How to Talk to Your Regular Doctor – Dr. Mike Diatte

00:04
Carmen
Hello and welcome to the N1 podcast. Today we have our usual suspects, and we have a good guest today that I’m super excited about. So we got Dr. Jamie, we have Kevin, myself, Carmen, and we have Dr. Diotti here today, who is kind of quite special to me, I’ll have to say. But primary care here in Nashville. And we just are excited to have you today to kind of talk about health care today and where it’s going and how things are and just how. How it all fits into what. What we do here at N of 1. So thanks for coming.

00:31
Dr Diatte
Yeah, thank you so much for having me. I’ve been looking forward to this and listening to some of your guys recent podcasts. Love what you guys are doing, and I know this is something you’re super passionate about, so thank you for having me.

00:44
Dr. James McDowell
Fantastic.

00:45
Kevin
Great.

00:46
Carmen
Pause for one second. You’re welcome.

00:50
Dr. James McDowell
So, Mike, I’m so excited that you’re here. You know, I’m. I’m so thrilled. You know, one of the things that I have recognized over the last 10 years in medicine is how the role of primary care. You know, the first thing is it’s hard for people to find a primary care provider. Right?

01:07
Dr Diatte
Yeah.

01:07
Dr. James McDowell
And on top of that, you know, a lot of times, you know, primary care has been divided into managing numbers. Right, right. And one of the. One of the goals that we have at N of one Wellness is, you know, I personally believe, and we’re going to talk about this at length today, is that about 80% of the problems that are dealt with by primary care providers all stem from one basic cause, and that’s over consumption of carbohydrates, metabolic syndrome, and insulin resistance. And so we’ve spent all this time managing hypertension, hyperlipidemia, type 2 diabetes, obstructive sleep apnea, and managing them separately with. And we can get to the root cause of this. And I think that the problem with it is there hasn’t been as much synergy between primary care providers and perhaps obesity specialists such as myself.

01:59
Dr. James McDowell
What are your thoughts on that?

02:01
Dr Diatte
Yeah, it’s. It’s been kind of a whirlwind, jumping, you know, out of residency and, you know, starting my practice. I. I finished training in the middle of the COVID epidemic, which, you know, it was 20, 21. And so starting my practice, it’s like, man, I’m meeting, you know, hundreds and hundreds of people with all these medical conditions, and as I’m getting to know them, it’s like, hey, they’re on all these medications. They are as I’m seeing them back in every three months, every six months, no one’s really getting any better.

02:39
Dr. James McDowell
Correct.

02:40
Dr Diatte
And at the same time, it’s like, man, people are having kind of a growing mistrust in the medical system in.

02:47
Carmen
General, especially post Covid. Especially like that.

02:50
Dr Diatte
Yeah. I mean, that was when all the stuff about, you know, the jab and all this stuff with pharmaceutical companies started coming out. So, like, it’s okay. I’m. I’m meeting all these different people from all these different backgrounds and trying to figure out, hey, how. What is my practice going to look like? How am I. What kind of doctor do I want to be? How am I going to, you know, approach people’s health? And, and so, yeah, one of the first things I realized is, man, it’s like I. In, in residency, right. In our training, we learn to treat all these different diseases, right? Like, hey, someone comes in with high blood pressure, I mean, I can tell you 15 different drugs to choose from.

03:31
Dr. James McDowell
Correct.

03:32
Dr Diatte
And I think that’s.

03:33
Kevin
Is that the directive, though, as far as the way that you’re trained? You have to give them this medication or can you go kind off.

03:39
Dr. James McDowell
Off script?

03:40
Dr Diatte
Yeah. And every, so every provider, I think, is going to practice in a very different way. Right. And so that was part of, like starting my practice is like, man, what is this going to look like for me? Right? Am I going to stick, you know, strictly to the guidelines that say, like, hey, if your blood pressure is over, you know, 135systolic, you should start on an asymptote. Right. Or if you’re LDL, cholesterol is over 190. Hey, you’re immediately put on a statin.

04:10
Carmen
And wait, let’s back up just for a second. Where do those guidelines come from?

04:14
Dr Diatte
They, they. So there’s different organizations, right?

04:16
Dr. James McDowell
Like pharma?

04:18
Dr Diatte
Yeah, yeah.

04:19
Dr. James McDowell
That’s where they ultimately come from. Now, yeah, you could say it’s from the government and you can say it’s FDA approved, but these directives come from the companies that make the anti hypertensive.

04:27
Carmen
Well, and from his. And from his standpoint.

04:29
Dr. James McDowell
So the studies are from.

04:30
Carmen
I just want to say, like, is it an institutional guideline too? Like, are you given from an institution a certain guideline to say, hey, you know, you can’t. This person’s at risk if their blood pressure, I mean, let’s say they run 140, 150 systolic on blood pressure. And that’s the top number, right. For Our listeners who don’t know, when you take a blood pressure, it should be somewhere, you know, in the 120ish range over a lower number. Right?

04:53
Dr Diatte
Yeah.

04:53
Carmen
And so if they’re creeping up and they have this constant blood pressure of 140, 150, how held to the gun are you to say you need to start a blood pressure medication? Like under what regulatory guidelines?

