felt like so pressured that I'm going to make a mistake. I'm going to harm somebody unintentionally because I don't have enough time. It was just, I was so insane. And looking back on it, I don't know how I did it as long as I did. But I will say I was initially nervous. Like, how can I do this? A year in, I just completed my first year of my practice. It has just been enormously gratifying. And I can't tell you, you know, the end of the year, I had a lot of patients come in with a lot of gratitude, telling me how I changed their lives because I had more time to thoughtfully order those labs and pick up on things that I wouldn't have had time to address. I was taught very old school, don't do labs that you can't act on results with. So even if I knew what the path forward would be, I really wouldn't, somebody would say to me, hey, can I just do my blood test here? I'd be like, oh, cringing, because I thought, oh my God, because there's going to be more stuff I'm going to have to address, honestly. And again, I just didn't have the time. I have all the time in the world. They get on the body composition. I do their labs. I do a deeper dive into lipid pro... I mean, just by adding lipo little a...

Speaker 2:
[34:20] Lp little a, apo b...

Speaker 1:
[34:21] .and apo b, I cannot tell you between that and body composition, looking at their fat, their visceral fat and their muscle. It is a game changer.

Speaker 2:
[34:30] It's a game changer in helping someone plan the next 30 years of their life.

Speaker 1:
[34:34] Because I think people knew me here in LA as like, you know, she does menopause, she wrote this book, she's on social media, whatever. But it's not really just the hormones. I mean, sure, it's the hormones. Yeah. But it is not, it's that this is the moment in time, whether you're, and I'm thinking about specific people, whether you're 47 or you're 69, whatever moment in time you come to me, there is something that we can do for you. And I'm seeing massive results. These are women who are really, really high functioning, successful, sophisticated people. And they were running all over town, getting no help, couldn't figure it out. All they needed was that, being able to sit, tell their story, we can unwind it. That's also when some of the secrets come out, things that they never told anybody, that they had a history of abuse, that they have a substance problem, that they are trying to work on their eating, that they have all this stuff that has big health consequences, mental health and physical health consequences, that they're not telling people. Because you're not gonna walk in and say, hey, I have a history of an eating disorder and I'm really worried about my bone density. I mean, like, who says that? They don't. But you know what? You spend a couple hours with people, they feel safe.

Speaker 2:
[35:52] Yeah. To open up to you.

Speaker 1:
[35:54] You can do the real work.

Speaker 2:
[35:55] Do you think that our, the way we deliver health care in this country for most patients is broken?

Speaker 1:
[36:00] Yeah. It's just not human. It's not human scale. It's not human size. It's not human for any of the humans. You and I are humans.

Speaker 2:
[36:08] How would you fix it?

Speaker 1:
[36:09] I mean, I'd blow it up. That's what I do. I think we need health care for all.

Speaker 2:
[36:14] Because it's been insidious and we've lived through the change, right?

Speaker 1:
[36:17] Oh, yeah. We've watched it. We've watched it. We've been, I think, in a slow-mo implosion.

Speaker 2:
[36:23] I think the most, and Dr. Mike had put this graph up, super popular medical educator on social media. He's a family medicine doc. He put the graph up that I've seen multiple times. When you look at physician's payment over time, which has grown under the cost of living, right? And then you look at administrative costs. And literally, it is like a skyrocket that has gone. We basically, health care costs have increased because of the cost of administrating health care, not paying the clinicians who are delivering the health care. And the outcomes are worse.

Speaker 1:
[36:57] I mean, in OB specifically, maternal mortality?

Speaker 2:
[37:01] We've lost ground in so many areas. And I've watched it reshape the way medicine is practiced, which is really scary to me.

Speaker 1:
[37:12] Tell me, what are your impressions about how it's been reshaped?

Speaker 2:
[37:15] Well, one, that we used to take care of curable cancers. We used to take care of these things for all the patients who walked in. But really, being so hamstrung by the time constraints. So like this administrator breathing down your neck, not only to see 30, 40 patients in one day, but to get all five stars from every patient.

Speaker 1:
[37:44] And then they tell us what we can and can't do to take care of these patients.

Speaker 2:
[37:48] And then the patient is frustrated because insurance won't cover, you know, they're all coming in on multiple different insurance plans, and there was no method for a long time, that there's a better one now, of me being, have any idea of what their insurance is going to cover.

