100. Progress Note #8: Journey & Lessons Through 100 Episodes!

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. All right, we're live, Altamash, progress though, 800th episode. We made it. How do you feel? Century Mark, feel old, I think. It's interesting though, technically this is, as we've talked about, because we've had multiple different iterations of how we're rolling this out, and it's a continuous evolving process. It's technically more than 100th episode, but nevertheless, that's where we're officially calling it. But it's good, man. I mean, it's a milestone. It's exciting, both two and a half years, probably, officially, in terms of timeline, so that's fun too. Yeah, for sure. Yeah, like you said, two years, it's incredible to think, and I'm proud of us for making it this far, because as you know, a lot of podcasts, it's allowed after maybe five episodes, four or months, three months, you know, but we kind of stuck through the journey, as we're both busy as hell, you know, you graduate through residency, me going through intern year and now, P2Y3. So, impressed with us, I'm going to say that. Yeah, a little patent on our own back, I suppose. Yeah, I think the number is 90% right, don't make it past number 10. So when do you think about some of the other ones that we routinely reference or listen to, you know, I think Chris Hutchins talks about this recently on his podcast, it's like his goal and issue initially it was just to make it past number 10 and see where it goes. And then over time, it just kind of created into this gigantic, just operational system for him, where he's able to step away from, you know, his financial planning type situation both front and now it's like his podcast is and his entire business. And so unfortunately, we haven't been quite as lucky on our end in terms of turning this into a full-time business or where we can retire from our primary gigs. But I think we've made certainly an impact and I think one of the things that, or some of the things that we want to talk about is as we recap some of the lessons that we've learned from our guests or throughout the process over the journey in two and a half years. Because I think I was thinking about this, recently posted about this, maybe on Twitter, I don't know where, where you're just kind of just staying in the game, staying in the game, right? Yeah, yeah, yeah. I did recently tweet that. Yeah, just keeping the arena, keeping in the arena and playing the game, you know, that's right. There's going to be ups and downs, right? But it's just about chipping away and keeping it going as long as it's a passion, as long as you're having fun with it, no, I totally agree. But yeah, so two and a half years ago, I think it's important to kind of recap the journey a little bit, right? Talk about how we started. I don't even know if a lot of listeners know how we started, you know, especially if they just started jumping on in like episode 70 or 80. But, you know, all the time when I met during my interview process for physical medicine rehab and, you know, you were at Hopkins and I was interviewing and, you know, we were at dinner or the residency dinner and you said, let me get your number because I'm sure of paths will, at some point in the future meet and it's at shore. So we exchanged numbers and then lo and behold, I think it was about four months later. You texted me and said, hey, do you want to start a podcast together given that we had a lot of similarities in how we viewed, how we wanted to treat patients, our thoughts on medicine, being more interested in the preventative side of things, the alternative holistic approach side of things. And then, yeah, it kind of just took off and took us a while to create the name medicine redefined. And, you know, I think one of the things I'll talk about later on too is just how that idea has morphed a little bit or evolved, I should say, into the way we even conduct our podcasts now. But yeah, we started with that first episode with Simone Maven. I still remember being in that room back there, enjoying a glass of whiskey to celebrate that. And here we are 100 episodes or, you know, 100 plus episodes later, but yeah. Yeah. That was an amazing episode because I think that might have been one of a few episodes where we weren't able to actually see our guests. So just bringing people behind the scene as her camera wasn't working and, you know, due to some scheduling issues, we decided to conduct the interview anyway. And so that was a challenge in itself. And I think, I mean, again, for the first one, I think we did a pretty good job because not having that feedback where you can visually see and pick up on cues and conduct an interview. I don't think I think, you know, people just don't realize how challenging it is. Maybe this is a good place or a later to talk about how challenging it is to do an interview with multiple hosts, you know, a lot of the podcasts that I listened to. I don't know if I listened to any podcasts where they're multiple hosts to you. VPCD, but it's more of a back and forth. Yeah. Do they interview other people? I guess maybe once or twice. I don't know. Maybe I know Sahul Bloom, Greg Eisenberg did that. They had a, they were a two hosts, but now it's just Greg Eisenberg taking, taking over that podcast. And there may be a millionaire mentor with Sam Parr and, oh my God, what's the, what's the ending guys name? No, I can't think about it right now. But yeah, there's not many out there, at least. So yeah, I think it is, it is definitely challenging to have two hosts interviewing. And the reason why is I mean, to be on the same page and same flow, I mean, we've done our fair share of individual interviews where it's just you hosting or me. And we quickly realize it's way easier to get into a flow of questions, because just stream a conscience. This is already thinking, you know, five, six steps ahead about those follow up questions. But if you have a follow up question while I'm speaking and then you go, I kind of have to pit it in my mind now to get on track with that. So it doesn't seem like we're going from A to M and then M back to B. So it can be more of a coherent thought process from both of us. Yeah. Yeah, I think, and that's where a little bit of planning ahead of time comes in handy, right? I mean, and again, to bring the listeners backstage is usually we have a thought process in terms of how like a general template of the things that we want to talk about, certainly researching the guest will in advance and thinking about things that they might be able to teach us, but also offer for the audience is helpful. But yeah, no matter what, because in order to keep them authentic and keep it conversational, which is kind of what we try to do. We try to keep it educational, but also conversational. I mean, I think you said it really, really well. We have gotten better and better as time has went on though, because there's often times where we can communicate during the chat and it's like, I've read my mind or still my question. And so, you know, that's certainly gotten better too. And the other thing is sometimes we're able to bring it back to, we can pivot back and forth if there's something that we desperately want to know about. And in a certain times, it's easier to do than others and not always goes perfectly. So, yeah, it's been a lot of fun. I suppose we should maybe think about some other barriers that we've had, not necessarily from a from an interpersonal relationship type situation, but other things that even as recently as today's technology issues, we've had a lot of them. And I know that people have talked about this as well, so you want to comment on that. Maybe it can be your worst enemy, it can be your best friend when it comes to podcasting, right? Because, I mean, nowadays, there's so much variability with audio quality, with hard equipment that we look at, right? When it comes down to even your dongle that you're going to connect, so you can connect other microphones and webcams to it. But, you know, throughout the last hundred-so episodes, we've had our fair share of disconnects with podcast guests, and unfortunately, can't even bring on a podcast guest because of it or something, but we bounced around, even with different platforms. We've had issues where audio just wouldn't record halfway through, and you wouldn't realize it. And