05:07
Dr Diatte
Yeah, so I’m like, I wouldn’t get in trouble one way or the other. There are, I think there’s a stroke. Right, right. Yeah. Then I could, then I could. That would not be good. So there’s like a couple questions in that. The first is like, hey, where do our guidelines come from? So with blood pressure, for example, you have the American Heart association, the American Cardiology Society. And so they’re putting out different types of guidelines on, hey, like what, at what point should we be worried about high blood pressure? What are the different treatment options? And so I’ve like taken a look at those guidelines, right. And they’re based on these studies that are funded by drug companies and even the guidelines themselves.

05:54
Dr Diatte
A lot of the advisors that were on the board of this, you know, are also advisors for Bayer and you know, all these like different pharmaceutical companies. And so it makes it really tricky. One of the hardest things about starting a practice has been like, man, there’s these different sources and these different guidelines that we can go to help, you know, guide our practice. Because really at the end of the day it’s like, man, I want to do what’s best for my patient. Right. And we’re trained, hey, follow the guidelines. Right. This is the very best. We’re practicing evidence based medicine, but that’s the buzzword. Yeah, evidence based medicine. But man, there’s been so much doubt that’s coming.

06:39
Dr. James McDowell
Is it a coincidence that evidence based medicine that we have seen in the last 10 years usually always involved administering a medication? Right, right.

06:49
Dr Diatte
Yeah.

06:50
Dr. James McDowell
I think now I’m not a good, maybe I am a conspiracy theorist. You know, I practiced in a time and I trained. My residency was a different era in that, you know, when you came to see your physician, there wasn’t an expectation every time that you’re going to write a prescription to solve a problem, you go to your physician to get life advice as much as it was to write a prescription. But many primary care, all physicians have been pushed for these treatments. And so the style of a practice, you know, now, I mean, I think this is unique. I see where you’re Going with this is not satisfying for physicians either, Right. I mean, if I take your blood pressure and it’s 160 over 95, okay. And I write a prescription, there’s no thought, there’s no creativity there.

07:34
Kevin
Right.

07:35
Carmen
And you can’t take that to the bank and say this was just a one off or every time they come in here, it’s high.

07:42
Dr. James McDowell
Well, there are consequences to this, these protocols.

07:46
Carmen
Right.

07:46
Dr. James McDowell
So, for instance, I took call yesterday. I took all yesterday at my hospital, and one of my responsibilities in call is trauma. Right? Now, trauma has traditionally been, you get shot, you know, you get shot, we got to take care of you. You get in a high, you know, a motor vehicle accident, we take care of you. Every trauma consult I get to a patient so far is an elderly person with polypharmacy who has fallen from a standing position and bumped their head. Now, that’s not trauma. Now, at the end of the day, we have an epidemic of this elderly people. Institutionalized elderly people, commonality. They have at least six to seven medications most of the time, two to three times that have been used for years because they go back in, their blood pressure is still high.

08:37
Dr. James McDowell
All right, we’re going to add another medication. Oh, my gosh, I’m depressed. Well, we’re gonna add another medication. Oh, my gosh, I’m anxious and I can’t sleep. All right, let’s add a benzodiazepine. Right. When all of this can be managed with lifestyle management. If you have the time to sit down and talk to your patients, we don’t. And this is the conundrum that the American public has now with the American healthcare system. And this has to be managed better.

09:02
Dr Diatte
Yeah.

09:03
Dr. James McDowell
People are dying of these problems. I don’t want at the end of my life to have to live within a mile of you because I need my prescriptions taken care of just to keep my heart beating. And that’s what it feels like. This is at end of life for elderly people.

09:18
Dr Diatte
Yeah, absolutely. We’re not. We’re not really improving the quality of anyone’s life.

09:22
Dr. James McDowell
Quantity is all they’re going.

09:24
Dr Diatte
Yeah, it’s like, hey, I can, you know, put you on five different drugs to extend your life a little bit, but you’re more likely than not going to be probably pretty miserable. You’re going to continue to get sick or you’re going to be bouncing in and out of the hospital.

09:38
Dr. James McDowell
Yes. And, and the irony of that is life expectancy in America has gone down.

09:43
Dr Diatte
Right, right.

09:43
Dr. James McDowell
Gone down right yeah. So we need to educate people. We got to get the message out that this is not the way to go.

09:50
Dr Diatte
Yeah. And as a physician, it’s like, you know, first thing is like, man, where can I even go to for. To find, like, good information, trustworthy information that’s not, you know, biased by big pharma or influenced by, you know, this or that. And, you know, I was. I’ve been surprised by so many things over the last couple of years. I. As I started to get into the blood pressure thing, for example, it’s like, hey, let’s. Let’s let me figure out how to do this, because I’ve had, you know, more than a dozen people hospitalized because of side effects from blood pressure in the past year. Right. So, hey, let me. Let me figure out what can actually reverse someone’s high blood pressure. Turns out, hey, for every kilogram you lose, your blood pressure comes down by a point. Hello. Right.

10:40
Dr Diatte
A high potassium diet, getting 4,500 milligrams of potassium, that can lower your blood pressure by five to seven points. That’s just as effective as a lot of our medications. And so I started. I started talking to my patients about this, and I’ll never forget, I had. I had one guy, I was like, hey, let’s like, start this high potassium diet. Your potassium’s low on your blood work anyways. Like, let’s bump up your potassium and avoid starting another medication. He saw his cardiologist three months later, cardiologist got super upset, and he’s like, hey, lifestyle change and dietary intervention is not the first line treatment for high blood pressure.