Speaker 1:
[38:02] Right.

Speaker 2:
[38:03] And then if you look at the rate of prior authorizations and how that has skyrocketed, I mean, it is a racket built to destroy patients and their clinicians trying to take care of them.

Speaker 1:
[38:12] A hundred percent.

Speaker 2:
[38:13] So. Yeah.

Speaker 1:
[38:14] I mean, they don't want to spend the money that you invested.

Speaker 2:
[38:17] So who's making money in healthcare right now?

Speaker 1:
[38:19] The insurance companies. The hospitals are losing money hand over fist, too, by the way.

Speaker 2:
[38:25] There's a lot of misconception about that.

Speaker 1:
[38:27] Yeah. I mean, people are getting these crazy, crazy bills and like they're Tylenol is $80, whatever. But that's because the hospital cannot bear under the weight of the insurance system either. So the pharmacy benefit managers, which are essentially owned by the insurance companies, which are setting the rates and telling you whether or not this medication will be covered. This is like a freaking cartel, man. It's a cartel. And I think the other thing is when people call it a health care, it's not health care, it's health insurance. I mean, it's there for God forbid you end up with a heart attack or cancer diagnosis or a car accident. You need to be insured. I believe people need to be insured.

Speaker 2:
[39:03] I mean, my husband and I are fully aware that our health insurance is to keep us from going bankrupt if something catastrophic happens. But I don't know if our listeners understand the number one cause of bankruptcy in the United States.

Speaker 1:
[39:20] It's medical.

Speaker 2:
[39:20] It's medical bills.

Speaker 1:
[39:21] Yeah.

Speaker 2:
[39:22] The number one cause of, this does not exist in Europe. This does not exist in Canada.

Speaker 1:
[39:27] Talk about moral injury and then we're involved in this. It's wrong.

Speaker 2:
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Speaker 1:
[43:31] Okay, so I have a 25-year-old who is on my insurance for another... I know, not that we're not counting because we are. And I mean, I'm spending almost $2,000 a month on the premium. That doesn't mean that it's paying for anything that I need or she needs. I had a fabulous experience this year where I ended up having to get whatever. I had to get a biopsy on my other breast and everything is okay. But I was $3,000 out of pocket and I'm paying my premiums. And this was a recommend. I wasn't doing some experimental procedure. It was like, hey, we saw something abnormal. We need a biopsy. No, I got to pay for that. You got your deductible, you got all these things. It's insane. So how do I think it needs to be fixed? I think that needs to go away. I think there needs to be a level playing field. I think there needs to be national health care for people. Will it all be fabulous? Maybe not, but it'll be something. It's better than people not being able to afford, not qualifying for state or federal insurance. So then they're not taking care of their chronic diseases. They're developing chronic diseases. They don't have any access. And now they're showing up to the emergency room for their chronic disease management. And it's costing them their lives. It's costing them their finances. And it's costing us a lot of money. Because someone walks in, having that stroke, we're going to treat them. So now it's costing a ton more money than if we just would have treated them. And there are going to be people, like in other countries where there's national health care, who have the means to invest in their health. And is it fair? It's the way it is. And they will seek doctors like you and I. And have a different experience. And I think there's a trickle down. One of the things that I say to my patients, you know, because I called you a lot about this, it was a very, very hard decision for me to make, ethically and morally, to leave the system behind as well. For the exact same reasons.

Speaker 2:
[45:21] And so, when we talk about alternatives to insurance, there's a lot of pushback from people who believe in socialized medicine or that health care should be a right and not something. How do you respond to that?

Speaker 1:
[45:37] I think they're right. I think it is a right. And I think it shouldn't be a privilege. I think people who have the privilege to afford the care that they want to access should have that right as well. And these are people often that are influential. And that can also have big impacts out in the world in the ways that they are, including in policy. But the reality is, why are we either or-ing everything? Why is everything so binary? It's very important that we have more than one way to do this. And I do think that it is a right. But the other thing is that people don't understand how you and I got here, right? I self-funded my medical education.

Speaker 2:
[46:10] Same.