so, definitely a lot of trials and tribulations when it comes to technology, and I think probably around episode 60 is when we kind of figured out like, okay, these are the quick maintenance check that we have to do prior to every episode. Make sure the guests on the same page, let the guests know that, hey, these are things that could happen. And for the most part, most of our guests have been understanding if they've been on other podcasts, they understand the troubles that can occur when it comes to technology. But yeah, here we are testing another software, so seeing if it works. To date, we've lost one guest, and they have decided not to come back, because of it. In fact, they've completely decided to ghost us after that one time. We won't name that person. But yeah, we've also had some amazing guests who just kind of come back on after we've completely lost that audio, shout out to Giselle Arnie, who's then a take-to with us, which has had so many gems, and you can never recreate it, but I think that the ultimately with the conversation came out to be, would that specific person was even more powerful the second time around? So, Dr. Arnie, if you're listening, thank you again, and hopefully we can get you back on here. Yeah, and just to give people a reference, right, I mean, I've been looking left and right. I think that the one that we use the most is squat cast. People might have heard of that. It's both good and bad. Every single one tends to have its pros and cons. We've tried Zencaster, we've tried Riverside, we've tried StreamYard, anything else that we've tried. I think we just haven't landed on the perfect one quite yet. Yeah, we started with Zoom, I'm sure a lot of us are like, why have you done Zoom now? We've done that, but audio quality is an issue with that, so. Interestingly, a lot of people still use that. It's the most reliable, right, and it has the most features, but I'm also surprised to learn of high profile individuals and podcasts that are using Zoom. I wonder if they decompress the audio quality later on. They might. Yeah, they might. Yeah. That's the luxury of having professional editors for you. Right. Right. Yeah. And that's another thing people don't understand is like only until recently is now that we have a team, an awesome team, we were doing all this by ourselves, right? And so with full-time careers, with a family, with a child, for me at least, but also go through the residency training, how hard it is, trying to do this by yourself and not necessarily having your time compensated, and not just the time that we are spending here and actually interviewing for the time for preparation, the time for searching guests, the time for communication, all that kind of stuff, and the follow-ups, and the marketing aspect, the advertising aspect of it, all that is, quote unquote, uncompensated. So it goes without saying that we're passionate and hopefully that shows, and people are taking something away. I think that's what it is. That's what it comes down to. Definitely. It's a second job, for sure, for the people I realize it. I mean, definitely a second part-time job, putting hours daily in and out, and we've had luxury starting around episode 80, something where we brought on three new interns, and so shout out to Harita, Ethan, and Iman for helping us out, helping us with the production, with the promotion. Definitely taking a load off of us, but then also filling us in with new ideas, with possible guest recommendations, with just recommendations overall on how to improve our podcast. So we've been definitely grateful for those three's help, and definitely wouldn't be possible because I know I was doing video on my own. We'd be doing audio on our own, we'd be posting on our own, and it was definitely a lot, so. So you alluded to the fact earlier that our purpose, our mission, our direction of the podcast is evolved. Why don't you elaborate on that a little bit? Yeah. So let's start off with the title of the podcast, Medicine Redefined, and we were definitely debating on a lot of different things, just different buzzwords, that we really wanted to capture our intent. And so we landed on Medicine Redefined, and correct me if I'm wrong, I'll at least speak for myself, is that when we first started this podcast, I was definitely thinking we'd be more learning about integrative, functional, holistic medicine and interviewing guests to learn those approaches, and to really teach people as well, the science behind that. And I think we obviously are not strictly a functional medicine or integrative medicine podcast. Yes, we've had guests, and we explore those themes quite often, but our guests are not just limited to that theme. And so as we kept going, you know, for the first 10 episodes, 20 episodes, 30 episodes, started to learn more and more about the inefficiencies that every single provider goes through within healthcare, and how healthcare affects from top to bottom, from the government all the way down to the patient consumer level. And to me, and I think our approach has definitely been more weaving in those fallacies within healthcare and trying to understand how on every level or every angle it's affecting people. And what we can do from that standpoint then, when it comes to the science and comes to the medicine, and how we can at least educate and better whether it's trying to go around these issues or whether it's trying to solve these issues directly, what we can actually do so that we can provide better care. And so whether you're a provider, you're going to see those inefficiencies, whether you're a patient, you're going to see those inefficiencies. And I think when we say redefine now, and, you know, we're obviously going to be putting out a new logo, and for those who don't know on social media, we already kind of put those out. But at least getting a new podcast logo that will show more of our intent now, right? Which is really evolving and changing healthcare and moving, and, you know, a lot of people talk about medicine 2.0, and now that we're going to medicine 3.0, it's how do we truly evolve? How do we get past all those barriers and find solutions or better trade-offs? Yeah. That's what I said. I'll add that for, from my perspective, yeah, initially, it was a lot of frustrations about things that we weren't learning in quote unquote, the traditional model of healthcare in medicine. You know, I think this was maybe, I probably had the idea maybe, I've actually had it for a long time, but probably somewhere on the, my intern year, maybe in fourth year, but second year, when I was getting really, really frustrated with it, and I was like, okay, why are my colleagues not talking about some of the things? So all the different practices that you highlighted initially, it was like, okay, well, what's different about these practices? And let's start highlighting all these things that, and especially how is it different from quote unquote, the current model of healthcare or the current model of medicine? And what you realize after talking to different providers in quote unquote, these different fields, you learn that there are significantly more commonalities that there are differences, right? And so much better to focus it, focus in on the commonalities than the differences. I think when we, and this probably applies to a lot in life, not just medicine, is when we focus on what we all have in the same rather than what's different about it, I think that it's just a better conversation. And it's not a conversation that gets a lot of attention, unfortunately, right? It's argument and discourse gets a lot more attention than concordance in general. But it'd be surprising, right? We all, no matter what field of, I shouldn't say all, but a lot of providers who are truly going for the altruistic reasons are trying to do better for their patient for themselves. And it's, you know, they truly believe whatever they're offering is going to make a difference for the positive, right? There are people who have malintend. Aside from those, though, you know, and it's so interesting when, with, with the conversations is perspective, as we talked about, when we're talking about evidence-based medicine versus evidence, the form of medicine is how you can find any study to support your, your point of view and, and what it is that you believe. And even looking at the same studies, how three