11:21
Dr. James McDowell
Come on now. Come on now. Yeah, really?

11:24
Dr Diatte
That was shocking.

11:25
Dr. James McDowell
That has got. I mean, that is revelatory, that attitude. That is exactly what the problem is. We are driven to write prescriptions.

11:33
Carmen
Yeah. So. So let’s back up just a little bit because I think we. We touched on something in the beginning, you know, of, you know, kind of post Covid and having, you know, this kind of, like, distrust. Okay. So that kind of. That kind of emphasizes a point here. I think it’s more of a limited lack of choice that people have. Right. And a. And a variable quality. Right, right. And then just a reactive versus a proactive decision making with physicians. So those are my three things that I kind of looked up, and I’m, like, looking. Looking to find how to pinpoint this. So back to the, like, you know, your doctor says one thing and you are really trying to help someone, and then you have another doctor and doctor don’t communicate Right.

12:14
Carmen
There’s a real, like, if I don’t, if I go to a different system other than you, the only thing you know about me seeing that doctor is what I told you.

12:20
Dr Diatte
Right.

12:20
Carmen
So. So, I mean, unless you’re in a system where everything is congruent and you can see the visit from someone else, which is kind of nice about staying in one system, which is why I do it. But from a patient perspective, the choices of going to other physicians because they, like the cardiologist at a different hospital system that their primary care doctor is in is not congruent. It’s not, you know, helpful to be able to match those. So I think it’s important that you started by saying that your style and how you feel is based on what you do. The problem is people don’t have a choice to come to you if they don’t have the right insurance.

12:57
Dr Diatte
Right? Yeah. So insurance is a huge roadblock for people. Just availability. And then also it’s like, man, you don’t know what you’re going to get. Right? Like every different provider, like, we’re all people, right? Doctors are. Are just people. They have their own, you know, worldview. They have their own biases, and they were taught differently. Yeah, were all taught differently. We. Well, to some extent, but we’re all practicing differently in terms of, like, hey, if, you know, you have this specific problem, this is how I usually treat it. It could be totally different if you go to a person across the, I.

13:35
Carmen
Guess not taught differently. Style teaching was different. So you may really like a, you know, a guru that had some sort of, you know, impression on you.

13:43
Dr Diatte
But again, yeah, and one of the challenges is, hey, a lot of our training was focused in on pharmacology, which there’s a time and a place for medication. Right. Whether it’s antihypertensives, antibiotic, GLP1s for weight loss. Right. These can be helpful at times and places, but to learn outside of that, it’s like, hey, you’re. Your provider has to put all this time into learning it because, you know, I was just listening to your guys recent. Some of your recent podcasts, like the one on magnesium, for example. I didn’t learn about the different types of magnesium supplements until I made a video about it myself. Right, right. So, you know, as an example, it’s like, man, a lot of people are put on magnesium oxide in the hospital for their heart health, and turns out it’s like, okay, why is their magnesium level still low?

14:38
Dr Diatte
Well, it turns out you only absorb, like, 4% of magnesium oxide. So they really need to be on maybe magnesium glycinate. And. But like, most providers just don’t know that because, hey, it’s not something we learn, we’re taught.

14:52
Dr. James McDowell
Well, even now, I mean, you think about it in the afternoons, you know, when you have the afternoon shows or you watch the news, every commercial, 90% of the commercials. Ask your doctor about Rebelsus. Ask your doctor about some exotic drug. Well, I always want to say I have no idea what that is. I have no clue what that is, and you’re going to ask me about it. And so they know that the natural. You know, they don’t make any money on those, but they know that the natural reaction for us is. I don’t want to look like an idiot when my patient asks me about Rebelsus.

15:28
Carmen
Right.

15:28
Dr. James McDowell
So I’m gonna go study it and I’m gonna go look at the studies that were actually performed by that company. And so this. I mean, again, we’re being forced to be salesmen for pharmaceutical companies with these commercials.

15:40
Dr Diatte
Yeah.

15:40
Dr. James McDowell
And that’s not what were trained to do. Or at least traditionally, that’s not what were trained to do, I think.

15:47
Dr Diatte
Yeah. For a lot of us, it’s. It’s almost like there’s. There’s almost these blinders on. Right. Like, there’s. There’s no really insight into that because it’s like, hey, we’re so overwhelmed with how busy our day is. Right. Like, I don’t have time to go look at studies or see who was sponsoring the studies. It’s like I’m gonna, you know, if someone asks me a question in the visit, it’s like I’ve got, you know, 30 seconds to go look at my source and find it.

16:14
Carmen
Well, that’s what I was going to ask, like, as a primary care. And not to, like, jump too far ahead of What I wanted to kind of accomplish today is how. How pressed are you to see multiple patients in a system to where it. It inhibits or it prevents you from being able to give the care that you want to give.

16:31
Kevin
Yeah. Because you can’t spend an hour with somebody. You.

16:34
Dr Diatte
Yeah.

16:34
Kevin
In your practice that you could eight.

16:36
Carmen
People a day or look up a medication that doesn’t pertain to anybody just because a commercial told them to ask your physician.