Speaker 1:
[46:13] My debt was probably half a million in premium, you know, just in my loans. So you can't ask doctors to sacrifice a decade or more of their life plus their financial future, and then come out and not be cared for. It's not a human system. I don't think any of us are saying like, I didn't go into medicine to get rich, okay? Hello, my friends of mine who wanted to get rich already did that like a long time ago. Yeah. That's not why I'm here. I didn't work 80 hours a week while I was pregnant, because all I care about is money. And I feel like if people understood what it took for us to become physicians, and then to stay physicians, they would understand that we're on the same side. And this is also this polarization is coming from forces that want us to stay divided, because if we all united, then we would all recognize where the problem really is. And it's not who's delivering healthcare and who's receiving it. It's how the healthcare is getting delivered and who's controlling that. It's a complex situation. I do think it's solvable. And I think right now we're in an interesting time, because people are thinking more creatively. People are thinking in a more positively disruptive way. And I do think that social media has brought patients and clinicians together in a very powerful way.

Speaker 2:
[47:36] I am a member of several physician groups online. And it just seems to me that a lot are leaving traditional medicine, wanting to leave traditional medicine or can't leave because they're tied down by loans or contracts and whatever. What do you say to them?

Speaker 1:
[47:53] Well, I mean, we are looking at, I think, a deficit of something like 86,000 physicians in the United States in the next 10 years. That's a huge problem. Who's delivering care, right? And we've been talking endlessly about how the system is really injuring the patients and the clinicians. So of course they're leaving. They can't take it anymore. And there's this sort of conversation that you brought up actually about burnout versus moral injury. And they are different. Burnout is physical and emotional exhaustion. And it sort of centers the problem on the person experiencing it. People will kind of depersonalize, get kind of like... You often see like a lot of negativity, skepticism, cynicism. Moral injury is the choices you're being asked to make are in conflict with your own ethical and moral guidelines. And that is really injurious. That's PTSD.

Speaker 2:
[48:45] We were kind of taught and we knew to expect the exhaustion. That is what you signed up for, you know. And at some point in your career, you start pivoting and shifting and whatever, but like people are leaving the system because of moral injury.

Speaker 1:
[49:01] Yes, that's exactly right.

Speaker 2:
[49:02] They cannot resolve a conflict in their head and it's killing them.

Speaker 1:
[49:05] Yeah, and it is killing them because physicians have actually the highest suicide rate of any profession. We're sensitive people.

Speaker 2:
[49:15] And females live longer than males.

Speaker 1:
[49:17] Unless you're a female physician.

Speaker 2:
[49:19] If you're a female physician, you lose that advantage.

Speaker 1:
[49:20] There's no joke. This is some serious stuff. And we're not here whining and complaining. We're just stating the fact. Well, because it's gallows, Amir. That's how you get through it. But I mean, we're just stating the fact. So it's like if we want to have excellent health care, excellent provision of medical care, which is what all of us deserve, then we need to start supporting our clinicians in a real way and offering opportunities for them to practice the best medicine. If people want to get great medicine, they have to expect it and they have to expect that the people who are delivering it are being treated well. I mean, this is a whole podcast in itself, unionization and all these other things. My response was to pull out of the system and say, you know what, I can't do this anymore, but I don't want to leave medicine. And with the help of a startup that I was a part of, I was advising and consulting for years in industry.

Speaker 2:
[50:13] So this is Monarch?

Speaker 1:
[50:14] Yeah, so this is Monarch, yeah.

Speaker 2:
[50:15] And let me get this right, you are the chief clinical officer.