different people can, can have three drastically different takeaways from the same study. And so, you know, how can we come together and be like, okay, let's, let's discuss and how can ultimately put the patient at the forefront and, and how can we use the information that we have to make this about the patient, make, make this about being helpful than being right. And yeah, it's funny you use the word discordance. This is, this is the typical read my mind situation because I was going to use that word. So, you know, I think for both of us as, we're still young as physicians and in our journeys. And so, every year that we get our practice, that we see patients, that we have more of these discussions, we're learning more and more. And so, when I look at myself from internear to PGY3 and being, you know, obviously siloed in the traditional healthcare model, I see this discordance from our podcast episodes, right? And, and what I'm learning and how it's possible to do things outside this traditional medicine model and how a lot of our guests are doing that, whether it's from a coaching standpoint or just a different model in general, like DPC or Concierge or just the way they're educating patients, they're definitely going in different directions. One is my training and the other is kind of learning about how other people are doing these things. And it's funny, about two days ago, I was with a medical student, I'm on my sports medicine rotation right now. And, you know, we were just talking about, he told me, he just all listened to a functional medicine podcast on curbsiders. And he was like, you know, it's super interesting that there's like seven, nine different pillars about categorizing how human dysfunction happens. Like you have metabolic, mitochondria, immune system. And I was like, yeah, I mean, it's really cool, et cetera. And he was like, yeah, I don't know why we don't necessarily integrate all those things within medical school, right? Like, those are things you think you'd learn when it comes to holistic or try to integrate all these biochemical processes, physiology, et cetera. And I agreed with him. And then I kind of told him, you know, what I'm interested in precision and performance medicines. They'll explain that. And he was like, all right, well, let me know whatever you have a podcast now. And I was like, well, it's going to be funny, but I do have a podcast. And so when I think about our audience, right? And this is something that we've always talked about is like, who the heck is our audience from the beginning to now? And it's been tricky because healthcare affects, again, everyone at every level. And so anyone is going to gain something of value when they listen to our episodes, whether you're a patient, whether you're a healthcare administration, whether you're a physician, whether you're a non-physician provider, there's something to gain from a perspective. But the more I think about it, I think there is a longing for this newer generation of physicians and providers for that type of care where it's all integrated. And they can really start to learn the science and teach that science, but also almost get to the root cause. And I'll use that word loosely because root cause can mean different things to different people. But it's just interesting to hear a student tell me that. And then he even asked me saying, man, so how is residency going for you? Like, if you have to go through every single one of these rotations, and this is your end goal, man, it must be a drag. And it's funny because I was like, I mean, you got to go through it to get through it. The degree obviously helps. The understanding and having the influence that you can have helps. So it's definitely something that that perspective and me just talking to them has really opened my eyes as far as maybe what we're trying to do here now with these episodes and kind of the flow and the interview that we use and the things that we try to bring out of our guests. Yeah. I mean, that's right on. So on that note, I think when I've initially had that idea, I was just reflecting a lot on some of the recent gets, specifically when Dutra Bo was something that she said and I was like, wow, man, that's powerful. A couple of a lot of things actually she said that resonated with me. And that's been the theme with almost every single person that we've talked to, right? Even the conversations that you and I have had, which has changed my practice and just my approach and how I conduct myself on a day to day. And that's ultimately the purpose, right? I mean, it changed start from within. And so I've thought about, okay, well, what are some of the lessons that, when I reflect back that have given me new insight into how I'm going to move forward? And this, hopefully after the next 100 or maybe even sooner, we'll change again, because that's what it's all about, right? So I'd love to share those with you now and then you chime in wherever you want and then also tell me if there's something that you have the different. So the first one, which actually kind of broke my heart, and this is from EC St. Kowsky. I don't remember when it was. And it's essentially that people change when they are ready for change, when they want to change. As somebody, again, we're medical practitioners and people come to us with a problem, more often than not. And then we provide a solution for them. And how often is it that they actually carry that out, right? And it's like when they come back to you and they're like, God, I just, I gave you all the answers. If you just do what I'm telling you, I think your problem is what we saw. And when it comes to, you know, passive treatments, like injecting somebody or giving them medications, stuff like that, that might work, but a lot of things that we talk to as signifies on our logo, when we're talking about medicine 3.0, the proactive healthcare model, this chronic disease healthcare burden requires a lot of active participation from the patient, right? And so, and that's challenging. And particularly for me, with my loved ones, who, again, both of you, we talk about health span and our health span at longevity is very important to us, but it's like, okay, well, what does that matter if the ones that we love and the ones who are closest to us aren't around for the last 10, 20, 30 years, or if they're not healthy for that time? And so those are the people you desperately want to change, at least I do, right? They're like, please, just make the right decisions, mom. If you just make the right decisions to add or my wife or wherever it is. And so coming to terms with that one, especially, that even my sister, who, I don't know if she's probably not listening to this, but she's like, didn't even go to a doctor until she was like 28 years old. And I was like, what are you doing? Like, nah, you know, it's just one of those people, like, if I go to the doctor, they're going to find something wrong with me and then I'm going to know about it. And I was like, right. And she's a brilliant, she's the smartest person in my family for sure. But it's such an interesting thing. And so coming to terms with even that is, even the your loved ones, you can't get them to change. And they're going to make the those changes, and specifically what she said was, I think this is a quote on Instagrammage, you know, people, I think change when they're sick and tired of being sick and tired, right, especially when we're talking about health. But it can apply to even their emotional health or really anything. So I completely agree with that one, especially when it comes to your loved ones, right? I think seeing a patient, sure, it can break your heart for maybe five, 10 seconds, right? And there's not that connection that you have with them as much as you would with your loved one. What do you think about your own future and how much we are invested as positions within our own health, right? There's a lot of positions out there who don't take care of themselves who strictly use it as a job. And I think for us, it's more of a job, it's a lifestyle, right? And we don't necessarily identify with just being a doctor. But again, it's a lifestyle for us that we need to look the part as well if we can go out and educate and try to make people healthy. When it comes to your loved ones, I think that's very tough. And that that thought goes through my mind a lot