16:41
Dr. James McDowell
You should be able to. That’s the problem.

16:44
Dr Diatte
Yeah. So the. I think there’s multiple problems with it. One is like, our healthcare system is just so overloaded. Right. Like, as an example here in middle Tennessee, so many People have moved here. Yeah, there’s not enough primary care doctors. So as an example, like I have right now a panel of about 2,300 patients. And I’ve calculated I have about 3,000 visits a year. And so that’s a 2,300 people to fit into 3,000 visits a year. Okay, Everyone can come see me once for their yearly checkup. And then a lot of people like, hey, maybe I have them on ADHD meds or pain meds and you got to follow up. They legally have to, you know, see me every three or six months. And so, you know, during my day, it’s like we’re my office. The trend is moving more towards seeing less patients.

17:38
Dr Diatte
Like my dad was a primary care doc. He was seeing, you know, 40, 50 people back in the day, 10, 15 minutes appointments, and now it’s moving to less than that. So I have a patient, I have 18 patients a day in an eight hour clinic, which is not nearly as bad. But the problem is, yeah, I get about 20 minutes with that person. Right. And that’s to do their entire annual checkup. You know, think about what blood tests we’re gonna get. A lot of them are on, you know, five or six medications. And it is so much to do in that just very limited time. It’s like just to ask someone about their diet, right. And go through that and say, hey, let’s make this change here, let’s get some more protein here. Takes 20 minutes.

18:26
Dr Diatte
And so it’s a, it’s a losing, it’s an uphill battle at the least.

18:31
Kevin
Well, how do you feel about concierge services and that like our practice for instance, that take, tries to take the time with each patient. Is there a fit? Because obviously we’re not insurance based.

18:43
Dr Diatte
Right.

18:44
Kevin
Is there a fit in and how you see the trend of modern medicine moving?

18:50
Dr Diatte
Yeah, I love it. I absolutely love it. I think it’s very important because for the people who are being proactive about their health and have the resources to come into a clinic like n of 1 and get, you know, that deep dive that in depth care, I think it can make a huge difference. The, the and obviously. Right, like, so there’s been a lot of primary care providers who have been moving to concierge medicine. So it’s like, hey, the appeal of that is, okay, I can go from a panel of 2300 patients to maybe, you know, 2 or 300. I have way more time to spend with them when they come in to see me. I think there is huge benefit to that. The downside is, man, a lot of.

19:38
Dr. James McDowell
People can’t afford it.

19:40
Dr Diatte
Can’t afford it, Right. Oh, and it’s not.

19:42
Kevin
And none of us like that idea.

19:43
Dr. James McDowell
Yeah, well, I mean, it’s beginning to evolve into a two tier system of medicine and this is something that we traditionally have been pretty opposed to. Everybody should be able to get great American health care.

19:55
Carmen
I think the blankets, the blanket term of concierge medicine, is kind of not realistic. Right. Because you can’t have a concierge primary care doctor. You’re still relying on specialists. You still need to coordinate care. So I think At n of 1, the concierge piece that we provide is, hey, let us help you with a problem. You still need your primary care doctor. I still have a primary care doctor, thank you very much. So, you know, I think that you have to. And my goal for n of 1 personally has been to help assist in navigating your own healthcare journey. Hence the reason we call it n of 1. Because it may just be one problem. Right. We may need more assistance on weight loss.

20:37
Carmen
And thank God I’ve been able to go down every avenue and help understand this disease and have, of course, someone like Dr. McDowell who is very well versed in how to help people, but it can’t be done through primary care. So I think concierge services are going to be split up. Right? Just like you have an orthopedic doctor and just like you have a cardiac doctor. And it’s going to be to a point where you take it into your own hands. Right. We’re given the resources online. It’s unfortunate that we have as many resources sometimes, but people have been educated themselves to know where they need help. So if it’s hormones, we can help you with hormones. If it’s just sleep, if it’s, you know, nutritional deficiency, something like that, you know, you kind of have to take that problem and go.

21:20
Carmen
But we still need and rely heavily on a primary care doctor or a specialist. Right.

21:27
Dr. James McDowell
Well, and let me compound the problem, and were talking about this, you know, before we started the podcast, is that, you know, people get their information from the Internet. And with the explosion of the Internet, I’m telling you, there’s so much just lies, just. In fact, it’s gotten to a point where you really need to know what you’re talking about to be able to tease out any truth in there. And so, you know, when you have patients that come in with these Preconceived notions that are completely wrong. You have to spend time to talk them out of that, and you don’t have the time to do that.

22:02
Dr Diatte
Right.

22:03
Dr. James McDowell
And so this is another problem that we have, you know, and again, much of medicine in the last 10 years has been trying to protocolize and, you know, try to have technology make up for this problem of we got so many patients to see and it is failing miserably. Miserably. In fact, not only has it made the process more complicated, but one of the things I’ve recognized. You know, last summer, my hospital had the entire electronic healthcare system turned off for a month. Right. Turned off for a month. It was a terrifying thing to watch because there was probably about 70 to 80% of the medical healthcare professionals in that hospital, including physicians, nurses, whoever didn’t know how to do their job without a computer. Without a computer. You had to have a computer.