Speaker 1:
[50:18] What does that mean? It means that I'm in charge of the clinicians, right? Basically, I help to shape who we want to bring into the company and I'll explain what we do. I also help support these doctors in practicing in the way that they want to practice. The company itself is operational support. So we support independent practitioners. The physicians own their own practice. We come in as operational support. All the things that doctors are not good at, running a business, like you said. We don't know how to start a business, the legal, the insurance things, the back office, the marketing, the billing, all that stuff. So we come in and we do that and you get to practice medicine the way you want. It's membership model. So that also actually takes a lot of pressure off because people pay for the year and they're getting their care. And now every visit isn't being billed. You're not like, do I call her because I'm going to have to pay? And I'm not thinking like, do I fill my day with 25 patients or I'm not going to be able to pay my rent and my staff. It just removes all of those barriers and what you get is time and you get bandwidth and you get creativity. So as chief clinical officer, I'm helping to shape who's joining us. And I'm also helping shape the clinical protocols. We don't have like a monarch way, but we are really excited to be like, we're working on a sleep module, we're working on a cardiovascular health module. So if you are practicing in an environment where you have great clinicians and referrals and people that you're working with already, terrific. But if you don't, here's what we have to offer you. It's really powerful medicine. We're allowing people to do great medicine because we're doing that structure and that foundation. So for me, it's been super exciting. And also listen, Mary Claire, I've been all over the country this year, talking to doctors like me, hearing their stories, and it's been hard. It's been gratifying because I think that whether or not they decide they want to do this kind of medicine, they see that there is some hope. There is a way forward for them. But it was rough to be all over. I mean, the East Coast, the South, the Midwest, it's everywhere where doctors are like, I'm done, I'm piecing out or I have to keep doing this. I have all these bills to pay. I'm stuck and I'm miserable. I mean, that is terrible. That is not a person who's going to be able to provide great care to anybody. So having an option for them has been very, very, it's been fun actually and reignited my passion for this.

Speaker 2:
[52:54] Now it's time for the MIDI PAUSED. I'm Dr. Mary Claire Haver, host of the podcast unPAUSED, bringing you a word from MIDI Health. Today we're going to take a pause and discuss heart disease. Did you know that heart disease is the number one killer of women responsible for one in three deaths? And here's what many women don't know. Up to 80% of your cardiovascular risk is shaped by your lifestyle. When estrogen declines during menopause, its protective effect on your cardiovascular system go with it. Cholesterol rises, blood pressure climbs, and visceral fat increases. Your heart needs more support now, not less. Heart health can have a significant impact on women, especially during menopause. The same hormonal shifts that trigger hot flashes and brain fog can hurt your cardiovascular health. But treatment could make you feel better. That's why MidiHealth is dedicated to changing the way menopause is treated with a personalized approach to each women's specific needs. Women come to MidiHealth to address the symptoms of menopause they see and feel every day. They partner with you to find a treatment. Whether that's HRT or a non-hormonal solution, that will relieve your symptoms and make heart healthier habits easier to put in place. I personally have found that these five habits can make a real difference. Number one, don't ignore your hot flashes. They're not just uncomfortable. Frequent untreated vasomotor symptoms are a signal that your cardiovascular system is under stress. Take them seriously. Talk to your clinician. Number two, move your body. A sedentary lifestyle is a major risk factor for heart disease. Aim for 150 minutes of cardio per week, plus two to three strength training sessions. Even daily walks add up fast. Number three, eat for your heart. Colorful whole foods, enough protein and fiber, healthy fats like omega-3s, and cut the ultra-processed foods. Studies link them directly to higher cardiovascular risk. Number four, if you smoke, please stop. Smoking is the single most modifiable risk factor for heart attack and stroke. Number five, have the HRT conversation. Women who start hormone therapy within the first 10 years of menopause or before the age of 60, show lower cardiovascular risk and lower risk of death from any cause. The science is clear, you deserve to know your options. It may not be right for everyone, but every woman deserves the conversation. And MIDI Health is setting a new standard for health care. As the nation's fastest growing women's telehealth company, MIDI provides accessible insurance coverage services. Building on its leadership and perimenopause and menopause, MIDI fills the critical health gaps women face at every age and life stage. If you want a clinician in your corner who understands what your body and your brain need right now, that's exactly what MIDI is built for. Go to joinmidi.com, joinmidi.com, and connect with one of their clinicians today. Integrative medicine. What is that? Because so many people don't know what that is.

Speaker 1:
[56:09] I mean, integrative medicine is really integrating more traditional holistic indigenous systems.

Speaker 2:
[56:15] You have special training.