of times is, hey, if I'm doing everything for longevity purposes and health span purposes, what's the point if nobody else around me is doing that, right? And I think that's tough. And a lot of times I have to remind myself, well, it's going to make me feel better today and it'll make me feel better tomorrow, right? I think sometimes we get a little too caught up in the future because who knows? I mean, I've got high risk for cardio metabolic stuff. And so who knows, right? But I totally agree with your point that it's hard to change people until they're ready, until they have a little bit of a downfall. And one of the things I've also come to grasp with is that people just need to learn it on their own. Like, they just need to go through that teaching point. They need to go through that lesson, which will hopefully make them stronger in the end. Yeah. What's interesting though that this has been just a personal development for me is also everybody has a different way in how they like to be communicated, listen to, right? Not everybody is going to feel good about falling like here in our regimen and how we do with things and then use that as inspiration for some people that could be intimidating for others. It could be just completely useless information. And so that's why I sometimes reserve like how I hear in my tactics because it's such a personal thing. It's so contextual dependent on so many factors in life, like, you know, a lot of things in that seem to work for you. I mean, just one of the point of contention, one of the few point of UNIs is just how we like to read our books, right? That's one of the one. Are the books the more people, I'm just kidding. And so it's interesting that, you know, everybody has their own individually. So just this is actually a point that has probably been shared by so many guests that I think it's probably worth mentioning at this point is like meeting people where they're at, right? Like if you are talking about change and if you are talking about helping people and choosing when to be helpful is meet the person where they're at. Like, you know, when somebody comes in and they're expressing some openness for fitness or health or nutrition, you don't just bombard them at all, you know, everything you're doing. Well, while we're talking about your nutrition, let's talk about your sleep and while we're talking about your sleep, let's also talk about your mindfulness practice and this and the person just like, whoa, whoa, whoa, I just wanted to ask if intermittent fasting is good or not. Like such a basic and silly question and we're like, well, that's a stupid question. Like even telling them that, like, okay, you know, that approach is not going to be helpful. So we try to use those opportunities and just meet the patient and also start by a place of inquisition rather than just like, okay, let me tell you all that I know, the facts that I know. And this book that I told you for the Ryan Holiday books, the one that resonated with me with the most, and I don't know if it's a good thing or not, is ego is the enemy. Why that was my favorite one, like, and yeah, I think that's a book that everybody needs to read. And especially if you're a physician or on one of these practices that are kind of in a quote unquote position of power. So to speak. Yeah, great book. I was actually looking at all three today and saying that I might need to reread them. So kind of somewhere there on that top shelf. Yeah. I like that. What's your, I mean, what else have you learned your second point? So on the thread of change, I think that what's becoming more and more clear to me is people have to be active participants in their care, right? I think that we most recently talked with Dr. Austin Permanor about this where we just said, hey, like, no matter what it is that we give information to people, they have to go through the journey. You just said, like, they have to arrive at that conclusion, and then they have to cause to be engaged. And as Peter talks about, you know, in his book, a new book out live, he just said that you are the captain of your own ship, right? Like, you're making the decisions and we are there just as guided. So part of the conversation that I have in my patience is when they come in and as I tell them, listen, like, you're the quarterback, you're the point guard, you're the captain of your ship. And I'm just here as kind of just like nudging you in the right direction and giving you the information. And I'm the one who's along for the ride, not the other way around. And if it doesn't seem to be other other way around, it might be successful for a very short period, but, you know, for that medical, excuse me, medicine 3.0 model that you're talking, when we're talking about the long game and we are talking about this preventative model, it doesn't seem to work. The 2.0 model, when somebody is really sick and they need care from us, yeah, somebody is sick as hell and they need some medication. We can provide them to the hospital. Somebody has a broken bone and they need to get, you know, repaired or sutured and stuff like that. We can do that. But for the things that we're talking about often on this podcast, 30, 40 years from now, things that are going to kill you, the chronic disease burden, people need to be active participants today. And that's hard. Yeah, I was just listening to the health premiere podcast with Yuri Elkram and one of the things he talked about today was why a virtual practice can oftentimes be better than a brick and mortar practice. And the reason why is you're forcing people to be an active participant in their care. You go see a chiropractor, you go see a physiotherapist, yeah, short hands on, they might feel better like you said for that moment for the next two, three days, but then what happens, they come back, right, because they know they can come back and get seen and get hands-on treatment. But when you start making it virtual, right, and we talk about medicine 3.0 and how things are potentially moving in that direction, you are now putting the burden or, you know, a good burden on the patient to take care of themselves, to do their, whatever it might be, foam rolling or to do the stretches, to go to the gym to get that proper sleep, because they know they don't have the luxury to at least come in and see you. But now they can at least come back and report to you what happened and then get some more tips. So essentially you're making them, like you said, the captain of their ship. Yeah, that leads me to, I think this is a good segue for the next one. I think a lot of things that we talk about, things that tend to be alternative quote unquote on the cost, things that are more progressive as we like to think about it, people will say, well, that's expensive, right, and what's the evidence for this? And the fact of the matter is healthcare is expensive, right, no matter which way you look at it, and I'm very closely involved in, you know, the insurance model, the business model, like that's a source of the area of interest for me, but what I've also come to learn, and I'm stealing this from Mike Boyle, where I saw it on Instagram, but I'm not sure if he's your originator of this is, everybody pays for their health, right? You just have to choose when you want to pay, do you want to pay today when you're young and you're healthy, or do you want to pay when you're older and you're sick and you're desperate and you need that, you're going to pay at some point. And so we've said time and time again, that this is an investment, right, this is an investment, you're just, you're putting money into the bank account so you can cash out later. And I mean, to your point about like you take on these, all these amazing trips all around the world, which requires serious physical health to be able to enjoy those experiences, right? So jump in here and talk a little bit about that because I think people just don't appreciate it. First of all, I think that's the greatest line, like I've heard, right? And I remember you putting that on Instagram because I say it all the time now, all the time, like whether it's trying to explain what precision medicine is and using it almost as a business motto to attendings to patients, it's, everyone's going to pay for health care. It depends when. And this is exactly what I say to my family as well, right? So I don't even blink