22:55
Dr. James McDowell
And my point is when the computer tells you a protocol of how to do something, you learn how to make you lose the ability to learn how to make those decisions. And so we had a staff that was terrified and we had to gather money. Look, we don’t need a computer to practice. So these are all of the things that we struggle with in a modern practice and that he’s having to deal with. My issue is we’re not serving our mission. There are people out there that just aren’t getting good care, and we have to come up with a system in which we can provide care to those folks that is outside of what we.

23:28
Carmen
Have now and just.

23:29
Dr. James McDowell
I don’t have a primary care provider.

23:31
Dr Diatte
Wow.

23:31
Dr. James McDowell
I don’t have a primary care provider.

23:32
Carmen
But just like he said, it’s like everybody’s style is different. So, like, you kind of have a hard time if your insurance company says you can only see this person for.

23:41
Dr. James McDowell
This reason and they’re trying to limit our choices.

23:44
Carmen
Right.

23:44
Dr. James McDowell
You know, if I want to write some exotic, you know, anti hypertensive, I can’t think of one off the top of my head for a special patient with a special condition. Well, I’ve got to get approval from an insurance company. They have to make that decision before I can make that decision.

23:59
Carmen
Right.

23:59
Dr Diatte
Wrong.

24:00
Dr. James McDowell
That’s not. That’s not the way we should practice.

24:03
Kevin
What do you guys think is driving the lack of primary care physicians? I think it’s all right. Well, let’s talk about money then.

24:10
Dr. James McDowell
Sure.

24:11
Kevin
So if money is it. So money is not driving enough qualified people into the medical profession.

24:17
Dr. James McDowell
So partially. I mean, look at his Practice. I mean, your average person who gets out of residency now, you know, most of them are going to get a job in a system, right. They’re going to be an employee of a bigger hospital system. That hospital system doesn’t care how they practice. They want throughput. So he’s got to get 18 patients seen a day.

24:35
Kevin
Right?

24:36
Dr. James McDowell
You got to get 18 patients seen a day. And at the end of the day, what revenue are they going to get from that from their insurance companies?

24:42
Kevin
And it’s going to be shared between you, the practice, the hospital, if you work for a hospital.

24:47
Dr. James McDowell
Right. And so, you know, I guess if you worked harder, you could make more. But at the end, how much of.

24:53
Carmen
That is really discussed with physicians though? Is that really something that we.

24:57
Kevin
Because it seems were never taught.

24:59
Carmen
Right.

24:59
Kevin
If we had more physicians because the money was well enough off, obviously you would attract more people there.

25:05
Dr. James McDowell
Right.

25:06
Kevin
That’s kind of the point I’m making. If you had, then you would get the best of the best qualified to come in and make these recommendations. And if the insurance companies weren’t driving this throughput conversation.

25:15
Dr. James McDowell
If you think about the health care, you know, we have a health care money problem. Of all of the health care dollars that are spent in America on Americans health, in the health care system, what percentage of that amount of money do you think goes to physicians?

25:33
Kevin
I think that’s the fallacy. That’s where the layperson, when they sit down at night, they go, just make too much money.

25:39
Dr Diatte
Right.

25:39
Kevin
We’re sitting here with two doctors and I can tell you, being around this for 25 plus years, that isn’t the case.

25:45
Dr. James McDowell
It’s 10 to 15% of the people who are actually doing the work getting paid to do the work.

25:51
Kevin
Right.

25:51
Dr. James McDowell
This is why we got all these middlemen that come in. This is how this works. And so again, we have. Our system has to break out of this. This is not sustainable for our patients.

26:00
Carmen
Right. But how are we going to make it work?

26:03
Dr Diatte
Yeah, it’s fascinating. I was, I was going to add on real quick the. So I do work for a hospital system and I know that, man, our primary care centers are losing money for the system.

26:16
Dr. James McDowell
Yep.

26:17
Dr Diatte
We are, we are in the red and lost sleep.

26:19
Kevin
You’re trying to attract the patient into the system, right?

26:21
Dr Diatte
Yeah. Oh, and it’s okay. How do we make up for that? It’s, it’s procedures, right. Surgeries. And so the goal is, hey, if we can be feeding more, you know, referrals into the surgery system, that’s how overall we make a profit.

26:37
Dr. James McDowell
That’s right. That’s right. And they aren’t doing as much surgery in your system anymore.

26:42
Dr Diatte
They are not.

26:43
Dr. James McDowell
And if you need help with surgery, I’m more than happy to help you.

26:47
Carmen
Well, and here’s the thing, right? We don’t want to feed. I mean, inherently, you probably don’t want to send your patients, if you can, to surgery. Right.

26:56
Dr Diatte
Well, I mean, yeah, there’s gallbladder. He’s going to. Yeah, yeah. The time and place for it, for sure.

27:01
Carmen
Right. But I think there’s choices again. So we go back to that thing where people have been taken away, the choice to be able to see the doctors that they want to see and to make the choices in their healthcare decisions. Because again, then you have to get approval from an insurance company to give them a medication or, you know, get approval for them to go see another doctor. And they can’t go see another doctor unless they get your permission. And those are processes. That takes time. So the other thing I really wanted touch on in primary care, before I forget, is, you know, getting an appointment. So, like when I come to see you, I schedule my appointment for the next year.

27:35
Dr. James McDowell
Right, Right.