Speaker 1:
[56:17] Yeah, I'm trained in Ayurvedic medicine, which is the medicine of India, the ancient medicine. I mean, it's probably one of the oldest medicines recorded on the planet. There are textbooks on surgery and on anatomy from, depending on how you date them, 2,000 to 5,000 years ago. So it's pretty interesting. It came out of spiritual practice like most indigenous medicine, right? It's rooted in the land, in the plants, in the seasons, in what was available there, in something bigger than ourselves. Came out of Hinduism. Chinese medicine developed around the same time. And so I just set up my own curiosity, started studying that after I finished residency. And I think it's because there was something missing. I was like, all this technical stuff is magical. You know, I can do surgery and people can be in the ICU and all these things. And I can, you know, do a C-section if I have to. But something was not quite there. And I was seeking, I think, some deeper meaning. And I found that the more holistic traditional medicines used everything. They talked about community and spiritual. And plants, which are medicine. And procedures, if you need to do it. It was fascinating to me. So I did it initially out of my own curiosity and to sort of fill some sort of gap that I thought I had. But then people started hearing like, oh, you know, she's open-minded. She'll use herb. I wasn't practicing Ayurveda. I was more open to things. So integrative medicine takes the best of science and modern medicine and convention and evidence and combines it with ancient. Because this idea that conventional medicine, like, it's just like, booped onto the scene magically. Like, that's ridiculous. It's, you know, the great, great, great, great, great grandchild of all these traditional medicines. And it's been really satisfying for me and interesting to me.

Speaker 2:
[58:02] Do you feel like this model, your new model, allows you to, like, integrate integrative practices more into?

Speaker 1:
[58:09] Yeah, definitely.

Speaker 2:
[58:10] How are the patients responding? Do they think you're too woo-woo or too crunchy?

Speaker 1:
[58:13] No, I mean, I don't, I'm not, you know, listen, you meet people where they are. So I'm not, like, throwing herbs and meditation at everybody.

Speaker 2:
[58:19] I saw you speak multiple times before I knew you did any of this other stuff.

Speaker 1:
[58:22] Because I'm, like, a regular, degular doctor with, like, this other interest. I weave it in. It helps me understand where that person's coming from. For a long time, especially when it came to perimenopause and menopause, people came to me because they didn't feel like I was going to force a prescription on them. And so I do have, specifically around that, I have a lot of interesting herbs that I use that have decent evidence to support their use.

Speaker 2:
[58:47] Okay, tell us, because everyone's curious.

Speaker 1:
[58:49] Of course I will. I love Chaseberry, which is also called Vitex. That's the Latin name. And one of the ways that it works is probably in helping to increase the amount of progesterone that is secreted from your own body in the second half of the cycle. So in perimenopause, it works really well because we see a loss of progesterone secretion in the egg as it's aging. And that's where we see a lot of the physical symptoms, a lot of the mood symptoms. Yeah, exactly. So that's a big one. It can help, especially with mood, sometimes some of the physical symptoms, like breast tenderness, sometimes sleep. That's a great one. And that's safe for everybody. Things like Russian rhubarb, Siberian rhubarb, acts possibly like a selective estrogen receptor modulator and can be quite helpful for hot flashes. I think we know black cohosh, which got a bad name. It is not hormonal, but there were a couple of case reports of liver toxicity. And so now all of a sudden, black cohosh caught... No, if you don't have high quality medicine, whether it's pharma or plants...

Speaker 2:
[59:55] Number one liver toxin is acetaminophen.

Speaker 1:
[59:57] Exactly.

Speaker 2:
[59:57] Tylenol.

Speaker 1:
[59:58] That's exactly right. But there is a long history in this country of marginalizing anything that is not standard of care. And who is setting the standards? So you just did...

Speaker 2:
[60:09] This is so fascinating. A substack. So Dr. Suzanne has a substack.

Speaker 1:
[60:13] I have a substack.

Speaker 2:
[60:14] Which I'm obsessed with.

Speaker 1:
[60:16] Talking about... The Flexa Report.

Speaker 2:
[60:19] Oh my God. I think it's worth it for our listeners.

Speaker 1:
[60:22] I think they'd be fascinated. It hurts my heart so much to talk about it because it's so... I knew about it. And I think I even had mentioned it in my first book. I'm working on another book on plant medicine. Yes. But when I looked into it even more deeply, I was like, whoa. So in 1910, the very early formation of the American Medical Association, was supported by Rockefeller and Carnegie Foundations, for better or worse, to look at like, hey, can we clean up medicine? Because it's a little bit of the Wild West out there. So I think that there were...

Speaker 2:
[60:54] Intentions were good.