an eye anymore when it comes to paying for supplement tests, right? If you get a omega three quant test, I don't blink an eye. I just got the walking patch should hopefully be coming in a couple hours because I need to get those steps in. So like, sure, I can afford these things, right? I'm privileged enough where I can afford these things. But I do understand that, yes, they're a little steep now in terms of price, but I'm hopefully not going to pay the price down the road. And I know Peter T has even talked about this in an episode when it comes to traveling. And you know, a lot of people save the rich, luxurious life for when they're older, right? Once they hit retirement to say, oh, I'm going to go to Italy or I'm going to go visit Tokyo or finally want to do the steps of XYZ in this country, but are you going to be fit enough to do that, right? And I think Bill Perkins also talked about this on his podcast. So for me, you know, this a lot, this plays the emotional health and a place to what I call living a full life, which is, you know, you never know how much longer you're going to live. You can be tomorrow, can be a month, a year, I don't, you know, need to say to everyone's kind of heard that. But I want to make sure that I can at least create the experiences now so that later down the road, I can look back and say, great, I've done these things. How do I keep doing those things, right? Like how do I keep my physicalness? How do I keep my emotional health, my spirituality up to optimal levels so that I can go and explore the world? I think when I'm on my deathbed, the one thing I'm going to look back on is how much did I live this life, right? Not necessarily how much do my patients do it or did anyone else do it, but what did I do? That's introspection in terms of, great, I got to see the world explore it like the treasure it is and go seek out some certain things. But in order to do those things, right, like catching a train, climbing up the pinnacle rock in Columbia, go, we're going to Tuscany soon. So being able to hop on different trains there, go to Lake Como, go up and down St. Pills, yeah, requires definitely some physicality and so a lot of the times I'm telling my parents, hey, you have to go to these places now because you're not going to be able to climb a multi-coast and go up this steep hill in 5, 10 years, like it's just not going to happen, especially in the way that you're going down right now. And so that has inspired them to go to the gym now. That's inspired them to get into weightlifting because now they're thinking, okay, now that COVID's over, we need to go travel, I want to be physical enough to do these things. And a lot of the times we don't realize it because we haven't been traveling. We forget that there's a physical component to this, even taking a 18-hour flight over, right? I mean, you're going to be dehydrated, your sleep's going to go out of whack, you're not walking and not mobile much, your muscles are going to get tight. So those first two days, three days coming out are miserable. But if you have enough resiliency and flexibility in your body, you can quickly navigate. And you know, when you understand your own body, you can really prevent those things from happening. Yeah. And people underestimate how much building physical resiliency builds mental resiliency. Right. And it's just a, it's just a carry over effect in every aspect of your life, right? Your emotional health, your mental health. There's a reason why everybody talks about if exercise could be, you know, put into a pill, it would be the most expensive pill in the world because it affects literally every system of your body and more often than not in a positive format, maybe not acutely, but over time, especially if you develop that. So, so let's, let's shift to the next one, which is more recently from when to Shaboe as I was talking about is, and this is when our conversation was during, you know, our foundational experiences in terms of this pyramid and what are the things that we should be addressing in terms of nutrition, sleep, all that stuff before we talk about supplementation, all these advanced testing. I think she said something to tune of like anything is better than everything, right? Or set another way for my brain is something is better than nothing. And I thought about that a lot because when people come to me and, or if they ask me a question or friends family, whoever might be and say, Oh, look, what about this supplement? What about this specific protocol for exercise, intermittent fasting is a hot one still, right? I hear a lot of the students who rotate with me talking about this and then the background. And my initial thought was, well, what about X, Y, and Z? Like, you know, I would want to ask them, what about the other foundational things? Like what, what's the state of that? And then my thought would be, well, you know, if you don't have that dialed in, I'm not necessarily sure this is a good idea to do. But what Wendy said really got me thinking about that is like, if you are making, if that's the only place that person, so this, this goes back to enticing with meeting the patient where they're at, right? Or the person where they're at. If that's the only thing they're interested in, that's the only change they're interested in. And after the conversation they've had with me, now they don't even do that much. Then I think ultimately I didn't net harm, right? Because I didn't necessarily help. Like if that would have made a 2% difference, that's better than 0% they would have had otherwise. Even if the suggestion that I was making would have made 10 or 20%, you know, 2% is better than zero, right? Less than 20, but better than zero, right? That's just a simple math there. The challenge is that I do want people to appreciate with that though is that sometimes you're still stepping over dollars, in some case, hundreds of dollars to pick up pennies. But again, pennies are better than nothing, right? So just to be very clear with an example is, you know, if somebody's talking about some type of supplementation and let's use a supplement, maybe that's not, doesn't have as robust data as some of the other ones. Like let's just use Ashwaganda, right? Pretty good data, but it's probably not going to be in my top three supplements when I'm looking for longevity. Is that fair? Do you agree with that? Very fair. Yeah. But if somebody is not sleeping well, like, and that's within their control, we're not talking about like new parents or sick persons, somebody's not sleeping well for the choices that are making themselves and not exercising like four to five times a week, and they're using Ashwaganda for some specific reason, then then I would say, okay, well, you're, that's the example where you're stepping over dollars and tens and 20 to $100 bills to pick up pennies because you're, you know, trying to correct something with Ashwaganda or even for like, I don't know, like apple cider vinegar or something like that for insulin resistance. Yeah. I see this as a very gray area at times. So I think I love your talk about percentages and looking to make it at least a positive difference, right? One of the things that I've started to realize is there's a lot of people out there who think cardio is super beneficial, and it is, right? I mean, we all need to work on our cardio respiratory fitness, but people, people overestimate how much cardio is actually burning their, or how much county calories are actually being burned during cardio, right? So a lot of people will let's say go for an hour run, and then they think because of that, they burn so many calories that they can start to eat more food than they actually would have, right? And of course, their appetite's probably gone up. And so I think the foundational pieces are important because understanding nutrition, understanding exercise, understanding stress and sleep, at least at the basic levels so that one doesn't actually cause the other harm is a very important concept because people then get confused and say, talk, I'm running three miles every day. And quickly, we can be like, okay, great, let's focus on that. But then you miss out on hearing about the component about nutrition, which is, oh yeah, but then I eat like this, right? And then you start again, this limbo of, wait, why are you actually not losing weight or why are you not being