27:36
Carmen
One year. So I have my 20, 26 appointment already. Same for my GYN because she’s in a similar system. Same for my dermatologist. And I will not ever, and have never in my 40 something years of life planned that far in advance, ever. So for me to do that as a very stable parent of five children is a big deal. But imagine people who are on the road, they’re musicians or they have jobs that, you know, they might not know as a photographer what job they’re going to have in a year. I mean, they work from, you know, month by month basis. So like, being able to be compliant as a patient is also hard. And so you can’t access the care that you need even if you do have insurance, because you can’t get in.

28:16
Dr Diatte
Yeah.

28:17
Dr. James McDowell
Well, you pose the question, how are we going to do, how are we going to get out of this? And it’s a complicated problem, but the way that we’re going to get out of this is the public is going, they’re catching on as we speak.

28:27
Carmen
Right.

28:28
Dr. James McDowell
You know, part of the disadvantages is most people pay their insurance through their, their work. And so they don’t feel it, but it’s a large amount of money. And, you know, if you really sit down and think about what are you getting out of those insurance premiums.

28:43
Carmen
Yeah.

28:43
Dr. James McDowell
What is it that you’re getting? You know, are you getting doctor’s visit? Okay. When you go to a doctor visit, what do they do? They check four different things. They check your cholesterol, your high blood pressure, they do your routine health maintenance. Is it worth it?

28:54
Carmen
Well, and here’s a number value for you. So with a family and when I had four kids, I tried to get my husband and the four of us on an insurance plan for a hospital institution that I worked in. So you think everybody wants a hospital job because they have great insurance. Okay. The cost per week out of my paycheck was $489 for us to have health care. Okay. That is, do the math, almost $2,000 a month. Okay. Which would be more than one of my paychecks. Okay. So I couldn’t afford to take on that plan. That’s why we don’t have health insurance through where I work. And I don’t rely on that. I had to find another option. So if you take that amount of money that people are forced to pay because they don’t have another option, right.

29:40
Carmen
And let’s say they are struggling and get and giving up a fourth of their monthly income towards insurance, they’re not really going to the doctor that much. You could take that money and take a lower insurance plan that had more of a catastrophic benefit and use those funds toward more quote unquote concierge services or being able to feed your health care needs based on what the needs are.

30:04
Dr. James McDowell
Well, I mean, the Obamacare made us have to buy insurance. We are obligated to buy insurance, which is part of what problem is now. You have to buy into this system by law.

30:17
Carmen
Is that still a thing?

30:19
Dr. James McDowell
Yes, absolutely.

30:21
Carmen
You still have to opt out, but.

30:22
Dr. James McDowell
You have to pay a tax for it. And so, you know, first and foremost, you’re right. And I think people are going to start shopping for quality. I think first of all, I don’t know if they’re going to take that away, the requirement for people to buy insurance. But look, my 20 year old son does not need health insurance. Okay?

30:44
Carmen
I had it for years.

30:45
Dr. James McDowell
He might need. I didn’t have health insurance for years. You know, why is it that he has to pay health insurance? Well, he’s paying health insurance to pay for all the others who are costly.

30:56
Kevin
Right.

30:56
Dr. James McDowell
This is wrong.

30:57
Carmen
But you can have a health insurance plan. And this is what I ended up getting when I was in college when there wasn’t the law that you had to have it. I just wanted. Just in case I broke a leg, right? Yeah.

31:05
Dr. James McDowell
You get catastrophic.

31:06
Carmen
And I was going to get a bill for, you know, $40,000. Cause I had to go to the OR and have to have pt, and I didn’t have the money up front to pay for it. I knew I needed something so catastrophic. And you know what? It was like 150 bucks a month. So it was a fair, responsible decision for a young person. Like, don’t they have these policies anymore for people?

31:23
Dr. James McDowell
No.

31:24
Dr Diatte
Yeah. It’s hard because you think of it big picture. It’s like, okay, we have a very sick nation.

31:34
Dr. James McDowell
Yes.

31:34
Dr Diatte
Very chronically sick people in many individuals who are, you know, tens of thousands, hundreds of thousands of dollars of. Of health care costs. And so it’s like, okay, as. As a whole. Right. I. It would be amazing if there were, you know, cheaper options, affordable options for people who don’t truly need, you know, health insurance, who don’t have chronic problems. And, hey, I just want to maybe optimize my health or use, you know, that extra money to.

32:05
Carmen
Or Instead of having $300 sneakers, you know, you have $50 sneakers and you pay for your doctor’s visit and you learn how to budget that. Like.

32:12
Dr Diatte
But then it’s like, where does that leave the people who are chronically sick? Right. In terms of them being able to get the care they need? I don’t know what the answer is.

32:21
Carmen
Yeah, I don’t think anybody has that.

32:23
Dr Diatte
I think the ultimate answer is, okay, fixing, you know, what’s driving all of our chronic disease. Right. Our food system and money.

32:32
Dr. James McDowell
That’s a great. That’s a great segue. Let’s talk about that for a second. Because again, you know, what’s a cheaper version to deal with most of these healthcare problems? Teaching your patients prevention, a healthy lifestyle. Okay. And we don’t. I would love to be able, you know, you talk about your guy who got his A1C from 9 to 5.4 in three months. You know, I mean, that’s fantastic.