Speaker 1:
[60:55] Intentions were good. But now in retrospect, it's like, but were they? Because there was also a big push from the early developing pharmaceutical industry to sort of standardize things. Not necessarily bad, but what's going on? And I want to make sure no one thinks I'm like a crazy anti-pharma because I'm not. No, no, no, of course not. So at that time...

Speaker 2:
[61:17] You prescribe more...

Speaker 1:
[61:18] Yeah, I do. I prescribe. I just sent a Z-Pak to our friend last night. Anyways, so they hired Abraham Flexner, who was an educator, and he went all across the country looking at all the medical schools.

Speaker 2:
[61:30] What did medical schools look like back then?

Speaker 1:
[61:31] Well, they looked like everything. So a lot of them actually integrated. A lot of them taught homeopathy. A lot of them taught natural medicine. A lot of them taught women. It turned out there were all these part-time medical schools that women went to. It's not true that women weren't going into medicine, but they were doing things. They were having babies. They were taking care of families. They couldn't just up, and if you weren't rich, you couldn't just go to Harvard. And also if you weren't a white Anglo-Saxon male, you were definitely not going to Harvard. So anybody who is ethnic of any sort was not getting into these schools. And there were seven black medical colleges at the time. They shut down all but two of the black medical colleges. They shut down like 80 or 90% of the part-time for-profit colleges, which is where women went. And they got rid of any homeopathy, natural medicine, all was marginalized. This is bad. This is dangerous. It became doctor as technician, patient as pathology. Look, there were things about that that were very modern and progressive for the time, but it was exclusionary to the point of really damaging, I think, damaging the way we delivered health care and the way we looked at humans. We started isolating parts and pieces of bodies. And they're looking at the whole person. And the cool thing that I have found, and I knew this from my study of Ayurvedic medicine, was that it turns out all indigenous medicines were communal. So there are these ideas, for instance, that if you're sick, your family is sick, your community is sick. So we need to work together to help you heal. You have to take responsibility, and you have to do certain things different. But we are a whole. Doesn't that sound like something we might want to look at again? One of the biggest problems I'm seeing now is isolation. We know the Surgeon General has told us that isolation and loneliness are more dangerous to your health than smoking cigarettes. I think we got a bad taste of it during the shutdown and the pandemic. But it's deeper than that. We can't even talk to each other if we don't have the exact same opinion. What is that? This is not humans. We're tribal. So I'm a little Pollyanna-ish, I guess. But I don't think we have to all like throw out our scripts and, you know, roll around in the dirt. Okay, I'm not telling you to do any of those things. If you want to go for it, it might be fine. But I think we need to be a little more expansive and a lot more curious and humble. That, to me, is what medicine is. Is my toolkit big and wide? Yes.

Speaker 2:
[64:07] So your new book is called Plant Medicine.

Speaker 1:
[64:09] And it's a little bit of a play on things because I know that for people who are in the know, plant medicine sounds like psychedelics and that's very interesting for people right now. But plant medicine is really where medicine comes from. Plants. Over 30% of our pharmaceuticals today are plant-derived. And they did not, again, some genius in a lab.

Speaker 2:
[64:27] It should be 100%, all right?

Speaker 1:
[64:29] Exactly. And we borrowed them from whatever people were living in that area. Okay, this is not new. So the book is about both the use of botanical medicine and how we can use it today and what the actual evidence to support that use is, but also the history of medicine and the history of humans with medicine and how we interact with nature in order to heal ourselves. And that is an inclination that we've always had. It's super fascinating. I'm having the best time working on it. And I'm so excited to share it with the world.

Speaker 2:
[64:59] Who should read it?

Speaker 1:
[65:00] Everybody should read it. I mean, anybody who's interested in healing themselves, this is not just for women. This is for everybody. I mean, there'll be some recipes in there for things. I brought you some things today that I made. But also people who are interested in the history of medicine or the history of like how humans interact with each other. It's the book that I've always wanted to write.

Speaker 2:
[65:19] Well, what does it look like when science and ancient, you know, practices coexist? I mean, I don't think they're exclusive, right? It's not.