as fit as you could? But I think looking at it as far as percentage points go is a very good idea because by doing that, I think you can start to get more of a little comprehensive review and you start to ask the right questions to say, are we at least moving in a positive direction? If it's something that's at the top of the pyramid that you're taking, you can take that. But is it causing harm to any of the other pillars? Yeah, and again, this kind of goes back to the ego point, too, right? I think this, this reminds me, this is a lesson that I want to make sure that I convey. And this is not something that was said on our podcast, but I heard about the John Barney podcast a long time ago, short lived, but a lot of valuable lessons from there is when it comes to being right versus being helpful, always choose to be helpful. And that's something that I tend to remind myself, right? So in that context of the examples we just talked about, you know, somebody's coming in and we know what the most powerful levers are going to be, right, for overall health. But and that's, that's right, that's, you know, there's no dispute about that. The evidence is clear. But it might not be helpful for that person. Again, we're seeing themes here. It's again tying into meeting where the person's at if that's all they're ready for. So that's another one that I think is very, very important. And I'll kind of jump into the next one, unless you have something to say about that. Nope. Go for it. I agree. This concept of active listening. So go on all the way back to Jotty Patel. I want to get her back on. Hopefully she'll come back on, but Jotty Patel, like, you know, attentiveness, curiosity, she hasn't been the one. And post made this point several times in each and gleeing like a bunch of different people, right, so attentiveness, curiosity. These go an incredibly long way to build therapeutic alliance, right, which is absolutely necessary. Right. So it's, it's basically motivational interviewing 101. And we really have to be generally curious and where that patient's coming from, what, what's matters to them, what their experience is like, what their view of the world is, what their view of their own selves is. And it starts with deep listening, like just simply just turning everything else off and just listening and not necessarily listening to, to respond, right, but actually listening to understand and to appreciate and digesting that information. Yeah, our mission is adding the health back to health care, but this is what puts the care back in health care, right. I've been thinking about that too. I think I mentioned to you as, you know, during my conversation with, you know, my therapist, like, it was about, hey, when I was describing, it was like, oh, it sounds like it's a lot of adding the care and I was like, oh, wow, it is because I think that we don't, we don't ask that question, but it matters just as much. Yeah, no, it's a very valid fair point of health care. Yeah, and I think a lot of young providers or providers of the traditional model might be thinking, you know, darshan, ultimately, it's, it's very tough to do when you only have 15, 30 minutes, 45 minutes with a patient and sometimes you have to interrupt them and you have to try to teach and listen at the same time and, you know, you're the next patients on your mind because you already saw that they're already in the room. And so how do you kind of go about this? And at least I'll give my strategy and I think I'll brag a little bit here and say that I think I've been known for doing, having great reviews from patients as far as being comprehensive, but also listening and showing that I care. And I think one of the things that I do is after every so often, you know, and I type while I'm in the room. So, you know, I'm typing as I'm doing this, but every so often I'm going to restate and also teach. So whatever they tell me something, I'm going to restate whatever it is. And then I'm going to take those 15 or 30 minutes as if it's a 30 minute educational lesson in the classroom and my goal is to take whatever their symptom is and teach as if they're in med school and go from here all the way to the diagnosis and take them through the pathology, take them through the exam, and just try to teach exactly what we all learn, what we're in our first and second year and doing an osc or something. And by doing that, without the patient knowing, when the attending comes in, I'm constantly getting a glance because whatever the attending is now saying, I've already said it before, I've already reiterated. And so when we start thinking about the next steps or, hey, we might get an MRI or we might need to get these labs. They're like, oh, that's the Dr. Truss, that's the Dr. Truss said. So that's the approach that I've been using, whether it's drawing out some diagrams or just kind of talking and teaching while also typing. It's been efficient on my end, but it's also at least made the patient feel like they've been heard and that somebody's actually truly thinking through their problem and thinking through their issue. Yeah, it's funny, it reminds me a little bit of a Brian Sutter set, you know, when people are like, I just came here for entertainment and, you know, I'm being taught stuff and patients like, I just came here for some answers or some medication and here I am getting all this knowledge. I love that, man. I mean, I think I learned this from you, right? I'm just because I'm not as smart that, I mean, the, the word doctor, like within it embedded his teaching, does that actually mean teaching or teaching? Doctor comes from the root doceria, which means the teach, yeah. Yeah, yeah. I mean, so it has to be part of that, right? You have to educate the patient otherwise. Again, these things that we're talking about, everything that we've said that's foreign in the last 30 minutes, it's not going to be applicable, it's not going to be successful. Which brings me to the next point, as you said, you're bragging about this and this is something that I need more work on is pouring from an empty cup, right? So again, a lot of people have talked about healing the healers and we talked about the great resignation time and time again. We talked about healthcare burnout, moral injury, all that kind of stuff. And also, we've touched on this a little bit, so we won't spend too much time is, you know, when we are on the deathbed and we are kind of at the end of life is, and we're reflecting back. And it's not necessarily about legacy, because I think that's kind of silly. There is no legacy. And that's just a thing that's more of a guttistical thing. But it's about, hey, have I, have I walked the walk? Have I lived my actions? Have my actions reflected my opinions or my teachings, so to speak? I think that's going to start with taking care of yourself. And this is something that I've been telling my students a lot now is I've had some amazing students come with me. I've been very lucky in that regard in the last couple of weeks and I've just been reminding them guys. And during that time, right, they're applying for residency and they can't see anything or they're studying for level two or sub two and they're just like, you know, how do I, how do I match? How do I match? And they can't see anything but that. Like, you know, it's going to be fine. Or they just matched and I'm like, yo, it's going to be fine. But remember this, like everybody gets through this. We've all been through this. Yeah. You got to remember this though. It's a long, long road. Yeah. So on that note, I'll go to the next one. It's about identifying your core priorities. So I might be ruining this, but this from James Clear, right? But we've talked about identifying our core priorities and shining our core priorities, right? We recently talked about Dan Pope about putting the mantle up there and making the least amount of decisions that you have to make once you identify it, how you want to live your life that that violate that model, right? This one I struggle with because I have so many interests and like with respect to being an academics and wanting to do research and also in podcasting and also teaching and also being a clinician and also doing a lot of procedures and whatnot and also caring for my own health and my family that there's just not enough time in the day. And so I'm often struggling