32:52
Dr Diatte
Yeah.

32:53
Carmen
And for those of you who don’t know, that’s somebody with type 2 diabetes that basically in three months reversed it. Yeah.

32:58
Dr. James McDowell
Very, very cured themselves of diabetes.

33:01
Carmen
And so again, here we are with resources. Right. This podcast is hopefully one that will be a very good resource for people to understand that you can fix these problems on your own.

33:11
Dr. James McDowell
Right.

33:12
Carmen
And the resources are there. So I think that’s where we’re moving. And I hope that the preventative, the.

33:19
Dr. James McDowell
Cheaper health care delivery is better. Right. If you can, if you can teach somebody lifestyle and show them that they can feel better and keep them off of the high blood pressure medications and the diabetes, they, you would think that they would want that, but they don’t. Yeah, because they don’t make money if you’re not writing prescriptions. And this is, this is the dirty little secret that both he and I know, right. He said, you know, you just don’t have time to teach your patients how to live healthy. That’s one of our missions as physicians.

33:49
Carmen
And that’s kind of why, I mean, you do this podcast, right? Like you’re able to donate part of your time. You’re not getting paid for it. No. Insurance dollars are coming from it. This is a free service for people to get information, to start to help themselves with their own healthcare needs.

34:03
Dr Diatte
Yeah. And I think it’s like I get excited to work with someone who’s interested in that. Like, hey, teach me how to fix this without medication. Now, now I’ll say that is rare. Right. People are people and they’ve got, you know, a lot of people place and they want a quick fix. And you know, I, I spend so much of my time begging people like, hey, maybe we can not have you on ADHD medication if we go, you know, get your checked out for sleep apnea. Right.

34:33
Dr. James McDowell
Or hormone replacement or hormone replacement. Middle aged women who are perimenopausal who are on ADHD medications when that’s not.

34:41
Kevin
The problem, or SSRIs. I mean, that’s an epidemic in the United States, right?

34:46
Dr Diatte
So it is. Yeah, it is. You know, nine out of 10 people are not gonna be interested in making the change or want to, you know, put in the work that’s required to do it. But it is, it’s very powerful to see it when it does happen like that patient, we have.

35:02
Dr. James McDowell
To move that needle. Well, you know, the reason why they’re not open to it is guess what? Most people don’t have the time to talk to them about it. Yeah, I mean most people, if they would be very open to the idea of, hey, you know, maybe you skip breakfast every other morning. You know, maybe you can see get the discipline to skip breakfast every other morning. This has tangible benefits, Right. You know, that’s something that’s going to bring somebody’s A1C down. That’s easy. It’s easy if you can teach them that.

35:29
Kevin
It’s a generational thing when you think, I mean, if you teach someone when they’re in 6th grade, 10th grade, what proper nutrition and education of their body. Looks like they have a better chance to grow up and ask all the right questions to their primary care. I mean, we teach a lot of things that are not education driven in our school systems as it is. It sure would be nice if the school systems got on board with at least, I wouldn’t say teaching like a whole class, but at least encouraging the messaging inside the school to do better. But we don’t.

36:05
Dr Diatte
Yeah, and I am already, I feel like I can say, hey, with my population, I do internal medicine, pediatrics. So you’ll see anywhere from newborns up to geriatrics. But the younger clients. Right. The people that come in their 20s and 30s, you know, 40s, have seem to come in with a much better understanding, like baseline understanding of hey, nutrition and hey, you know, I’m leaning maybe more away towards medication. I have, I have patients who are older who, you know, have been doing research and reading and keeping themselves up to date. But in general, yeah, the, with all the information, social media and all the, you know, education people can provide for themselves, there’s a lot more people who are advocating for their own care, which is helpful because that’s a good foundation to build on.

36:58
Kevin
I would much rather see commercials like that on tv. Yeah, Rebels this commercial or whatever.

37:03
Dr. James McDowell
I don’t make any money on that.

37:04
Kevin
Well, I mean, we spend a whole lot of money in this government on some really stupid things. Yes, it sure would be.

37:10
Dr Diatte
We’re the only country that allows advertisements for pharma.

37:13
Kevin
Right, right.

37:14
Dr Diatte
I think New Zealand might, but it’s, they’re much more, you know, laid back then.

37:19
Dr. James McDowell
Well, I mean, there’s a free speech argument there, but at the same time, it has not benefited patients and physicians in any way.

37:26
Carmen
Well, and I think going back to kind of how we can help this situation and what the primary care world can do for people if they’re able touch on these things like prevention and diet, is to just continue to push out education. Right. And to help people and show results. I mean, we have, gosh, half of our practice of patients who are successful with weight loss, but we don’t give whopper doses of GLP1s. We teach them how to try to get off their medications and how to try to change their lifestyle and increase protein and all the kinds of things that we talk about with all of our little tools. And I think there’s just so much more to it. Fasting. I mean, Dr. McDowell is really big on fasting. And just all the resources.

38:09
Carmen
But I think there’s an over saturated market too, with all of these things and you don’t really know sometimes where to go and who to trust. So my thought was, with our practice is to keep it small so that we can establish a trust for what we’ve done. And, you know, I’ve done this for 25 years, he’s done it for probably more. And same with Kevin. We’ve been in healthcare for so long that hopefully people will start to respect, you know, some things that we’ve picked up along the way. But also the young people who are coming in have such great knowledge as well, and I think that’s sometimes overlooked.