Speaker 1:
[65:27] But people make assumptions. And I think if you understand that flexner thing, you understand where some of our biases come from. Like we didn't get trained learning about flexer at all. No, never heard of them. Right. I read your substance. Right. So there's a lot of biases that are built into the way we as clinicians are trained. And I think that that's a big opportunity to widen the lens here and look at like, wait, what is medicine? What is the art and the practice of medicine? And this idea that there's no science to support the use of herbs is untrue. There's a ton of ethnobotanical research. There's a ton of bench research, you know, so, so not clinic, not necessarily in humans, but we know how Rosemary works, right? We know that Rosemary, most of your cooking herbs are medicinal because they have very specific chemical components that, for instance, are immune boosting or are literally anti-infective. They work against microbes. They're anti-microbial. So you know, we know that honey does that too. There's science to this. I'm not making this up.

Speaker 2:
[66:26] How would a woman integrate this into her life responsibly?

Speaker 1:
[66:30] Well, so a couple of things. First of all, because most of you aren't going to go out and make your own medicine, although if you grow oregano, for instance, it's very easy to infuse it into oil. I'm going to tell you how to do it right now. Clean it off. Make sure there's no pesticides on it. Dry it. Put it into a jar, like, you know, maybe an eight ounce jar of really high quality olive oil or some oil that you like. Let it soak. Close it. Sit it in the sun in a sunny window for two weeks. Strain it. Now you have oregano oil. Okay. You can put that on a burn, on a cut. You can put a couple of drops in your mouth to help fight off a cold. Anybody can go to the market today and do this. Most of you are not going to make all your own medicines. So if you're looking at the supplement world, it is regulated. It is not regulated to the same level as the FDA and pharma. There's something called dechet. It's not perfect. It's something. You have to be very careful. When you're purchasing online or in a store, you need to make sure that that is third-party tested. That what you think is in it is in it.

Speaker 2:
[67:31] How would they know it's third-party tested?

Speaker 1:
[67:32] There's usually a label on there. And if you go online, usually there'll be a search engine in their own website. Just put in third party. If you can't find it, if you're looking for a long time, forget it. It's not there. It shouldn't be that hard.

Speaker 2:
[67:44] It should be prominent.

Speaker 1:
[67:45] Because any brand that has integrity wants you to know that somebody else is coming in. Scientists are coming in and testing it and saying, yes, this is the strength. Yes, it's unadulterated. No, there are no lead or mercury contaminants. Exactly. A lot of stuff is coming from other countries and it's not so clean. So that is my number one piece of advice. And I think working with somebody who really knows what they're talking about, because I think if you're going to start treating yourself and now you're going to go to your physician and they're going to be like, what are you doing? Throw all that out. I mean, that's not helpful. I will say, just from the Ayurvedic perspective, we don't treat the same way like, oh, you have this problem, here is the solution. It's much more nuanced than that. So we're going to leave that to the side for a minute. But there are plenty of things that we can reach for, that can be helpful to us on a daily basis. And I think the practice of it helps us reconnect again to our human history, to ourselves, to some kind of intuition. And I think that's really healthy. Because when we're outsourcing, we started talking about how to advocate for ourselves. When we're outsourcing our entire being and all of our health, that's actually where we get into trouble.

Speaker 2:
[68:55] I think you're right.

Speaker 1:
[68:57] We got to own it a little bit.

Speaker 2:
[68:59] It's so confusing.

Speaker 1:
[69:02] It's very confusing.

Speaker 2:
[69:03] Misinformation, disinformation, people trying to profit.

Speaker 1:
[69:09] And people also who really think that they know and they don't have the chops. I have been in medicine for... I graduated my residency 26 years ago. I have been practicing medicine for 26 years. I had four years of residency, four years of medical school, four years of life, and four years of college before that, okay? I studied... I have studied Ayurveda for almost 20 years. I'm an authority, okay? I think there are people out there who are super interesting, creative, brilliant thinkers, and they don't have the chops. So I think that they should say they have an opinion, say they're thinking about something, share their ideas, collaborate with people who have works. I studied with people who studied this ancient technology for years and decades and had generational transmission of this information, which is what we did in medical school too, right? And I still am learning. I don't know anything. So we have to be a little bit careful about where we're getting our information from and just because somebody says they're an authority does not mean they're an authority.

Speaker 2:
[70:15] I know. I always like, if you can't clearly see someone, if they're representing themselves as a doctor, like I see this all the time on social and you'll see Dr. X, right?

Speaker 1:
[70:24] Right.