with, okay, what's the most valuable thing in this time? That's a tough one for me because it's like, you know, I have a lot of priorities and any priorities change from different seasons of your life as we talked about as well. But for somebody who's so ambitious, type A, I tell people there's no such thing as type A and medicine type A, one type A, two, you know, like type AA as my previous program director would say there's type A and then there's type A, alt mush and that's what's hard for me, man. I know you're much better at this than I am, so I don't know, I mean, I totally see your point and I go through it too, you know, there's a lot of core things that aren't my mind from a personal development standpoint. And so that's, you know, getting the workout in, that's like a non-negotiable almost every day. Then it comes down to, can I read a book, can I at least get some breath work in? Now I've done ice bath. So I try to structure my day as far as I would like it to be, but at times it's like, okay, I'm going to wake up at 6 a.m., guess what? Not happening, I'm too tired. I'm going to hit that snooze button, wake up at 6.30. And then I have a choice, do I just get mad at myself or do I just keep moving on? And, you know, Darish probably last year or even like five months ago would be pretty pissed and say, damn, you know, I like, I like go of today when I could have done something more. But I've, I've now, I've got, I shift my perspective and I look back at, you know, the last year and I think and I say, okay, there's been plenty days where I haven't touched, last three days, I haven't touched a book, I haven't even read 10 pages like I usually do because I just had no time. And I shifted my perspective to think there's been many days where I've not completed everything I've wanted to, right? That's our issue is that we get overly ambitious and we think we can do it. And life gets in the way and shit happens. And you're, you're unable to, but out of that last six months, has my life still improved or did I plateau or am I downhill and I'd say it improved, like I've still done enough things where I've gotten stronger physically, I've at least finished one or two books where I've learned things, I'm learning more about my nutrition and calories and kind of figuring out that game, stress management's been great. My new breathwork techniques, got a new cold plunge, got a walking pad, so like I am doing what I need to do to at least be on uphill trajectory, right, to do the right things. Now let's say I was a 5% improvement, could I have gone 10% maybe, but maybe doing those things also could have dropped me to 2% or even negative, right? Like if I choose to wake about six, maybe I need to more sleep that day. So I've learned to just kind of be flexible, sure have ambitious goals, but also don't get too tied up in terms of completing everything. And you know, I'm not in the position of you yet where you're in a 10 day, you've got a family, you've got a kid, and you've definitely got more, I'll say, roles and responsibilities than I do. For me, I don't need to do these things, right? These aren't necessarily life or death, and even from an evolutionary perspective, important, but for you, they absolutely are. And so I think identity for you is definitely going to be different than identity for me. It's kind of a choice, but for you, you are a father, you are a husband, right? Like these things absolutely matter when you look at the greater outlook of things. I love them, man. That's the first point that you made about if you miss something that you're supposed to do that day and you're like, come man, I feel today, or I didn't accomplish X task out of all the tasks that I wanted to do, and then you're beating yourself up. And you know, at this point, the non-negotiable, so exercise you mentioned that is, and for me, that is, to a lot, but then there are often times I can't because of circumstances to your daughter gets sick, whatever that kind of stuff happens. And that's a still challenge for me some days, but looking at, okay, in the next six months or three months, if a 10,000-foot overview isn't good enough for you, take a 30,000-foot overview, maybe 50,000-foot overview, I drew this out for my patient the other day. I don't know if you can see that screen, or people can see it. On the X, on the X horizon, I drew a time, and on the Y horizon, I drew a progress, right? And this is a patient, 70, almost 80 years old, engineering background was so, so challenged with their pain. And what you're telling me right here is like, if you look at the wrong interval, if you look at the time interval, like here, and you might just catch up the downslope, you're like, nope, I'm going in the wrong direction. But then you take that 50,000-foot overview and look over the last six months, over the last year, all the way up here, this is where I started. That one, again, we tend to get myopic too, and people don't appreciate that, because we're like, okay, it hits one step back, but sometimes you've got to take a step back to take three steps forward, you're still moving forward. So I think I really, really love that. For sure, so I was going to make an Instagram video on this soon, but there's two principles that I really use when it comes to emotional health and not getting down on yourself or getting down on other people. And you know, this is still a work in progress for me, but the first one's called the 1,000 time principle, right? So stuff's going to happen. You miss something, you just made a plate of food, it's going to drop, you can't cry over spilled milk, right? But you can't win everything, you're going to lose some shit happens in life. So the first principle is called the thousandth principle, meaning imagine that this is the thousandth time this has happened. It has happened 999 times before. And it's going to happen again, a thousand one. What is the point in you trying to be upset over over it in that moment, right? I mean, it's going to happen again, right? So that should hopefully bring you back to a calmer baseline and say, whatever, I'm over it, I know this is going to happen again in the future. It's going to happen. There's nothing you can do. The second principle is called the deathbed principle, which we kind of just talked about is when you're on your deathbed and you look back on this scenario about you missing a workout or you not eating clean that day and having a cheap meal, is that something you're going to be worried about when you're 90, 100 years old on your deathbed looking back, probably not. You're going to be looking at that graph and looking at it from a way, like far away view and seeing was that was it was lying going up straight or down. And if it's something that's going to bother you on your deathbed, then you know you got to take action. So at least it's a wake up call. There's something you can do about it and that should clue you in and cue you in to doing something. And so those are kind of the two principles that I use now, whenever something doesn't go my way to really just get over it or say, hey, okay, I need to do something about it because this will bother me when I look back in my life. Yeah, I love that. We've talked about time a little bit and that's something that I've been thinking about a lot, right? We were just talking about this earlier today with the 4,000 weeks. Have you read that book yet, by the way? I haven't. It's on my list. I haven't read it yet though. Amazing. Highly recommend to everybody. Oliver Berkman. I have a really, really good book. Change is a perspective on things in life. And you know, what else does is death for people always, right? Some powerful thing that will change your perspective and I've had my fear sure in the last few years of that. So that makes you think about how finite this is and how that's the only non-renewable resource. So another powerful one is you want to spend it where it matters the most to you for you, right? And so, you know, podcasting gives us energy in that sense. It helps you and I connect a lot, right? I mean, even though we could probably be better by hanging out in person, but, you know, we learn so much from each other, I learn so much from you. And then together, we learn a ton from our guests and even during the research and all that stuff, working, spending time with our family. And as, you know, sometimes I sound so old when I say this, but I'm only 33, almost 34. Are you 30 yet? You're just 30. 