38:42
Carmen
So, you know, if there’s one thing I could say is thank you, because I know you’re trying and going at it from a different perspective, but I do feel like you can tell me if I’m wrong. The system puts a damper on how much you’re able to do.

38:55
Dr Diatte
Yeah, yeah. Oh, no. Oh, thank you for saying that. I appreciate it. I’m a work in progress and it’s crazy how much more there is to learn. Right. It’s definitely challenging because again, like, going back to, like, man, where do I even find information that, you know, is believable and is, you know, true and accurate and not biased? So. And I’m hoping, you know, more and more providers, as they’re going through their practice and building their own style, will be pushing more and more towards this.

39:27
Kevin
Well, even if it isn’t our practice that people get pushed toward, even as a primary care physician, if you take a look at our podcast and see that as a resource to provide to your patients.

39:36
Dr Diatte
Yeah.

39:37
Kevin
And by the way, he has his own YouTube channel, so everybody needs to. It’s really nice.

39:44
Carmen
Yeah.

39:44
Kevin
So I think that’s what we, you know, our overall arching goal is to just make people better.

39:49
Dr Diatte
Yeah.

39:51
Carmen
Honestly, I think people want to feel better and I don’t think they want to take the plunge to say, well, my doctor told me to take these 10 medications they’re afraid to do. You know, kind of like my family, like, they just rely on what the doctor says so much. They’re afraid to break away and make a change that would be off of their, you know, normal.

40:10
Dr. James McDowell
Well, I think the baby boom generation grew up in an era in which, yeah, you went to your doctor and he was the man and you did.

40:17
Carmen
What he said, but you got to choose them too.

40:19
Dr. James McDowell
And you got to choose and, you know, and it was a much kinder and gentler system to a patient. Well, they haven’t gotten outside of that. And now what we’re seeing is this polypharmacy problem. It is terrible. It’s killing people, this pol. And they’re doing what they’re supposed to do.

40:36
Carmen
Yeah. You know, one question I didn’t ask you though too, speaking of polypharmacy, because you can get the drugs in lots of different places, right? And sometimes you’re like, okay, well I didn’t prescribe that, but you’re on 20 different things. What about these urgent care places which are, I mean, they’re bad, but at the same time, if you can’t wait till next year to get into your doctor and you’ve got a sore throat and you think you might have strep, you’re forced to go. And then it’s like a whole nother Pandora’s box, right? So like, I think there’s. So like I said, the resources are invaluable, but they’re picking up these drugs from other places too, because they’ll say, oh, you should try this or oh, you should try that.

41:13
Carmen
Like, I think at some point you have to get back to the loyalty of even if you don’t like the doctor that your insurance company has given, if you stick to one thing, at least you’re all on the same page about it, right?

41:24
Dr Diatte
Yeah, yeah, it’s, yeah, there’s obviously, you know, the walk in clinics, urgent cares are helpful, especially in cases like, hey, I got strep throat, you know, I need to go get tested, get antibiotic and treat it. But yeah, a lot of different voices, right? Like, hey, me sending that guy to the cardiologist, like it’s different people, different opinions, different saying a lot of different things.

41:50
Carmen
Yeah, Well, I think that kind of wraps it up because I know we don’t have that much time, but you know, thank you for being here and I think we could talk for days about this stuff. But I guess the takeaway is really.

42:01
Dr. James McDowell
I mean, if you can’t find a primary care provider, call us, okay? We can, we can at least help you find someone. And that’s part of what our mission here is at NF1. And we’d like to be able to get you in to see a guy like this. Obviously brilliant, he knows what he’s doing.

42:16
Carmen
If he has availability, man, because you might have to wait. And sometimes I tell people, like, go ahead and take an appointment, even if it is six months away, guarantee you’re gonna come back to me and be like, thank God I had that appointment because I still haven’t found anybody. And then at six months of waiting, you’re still on another six month wait. So I feel like maybe that could help if people are just patient and knowing that they might need someone. Right? I mean, absolutely. And not knowing where to go again. And a one, we can help, we can try to dive into small problems and try to help you, but we do advocate for, you know, having people in your pocket. So thanks for being here.

42:54
Kevin
We’d like to thank our sponsor, Tanasi, producer of CBDA and CBD products for use of all kinds of inflammation.

43:02
Carmen
Sometimes we talk about our sponsor and I will tell you, since you’re my doctor and so are you. So I’ve got two doctors in one room. Occasionally I’ll have a headache and not want to take Tylenol and not able to take Motrin, obviously. And I, you know, tried to stay away from just popping pills here and there. But we do try the products that we use and have seen a lot of success. They also have some good cbd, CBA oil, and I’ve used that on my wrist and had some success. So, I mean, again, this is a great example of how we can try to help our patients find another alternative to that. You know, popping the Tylenol, popping the Motrin.

43:37
Dr. James McDowell
It’s not like you ever prescribed CBD oil. That’s something completely outside of what we do. So, again, I think the world is opening up, and we need to adapt to that.

43:45
Carmen
Yeah. Well, thanks for being here.

43:46
Dr Diatte
Thank you.

43:47
Dr. James McDowell
Thank you, brother.