Speaker 2:
[70:24] But there's no credentials after their name. Doctor of what? Doctor, you know, and I always tell people, take that with a grain of salt. Most of us will put our credentials out there.

Speaker 1:
[70:37] Exactly.

Speaker 2:
[70:37] So you know where this person is coming from.

Speaker 1:
[70:39] That's exactly right. You know, these kinds of conversations bring me hope. I think, you know, working on this book has given me a lot of hope also because I see that humans have always struggled and we've always had challenges. But when we come together, we come up with solutions. I got a shout out to my dad for being 89 and publishing a book. That gives me a lot of hope. Like, you know, it's interesting because I early in this kind of menopause conversation, I talked a lot about shifting the narrative and reminding people that menopause and beyond is a significant part of your life and it can be the best part of your life if you have the right resources. To look at my parent who just keeps going and like decided he should write a book at 89, says everything. Like, it's over when you decide it's over. That gives me hope. I'm here now.

Speaker 2:
[71:31] What do you want women to feel after listening to this conversation? What are your big takeaways for them?

Speaker 1:
[71:37] I want them to feel like they have a chance. I do want them to stop adopting that narrative of victimhood, that there's nothing that they can do and that it's all like we're being oppressed. I mean, we are, we are actively being oppressed, okay? But that doesn't mean that we can't exist in some very specific way. We always have, when I look at the history of women and the history of medicine and the history of witches, you know, seriously, like, female healers, midwives existed always, and they always were a little bit under the radar, and they were super powerful. I learned that some of the only women that were allowed to travel around the countryside in, you know, like the Middle Ages were midwives and healers. They could go independently. These ladies were, they were very smart. They were going around, and they were not just going around and taking care of health. They were going around, and they were talking to people. They were listening to people. They were empowering women in the way that they were capable of doing. So we can do things, but we have to work together and support each other. We have to lift each other up. We don't have to be slapping each other down. That doesn't help.

Speaker 2:
[72:40] Yeah. That, I think, is core, at least in our field, you know, at this level, is really collaboration, you know, respecting each other's strengths, really respecting differences.

Speaker 1:
[72:55] Yeah.

Speaker 2:
[72:56] Really, if someone is thinking different than you, listen to her and try to understand why, you know, it's usually, you'll learn something from that conversation.

Speaker 1:
[73:04] Absolutely. It's an opportunity.

Speaker 2:
[73:05] Thank you so much for coming on UnPAUSED.

Speaker 1:
[73:07] Thanks for having me. We love you so much. I love you more.

Speaker 2:
[73:12] You can find Dr. Gilberg-Lenz on most social platforms at AskDrSuzanne or through her website at thedoctorsuzanne.com or at www.gilberg.monarchmd.com. You can find full episodes of UnPAUSED on YouTube at Dr. Mary Claire. I would love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health fitness and navigating midlife at thepawslife.com. My new book, The New Perimenopause is available on Amazon. If you're loving this podcast, I have an important request. Please take a moment to follow UnPAUSED on your favorite podcast app. Following and listening is what pushes this information to more women who need it. So if this podcast has helped you feel seen, understood or supported, hit follow right now so you never miss an episode. Thank you for being here with me. Let's keep going, UnPAUSED. UnPAUSED is presented by Audacy in conjunction with PodPeople. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on UnPAUSED are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis or treatment. This episode was sponsored by Midi Health, the first virtual clinic created for women by women for the treatment of menopause. Don't let anyone tell you menopause is something you have to suffer through alone. Midi can help. Visit joinmidi.com to learn more. Perimenopause is not early menopause. It is its own distinct biological phase. And it has been largely ignored. My new book, The New Perimenopause, is about the seven to ten years before periods stop. A transition that is anything but gentle. Hormones fluctuate wildly. And for many women, this is when anxiety, brain fog, sleep disruption, weight changes, mood shifts, joint pain and that unsettling feeling of, I don't feel like myself anymore, begin. Long before anyone says the word menopause. Perimenopause often starts quietly. It shows up in the brain first, then the body, then everywhere else. And all too often women are told nothing is wrong. I wrote The New Perimenopause because you deserve answers before things spiral. You deserve care before burnout. And you deserve a clear roadmap for a transition that medicine has ignored for far too long. The New Perimenopause is now available everywhere books are sold. Learn more and order your copy at thepawslive.com.