31. 31. Okay. Look great for 31 men. Look like a 25. That we really have to to prioritize whatever it is that matters to you the most. And so this ties into the core priorities thing really, really nicely. And hopefully, people are seeing that we're transitioning to more of a more philosophical thing, more to your area of expertise here, but this is something that I think is really important for people to appreciate. Really for the younger professionals listening to this, the medical students, residents, trainees, that you really need to identify what it is that gives you energy and not just do things for the sake of doing things because that's going to preserve that. That's going to make it easier for you to stay in the arena, stay in the game. Yeah. You know, there's this common Tim Ferris talks about all the time, right? How to say no and what to say no to. And I'm a little, I'll go against the grain here a little bit and I don't think people young in their journey and are still trying to figure things out should say no, unless you absolutely know it does, you know, it doesn't give you energy or that it's not something you'd want to do. But I think saying yes to a lot of things, especially initially, can do a lot of good and get you a lot of diverse experiences and get you out there to figure out what you want to do. You kind of have that vision. It's important to understand how to say no and when to say no. And you know, Sahel Bloom just put a post up today talking about what game are you playing and you should understand the game you're playing. What is the prize if you win that game and then third, if you win that prize, does it even matter to you, right? And just using that checklist, which I thought was pretty insightful. And I think really that applies once you have a vision and once you know what you want to do. And I think that's the point where we have a goal within certainty that we want to accomplish what we want to do and how we want to practice where, you know, if things come our way, we now know how to say no to certain things because we have other priorities, we have other non-negotiables. And yeah, spending energy, good energy where it matters is super important. And that's why I think we also brought on interns for this podcast, right? I mean, there were parts of this podcast that were draining for us, you know, making videos sometimes or promoting and I love doing those things, but to do it day in and day out was very challenging. And so bringing on other people who get joy out of that and really can contribute, it definitely has made this a better experience. Yeah. Speaking of what matters, last one for me, with all the podcasts out there, all the people in social media putting on information, health information, their point of view of how people can be better, making a difference, the countries, the planets, the galaxies, in the grand scheme of the universe, whatever you guys is, at least for me, I don't really matter. Right? Like, it's just, again, this goes back to, again, turning into a bit more stoic, more philosophic is like, you know, when you die, it's like, this is why the whole thing about the legacy thing, it's like, nobody's going to remember, like after your loved ones, it's like that 100 years from now, 50 years from now, maybe even depending on where you are in your state of life, nobody's going to remember, like you're not going to matter, right? We're all going to dissolve. And so just keep that in perspective. I think that everybody gets really overinflated in terms of whatever it is that we're doing. Like again, we've been doing this for two and a half years now and you know, we have a direction that's continuously evolving and we think we're doing it for the best. And when it's not serving our purpose at some point, I'm sure we'll call each other out or we'll call it quits at some point, but I also recognize that there are billions of hot gas out there, there are billions of social media accounts and handle and stuff like that and everybody's trying to do their best, but it's like, at the same time, it's like, none of it matters when it's gone. So just remember that. Right. No, I can take that a lot of directions. It's a big point that I live on that I focus on and meditate on. Have you read the Omanok of the Volrovikun? No, I haven't though it. I bought it. Yeah. Dude, yeah. There's a paragraph in there where he essentially says like, you know, just be grateful for the life that you have, like we're just supposed to be, we're just monkeys sitting on a rock floating in space like that. That's all we are. Like you said, a lot of times we have these like grandiose thoughts and things and grandiose and perspective, right? I mean, but this is why I had the balcony thoughts podcast is just like looking up at the stars and realizing like, damn, we are absolutely a speck of dust. Less than that. We're an atom essentially in this universe. And you know, when it comes to time, we're like a nano, nano, nano second of time when you look at the entire entirety of this universe and how long it's been around for. So to think that we can make the biggest difference beyond when we're dead, right? AKA legacy is really, is really just funny and not a real thing. But this is not meant to be depressing, right? This is meant to be more just a realistic view as far as if you ever get down in yourself or you're trying to compare yourself to somebody else or you're trying to chase the number of followers. That none of it matters in the end, but you do matter, right? As a person, I mean, you can definitely make a difference in somebody's present moment. And I think that's the, that's the thing. And I think that's why we do this. So when we look back on it is we're taking a lot of our learnings and trying to affect people's everyday life so that they can have a better present moment, which will hopefully enlighten them. Yeah. Yeah, I agree. Yeah, it wasn't meant to be self-deprecating or depressing in any sense, but also to remind people just like choose what matters today, choose what matters to you, right? Just keep that in perspective as don't focus, again, your energy to the last point and the wrong, the last two points really in the wrong areas. Yeah. Well, man, this has definitely been a longer progress note for us. So, but I thought it was worthwhile because it's been a fun 100 episodes. Any last minute thoughts, any closing comments you want to make for the folks to wrap this up? I think the biggest thing like podcasting has been a blessing, doing it with you has been a blessing for sure these first 100 episodes excited to see, you know, obviously what the future brings and the networking and meeting more guests and just seeing how our thoughts evolved, you know, I was always known to be a black and white person kind of growing up, but I've definitely evolved to be more of a gray area and had a different approach, detach from certain ideas and learn to make my identity as somebody who doesn't identify with things now and just kind of live life and flow and not force. So it's definitely been fun. Love it, man. Let's do it again and after the next 100, 100% all right, all right, but I really want to take this time and thank you all, all our wonderful listeners for making medicine redefined a part of your lives, maybe a partner commute, a part of your block, maybe part of your daily routine, but we truly appreciate all of your support. So from the bottom of our hearts, thank you, thank you for subscribing, thank you for sharing our episodes, and most importantly, thank you for learning alongside with us. I also want to thank our team Ethan Chu, Aretha Yeburi, and Iman Vashiri. Once they join the team, our podcast has definitely reached a new height. We're truly excited for the next 100 episodes and hopefully even more beyond that and we're excited to learn, we're excited to change our opinions, we're excited to promote better health to the entire world. As a reminder, everything in this podcast is for educational purposes only, it does not constitute the price of medicine and we are not providing medical advice, no physician, patient, or a ship is formed, and anything discussed in this podcast does not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health related issues. Cheers to 100, thank you.